Betahidroxibutirato capilar en la monitorizacion de la cetoacidosis diabetica / Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis

Fundamento y objetivo La cetoacidosis diabetica (CAD) es la complicacion aguda mas grave de la diabetes mellitus tipo 1. Su tratamiento con insulina viene guiado por los valores obtenidos en las determinaciones de glucemia y los cambios gasometricos, mientras que los niveles de beta-hidroxibutirato (BHB) raramente son determinados. El objetivo del estudio fue evaluar la utilidad de la monitorizacion de BHB capilar en el curso y resolucion de una CAD. Pacientes y metodos Se estudiaron 30 pacientes diabeticos tipo 1 con CAD a los que se les aplica un protocolo estandar, con monitorizacion de glucosa y gasometria venosas, cetonuria semicuantitativa y BHB capilar. Para el seguimiento se establecieron a priori tres grupos de acuerdo con el tiempo de recuperacion segun criterios bioquimicos (grupo 1: < 24h; grupo 2: 24-48h; grupo 3: > 48h) y se correlacionaron las (..)(AU)

Background and objective: Diabetic ketoacidosis (DKA) is the most severe acute metaboliccomplication of type 1 diabetes mellitus. Insulin treatment is commonly guided by plasmaglucose levels and changes in venous blood gases, while -hydroxibutyrate (BHB) levels arerarely measured. The study objective was to evaluate the value of capillary BHB monitoring inthe course and resolution of DKA.Patients and methods: Thirty patients with type 1 diabetes admitted for DKA were enrolled. Astandard protocol including monitoring of blood glucose, venous blood gases, semiquantitativeketonuria, and capillary BHB was used. Patients were divided into three groups by time to DKAresolution (group 1: < 24 h, group 2: 24-48 h, group 3: >48 h), and BHB results were compared toall other biochemical measurements.Results: Mean laboratory results upon admission were: blood glucose 415 (standard deviation[SD] 106) mg/dL; bicarbonate 9.6 (SD 1.5) mmol/L; pH 7.13 (SD 0.04); BHB 4.33 (SD 0.48)mmol/L, and ketonuria 3+ in 22 patients and 4+ in 6. BHB correlated well with bicarbonate(r = -0.24139; P = 0.0161) and pH (r = -0.56419; P < 0.0001). BHB normalized earlier than ketonuriain all cases (group 1: 15.5 vs 18.8 hours P < 0.05; group 2: 18.2 vs 23.5 hours P < 0.01; group3: 37.3 vs 41.7 hours P < 0.01). Ten percent of patients still had ketonuria when blood ketonelevels were already normal (<0.5 mmol/L).Conclusion: BHB measurement is an easy, practical, and reliable monitoring method in DKA andmay be used as a parameter to adjust insulin treatment (AU)

[Capillary beta-hydroxybutyrate determination for monitoring diabetic ketoacidosis]. / Betahidroxibutirato capilar en la monitorización de la cetoacidosis diabética.

BACKGROUND AND OBJECTIVE: Diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of type 1 diabetes mellitus. Insulin treatment is commonly guided by plasma glucose levels and changes in venous blood gases, while ß-hydroxibutyrate (BHB) levels are rarely measured. The study objective was to evaluate the value of capillary BHB monitoring in the course and resolution of DKA. PATIENTS AND METHODS: Thirty patients with type 1 diabetes admitted for DKA were enrolled. A standard protocol including monitoring of blood glucose, venous blood gases, semiquantitative ketonuria, and capillary BHB was used. Patients were divided into three groups by time to DKA resolution (group 1:<24 h, group 2: 24-48 h, group 3: >48 h), and BHB results were compared to all other biochemical measurements. RESULTS: Mean laboratory results upon admission were: blood glucose 415 (standard deviation [SD] 106) mg/dL; bicarbonate 9.6 (SD 1.5) mmol/L; pH 7.13 (SD 0.04); BHB 4.33 (SD 0.48) mmol/L, and ketonuria 3+ in 22 patients and 4+ in 6. BHB correlated well with bicarbonate (r=-0.24139; P=0.0161) and pH (r=-0.56419; P<0.0001). BHB normalized earlier than ketonuria in all cases (group 1: 15.5 vs 18.8 hours P<0.05; group 2: 18.2 vs 23.5 hours P<0.01; group 3: 37.3 vs 41.7 hours P<0.01). Ten percent of patients still had ketonuria when blood ketone levels were already normal (<0.5 mmol/L). CONCLUSION: BHB measurement is an easy, practical, and reliable monitoring method in DKA and may be used as a parameter to adjust insulin treatment.

Detection of ketonemia and its relationship with hyperglycemia in type 1 diabetic patients.

The aims of this study were to assess the prevalence of ketosis in type 1 diabetic patients with casual hyperglycemia (>250 mg/dl), to establish the relationship between glycemia and ketonemia during daily life, and to determine the utility of ketonemia. Capillary glycemia levels from 562 type 1 diabetic patients were recorded. Prevalence of casual hyperglycemia was 27.58%, and prevalence of asymptomatic ketonemia was 8.39%. Regarding blood ketone levels, 110 out of 155 patients (70.96%) had blood ketone levels of between 0 and 0.1 mmol/l and 32 out of 155 patients (20.63%) had blood ketone levels of between 0.2 and 0.4 mmol/l. Surprisingly, the mean glycemia levels in these subgroups did not differ and was consistently high (around 300 mg/dl), leading to the observation that even ketone levels considered as non-pathologic should probably be taken into account for a proper diabetes control. Some discrepancies between quantitative determination of ketonuria and qualitative determination of ketonemia were observed. That is in 20 patients with positive ketonuria, ketonemia was not detected, probably because ketosis was already resolved. Asymptomatic ketosis was observed in the hyperglycemic type 1 diabetic population, and metabolic control of these patients with a point of care device is recommended, together with a subsequent revision of insulin treatment. Furthermore, this study supports the opinion that the presence of ketosis, detected by beta-OHB levels, even below levels considered as pathologic, together with hyperglycemia, must be taken into account for proper monitoring and therapeutic control of diabetic patients.

[Easier and more comfortable measurement of capillary glycemia: the objective of a new electrochemical coulometric device "freestyle papillon mini"]. / Medición de la glucemia capilar más fácil y cómoda. A propósito de un nuevo dispositivo electroquímico columbimétrico.

Specific self-diagnostic devices are used to measure capillary glycemia in order to obtain an adequate glycemic control in people with diabetes. In response to the patients's needs, techniques which minimize the drop of blood and the response time needed for these tests are serched. The Abbott company has succeeded in doing this with its FreeStyle Papillon mini meter, a device which needs 0.3 micro/ of blood and yields a reading in seven seconds. With this device, taking measurements from alternative sites such as the arm, forearm, palm, thigh or calf become a reality. Specifically even in the case of an hypoglycemia, the eminence thenar (base of the thum) can still be used with the same reliability as the fingertips. The current article describes this new electrochemical coulometric technique which allows to use this minimal blood sample, and the physiology of the alternate sites, as well as the advantages derived.

Medición de la glucemia capilar más fácil y cómoda. A propósito de un nuevo dispositivo electroquímico columbimétrico / Easier and more comfortable measurement of capillary glycemia: the objective of a new electrochemical coulometric device "FreeStyle Papillon TM mini"

La medición de la glucemia capilar para conseguir el adecuado control glucémico de la persona con diabetes se realiza con dispositivos de autodiagnóstico específicos. En respuesta a las necesidades de los usuarios, se intenta conseguir técnicas que minimicen el tamaño de la gota de sangre y el tiempo de respuesta. Esto es lo que ha logrado la compañía Abbott con su medidor FreeStyle PapillonTM mini, un dispositivo que precisa 0.3 µl y da una lectura en unos 7 segundos. Con ello, la medida en sitios alternativos {brazo, antebrazo, palma de la mano, muslo y pantorrilla) se convierte en una realidad. En particular, incluso en hipoglucemia, se puede seguir usando la eminencia tenar o base del pulgar, con la misma fiabilidad que las yemas de los dedos. En el presente trabajo se explica la nueva técnica electroquímica columbimétrica, que permite este mínimo tamaño de muestra, Además, se describe la fisiología de los sitios alternativos y se detallan algunas ventajas derivadas de todo ello

Specific self-diagnostic devices are used to measure capillary glycemia in order to obtain an adequate glycemic control in people with diabetes. In response to the patients's needs, techniques which minimize the drop of blood and the response time needed for these tests are serched. The Abbott company has succeeded in doing this with its FreeStyle Papillon TM mini meter, a device which needs 0.3 µl of blood and yields a reading in seven seconds. With this device, taking measurements from alternative sites such as the arm, forearm, palm, thigh or calf become a reality. Specifically, even in the case of an hypoglycemia, the eminence thenar (base of the thum) can still be used with the same reliability as the fingertips. The current article describes this new electrochemical coulometric technique which allows to use this minimal blood sample, and the physiology of the alternate sites, as well as the advantages derived