白细胞异常增高时血糖明显降低(附白血病血糖检测的观察报告)

2 0 0 2年 9月我们遇到了 1例血糖检测值严重降低的慢性粒细胞白血病 (CML) ,现报告如下。1　病例资料女 ,14岁。因确诊CML 5年 ,腹胀、乏力 3个月 ,发热 1周入院。入院后查血白细胞 5 40× 10 9/L ,幼稚细胞 0 0 7,血红蛋白 10 7g/L ,血小板 15 3× 10 9/L。骨髓象提示CML     

Ambulatory glucose profile: representation of verified self-monitored blood glucose data

Sixty-nine individuals with diabetes (23 with type I, 15 with pregestational, and 31 with gestational) used specially modified reflectance meters containing memory chips enabling the instruments to store 440 individual blood glucose values with corresponding time and date. These data were organized into 14-day periods and then collapsed into a graphic depiction, the Ambulatory Glucose Profile (AGP), which was represented as the pattern of the 25th, 50th, and 75th percentiles of blood glucose values. These three curves illustrate the median level of control and provide an index of variability in control at each hour of a "typical day." We observed distinctive AGPs related to the variability in metabolic control and the type of diabetes. Comparisons between diagnostic groups showed consistent differences between groups, independent of level of glycemic control. Review of serial AGPs obtained for sequential 2-wk periods for 23 non-pregnant individuals with type I diabetes and 10 women with gestational diabetes revealed changes in AGP corresponding to alterations in regimen. The AGP provides a new approach to the evaluation of glycemic control, with applications to patient and physician education, clinical investigation, and individual patient care.     

Self-monitoring of blood glucose

Many would argue that the introduction of modern-day diabetes management started 30 years ago with the introduction of self-monitoring of blood glucose (SMBG) at home. While that may be true, it is interesting that many of today's fundamental questions have yet to be answered. Furthermore, the technology itself continues to change, to improve and to better exist with our non-diabetes technology. For example, the first SMBG 'apps' are available now for smart-phones (iPhone), and we can expect the phones themselves to participate more directly with SMBG and diabetes management. Still, both researchers (and payors) continue to ask some fundamental questions. 1. What is the efficacy of SMBG for patients not requiring insulin therapy? 2. What is the optimum frequency of SMBG for patients who do require insulin therapy? 3. What is the role of software to assist in data management for SMBG (for both patients and clinicians)? 4. What is the cost effectiveness of SMBG for all of the different patient populations with diabetes? 5. What is the ideal chemistry which results in the least amount of interfering substances with SMBG? 6. What is an acceptable accuracy for SMBG both at home and in the hospital? The accuracy question is more important than ever since all continuous glucose monitoring (CGM) for now are calibrated with SMBG results. 7 What is the best strategy for teaching patients how best to use their SMBG data? 8. What is the best way to integrate SMBG with insulin pump therapy? 9. What is the role of SMBG with today's CGM devices? 10. What will the role of SMBG be 5-10 years from now with future CGM devices? These are just some of the questions which need more thought and study as we move into 2011. In this chapter we have selected papers that appeared in the PubMed on this topic and chose those we thought were most influential in this area. We have then addressed many of these topics although answers are far from clear for many of them. Although SMBG is not 'new' technology, much research needs to be completed before we fully understand this tool's full impact, particularly as CGM becomes more popular.     

Self-monitoring of blood glucose

Many diabetic patients can achieve a normal blood glucose level throughout the day by self-monitoring of blood glucose. Improved control reduces the complications of pregnancy and the development of microvascular disease. Multiple doses of insulin are usually necessary for tight control of blood glucose in patients with insulin-dependent diabetes. In the absence of insulin resistance, 1 u of regular insulin lowers the blood glucose by 30 mg per dL in 90 minutes.     

Assessing glycaemic control: self-monitoring of blood glucose

Diabetes Mellitus is a chronic, lifelong metabolic disorder characterized by an elevated blood glucose level resulting from an absolute or relative shortage of insulin. Self-monitoring of blood glucose (SMBG) has escalated over the years following the outcomes of evidence demonstrating a strong correlation between tight blood glucose control and the significant reduction of diabetes-related complications. While glycosylated haemoglobin (HbA1c) measures mean glycaemic exposure during the preceding 2-3 months, it does not provide day-to-day changes in glucose levels. SMBG represents an important adjunct to HbA1c because it distinguishes among fasting, preprandial (before a meal) and postprandial (after a meal) hyperglycaemia and provides immediate feedback about the effect of food choices, activity and medication on glycaemic control. The successful outcome of glycaemic control cannot be effectively achieved without the input of the nurse. The nurse's role is to identify people with diabetes who are most likely to benefit from SMBG and provide them with appropriate education, problem solving skills and ongoing support.     

快速血糖仪在急诊检验血糖中的应用价值

目的探究在急诊检验血糖中应用快速血糖仪的临床应用价值。方法选取2013年8月至2014年8月在该院就诊的186例危重患者进行临床研究,使用快速血糖仪和全自动生化分析仪对所有患者进行平均血糖检查,并比较两种方法的检查结果。结果对比两组检测结果可知,结果一致率达22.04%,数据差异相对较小。此外,快速血糖仪检测用时明显少于全自动生化分析仪,差异具有统计学意义(P0.05)。结论快速血糖仪的检测结果与全自动生化分析仪的检测结果无太大差异,对治疗诊断具有同样的指导意义,且使用快捷、方便、耗时短等特点,可在急诊中使用。     

Capillary blood glucose monitoring

This article, the first in a series of articles relating to clinical skills in nursing, outlines the procedure of capillary blood glucose monitoring. This is a convenient way of monitoring blood glucose patterns and can be a useful aid in guiding treatment changes in patients with type 1 and type 2 diabetes, especially during periods of illness or frequent hypoglycaemia.     

Home blood glucose monitoring

OBJECTIVE: To provide a review of self-monitoring blood glucose including home blood glucose meters and patient education. DATA SOURCES: A MEDLINE search (January 1966-January 1998) was conducted to identify original and review articles. Search terms included self-monitoring blood glucose and blood glucose monitoring. Owner's manuals and package inserts were reviewed to determine specific characteristics for each glucose meter. DATA EXTRACTION: All current original and review articles about self-monitoring blood glucose and home blood glucose meters were included if they contained information about benefits of self-monitoring blood glucose, technology and performance of blood glucose meters, quality control, selection characteristics of blood glucose meters, and patient education. DATA SYNTHESIS: Self-monitoring of blood glucose has become an increasingly vital component of the care of the diabetic patient. Many glucose monitors are available with various features that may be confusing to pharmacists. Pharmacists need to be able to aid patients in the selection of an appropriate glucose meter and provide the education necessary for proper use and follow-up. Patient education is a key component in optimizing the potential benefits of self-monitoring. CONCLUSIONS: Self-monitoring of blood glucose, if used properly, can have a positive effect by increasing patient involvement in overall diabetes care. Pharmacists are accessible and can teach patients necessary skills that will enhance their ability to self-manage blood glucose.