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Found 17 results

  1. Glucose metabolism in the newborn can be a tricky thing to manage. Neonates can have significant fluctuation in their serum glucose in the first few days of life which can lead heels to look like pin cushions. How many times have you been asked as a physician if there is anything we can do to reduce the number of pokes? That something may have arrived at least in a feasibility study that could pave the way for this becoming the standard approach to hypo/hyperglycemia in the newborn. This is an important area to improve tightness of control as hyperglycemia has been associated in VLBW infants w
  2. How to calculate insulin glucose ratio?. Insulin reported as microIU/L and glucose as mg/dl.do u need to convert insulin to picomll/l or glucose to mol/Lt, before putting the ratio? The reference value said as<.2 normal and >.4 abnormal is without unit conversion or what? Do u take insulin levels only during hypoglycemia or induced hypoglycemia to detect hyper insulin em is.
  3. I have seen 2 newborns recently with hyperinsulinemic hypoglycemia. Both of them settled down with diazoxide.How common is the transient form?
  4. Hypoglycemia has been a frequent topic of posts over the last few years. Specifically, the use of dextrose gels to avoid admission for hypoglycemia and evidence that such a strategy in not associated with adverse outcomes in childhood. What we know is that dextrose gels work and for those centres that have embraced this strategy a reduction in IV treatment with dextrose has been noted as well. Dextrose gels however in the trials were designed to test the hypothesis that use of 0.5 mL/kg of 40% dextrose gel would be an effective strategy for managing hypoglycemia. In the Sugar Babies tr
  5. In 2015 the Pediatric Endocrine Society (PES) published new recommendations for defining and managing hypoglycaemia in the newborn. A colleague of mine and I discussed the changes and came to the conclusion that the changes suggested were reasonable with some “tweaks”. The PES suggested a change from 2.6 mmol/L (47 mg/dL) at 48 hours of age as a minimum goal glucose to 3.3 mmol/L (60 mg/dL) as the big change in approach. The arguments for this change was largely based on data from normal preterm and term infants achieving the higher levels by 48-72 hours and some neuroendocrine data suggesting
  6. In the first part of this series of posts called Can prophylactic dextrose gel prevent babies from becoming hypoglycemic? the results appeared to be a little lackluster. The study that this blog post was based on was not perfect and the lack of a randomized design left the study open to criticism and an unbalancing of risks for hypoglycemia. Given these faults it is no doubt that you likely didn’t run anywhere to suggest we should start using this right away as a protocol in your unit. Another Study Though May Raise Some Eyebrows New Zealand researchers who have been at the fo
  7. I have written a number of times already on the topic of dextrose gels. Previous posts have largely focused on the positive impacts of reduction in NICU admissions, better breastfeeding rates and comparable outcomes for development into childhood when these gels are used. The papers thus far have looked at the effectiveness of gel in patients who have become hypoglycemic and are in need of treatment. The question then remains as to whether it would be possible to provide dextrose gel to infants who are deemed to be at risk of hypoglycemia to see if we could reduce the number of patients who ul
  8. Hypoglycemia has to be one of the most common conditions that we screen for or treat in the NICU and moreover in newborn care in general. The Canadian Pediatric Society identifies small for gestational age infants (weight <10th percentile), large for gestational age (LGA; weight > 90th percentile) infants, infants of diabetic mothers (IDMs) and preterm infants as being high risk for hypoglycemia. It is advised then to screen such babies in the absence of symptoms for hypoglycemia 2 hours after birth after a feed has been provided (whether by breast or bottle). I am sure though if you ask
  9. Hypoglycemia has to be one of the most common conditions that we treat in the newborn admitted to NICU. For many infants the transitional phase of hypoglycemia can be longer than a couple low blood sugars and as nurses commonly express, it doesn’t take long before the heels of these infants begin to resemble hamburger. For those of you who have used diazoxide in the treatment of hypoglycemia you know that it works and it works quickly to raise the blood sugar. It works by blocking the production of insulin from the pancreas, so particularly in the setting of an infant with detectable insulin
  10. We sure do poke a lot of babies to test their blood glucose levels. Some of these babies don’t have so much blood to spare either so checking sugars multiple times a day can drain the body of that precious blood they so need for other functions. Taking too much can always be addressed with a blood transfusion but that as I see it may be avoidable so shouldn’t we do what we can to cut down on blood work? Those with diabetes will be familiar with a continuous glucose monitor (CGM) which is implanted in the skin and can stay in place up to 7 days. The device does require calibration twice a da
  11. I guess many of you read about the Sugar Babies Study, about giving dextrose gel to (well) infants at risk of developing hypoglycemia. Link to the paper in Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961645-1/abstract I would be glad to hear more from people with experience from this treatment, involved in the trial or having experience outside the trial. - is the gel produced by pharmacies "in-house" or bought from a manufacturer? - who is administrating the gel (midwife, nurse, doctor?) - dose weight-dependent (SGA vs LGA babies)? - experience reg
  12. I have probably received more requests for our glucose gel protocol than any other question since I started writing on this blog. Dextrose gel has been used more and more often for treatment of hypoglycemia such that it is now a key strategy in the management of low blood sugar in ours and many other institutions. If you are interested in the past analyses of the supporting trials they can be found in these posts; Glucose gel For Managing Hypoglycemia. Can We Afford Not To Use It? and Dextrose gel for hypoglycemia: Safe in the long run? As you can tell from these posts I am a fan of dextros
  13. The Sugar Babies trial was the subject of a post earlier this year as the largest trial to date examining the effects of using dextrose gel to treat hypoglycemia. For an analysis of the use of gel in this situation please see the original post Glucose Gel For Neonatal Hypoglycemia: Can We Afford Not To Use It? In summary though, the trial involved 118 infants who received 40% dextrose gel vs 119 who received a placebo gel. All of the infants in this study were selected based on risk factors for hypoglycemia (IDM, IUGR, LBW, LGA, near term) and were all 35 weeks or greater. Each infant ha
  14. We are quite dis-satisfied with our current equipment (Freestyle light, Abbott) https://www.abbottdiabetescare.com/products/patient/fs-lite-overview.html as we often feel that the instrument gives false low values. So... what equipment do you use for routine blood sugar measurements in the NICU and maternity ward? What method do you use for blood sampling?
  15. I am interested to learn more about microdialysis in newborns, for monitoring of subcutaneous glucose monitoring. We have an idea for a research project and would need a good way to monitor glucose homeostasis contineously. Microdialysis would be an option(?). This article here catches well what we want to learn more about: http://www.ncbi.nlm.nih.gov/pubmed/11694701 If you have experience from technologies (commercially available or DIY) and the use if such technologies, please share!
  16. We currently use the Freestyle glucose monitoring device (a variant of this one http://www.abbottdiabetescare.com/freestyle-lite-blood-glucose-monitoring-system.html) but feel frustrated about it. This monitoring system was evaluated at Karolinska about ten years ago (http://www.ncbi.nlm.nih.gov/pubmed/16299875) and the correlation with our previous "gold standard" - venous blood sugars measured with the Hemocue machine - was found to be good. Now, we often see that low values obtained with the Freestyle are commonly normal when venous samples are measured by the regular lab or with Hemo
  17. 5 wk old infant came to ER with scalp discoloration (grayish) for 2 days. Baby was treated soon after birth for persistent hypoglycemia (in another hospital) and diagnosed as hyperinsulinism. Infant was sent home on po hydrochlorthiazide and diazoxide. Exam showed active, alert baby. Grayish area of discoloration covering most of scalp. No edema. BMP showed Na 133 K 7.8 (heelstick). Rest normal. CBC normal. What is the cause of this discoloration? Can this be acanthosis nigricans though i have never seen it this early in life? What other things should one look for?
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