Quick Diabetics Guide ("Easy Chulear") - New Diabetes

Friends, to avoid losing important advice when we need to act quickly or simply when doubts arise, and in order to refresh the memory or have everything well organized to quickly find the information, I have taken the freedom to open this post.It will be like yellow pages of diabetes, where to have everything at hand.

I will share this information little by little, since they are several, so that they have time to read them calmly.They are also published in another forum, but do not worry about copyright (and if there are, as I do not care), because I have created them and other collaborators, so there is no problem: I will bring them almost daily.

Hypoglycemia: How to recognize a low level of consciousness

The brain does not allow two critical situations to occur, among others, which must be immediately stopped: the lack of oxygen and the lack of glucose, the latter being the one that interests us at this time.

Hypoglycemia can cause alterations in the level of consciousness ranging from a state known as drowsiness to coma.Therefore, it is useful to recognize the different degrees of alteration of consciousness that can occur during a decrease in sugar.

To begin, a normal state of consciousness includes:

- A clear perception of oneself (eg, "I call me ..." or "I am ...").
- A clear perception of the environment itself (eg, "I am in my house and you are, for example, my mother").
- An adequate response to stimuli (reaction to simple orders: "What day is today?", "Where are you?", "What are your parents called?", Etc.).
- And a correct alternation between sleep and vigil (when you must be awake, the person does not sleep).

The degrees of alteration of consciousness are the following:

- Somnolence: Here there is only a tendency to sleep with an adequate response to simple and complex verbal orders, as well as painful stimuli.That is, if you ask the person something, he will answer you without problems, and if you give him a soft pinch in the chest or shoulder area, he will answer that you are hurting him.The only thing is that when you stop stimulating it, he will tend to fall asleep again, but if you stimulate him again with his voice, he reacts without any problem.

- Obnubilation: This is a more marked degree of drowsiness where responses to simple verbal orders and painful stimuli are intact, but there is no adequate response to complex verbal orders.If you tell him that he gets up or touch, for example, the legs, he will not do it, but will try to continue sleeping.If it is stimulated in a strong voice, react without problems.

- stupor: Here the person is in a deep sleep and there is no response to verbal orders, neither simple or complex.It will only properly react to a strong painful stimulus, such as a pinch in the chest or shoulder, or press strong in the eyebrow.These maneuvers are necessary to determine that they are reacting to pain and that the person is not in a coma.

- Coma: In this state, there is no response, nor at simple or complex verbal orders, and what makes the difference with the previous state is that there is no pain reaction, at least correctly.

Before a drowsiness or an obnubilation, the person cooperates with the stimuli, will be able to incorporate and be able to order without problem, for example, a juice with sugar, or sugar water or what is preferred to stopHypoglycemiaThis indicates an expeditious and permeable airway, and it will be able to eat liquids or solids without problems,

These actions are always dynamic, that is, we can "pour a little hand" and be wide

Also please if you see something that has been commented on interest by the forum you could do the favor of copying and paste it here, for when something is needed to know where to go without surroundings.
A big hug, today I am a happy jart, Spain, you know, world hahahahaha

When a acetone control in urine/blood must be performed

(1) - When there is an important insulin deficit and glucose levels are high (greater than 250).The organism does not obtain the necessary energy from carbohydrates as it would be normal and tends to use fat reviews, then acetone appears that is detectable in the urine.

Why does this occur?For errors in insulin administration either:

- By omission of the dose

- By guideline or inadequate dose

In summary "when insulin is missing to metabolize carbohydrates."

(2) - When carbohydrates are missing in the diet, ketonuria (acetone in urine) is also produced but blood glucose is normal or low.This can happen in circumstances such as:

- Very low calorie diet

- Prolonged fast

- Vomites or diarrhea that prevent the normal absorption of dietary carbohydrates.

This must be solved by providing enough carbohydrates and is resolved without any problem.

(3) -When there is an intercurrent disease, mainly an infection that is the cause that usually decomposes more frequently to the diabetic.Here it is always essential to perform ketonuria control provided that blood glucose is greater than or equal to 250 - 300 and symptoms appear as:

- NAUSEA

- Vomites

- Located abdominal pain anywhere in the abdomen

- General discomfort

- ketosic breath, that is, a smell like fruits, describe it as a smell of apples.

(4) -It always there is a hypoglycemia or after severe hypoglycemia, ketonuria may appear temporarily and does not have the importance as in the previous situations since it is passenger and easy to solve.

Here you just have to remember that ketonuria that is accompanied by normal or low glycems constitutes an indication of:

- Fasting state

- Prior hypoglycemia

- A lack of carbohydrates in feeding

The only thing that must be observed is that Cetonuria disappears after normal food intake and see that insulin dose is adequate so that hypoglycemia does not occur.

(5) -And the ultonuria control should be carried out. When an important exercise is going to be performed, that is, if before performing the exercise, capillary blood glucose is equal to or greater than 250, you have to measure ketonuria and if it is positive notNo type of physical exercise must be performed and absolute rest must be saved

Jopé, Seluarca, who already knew that it was a good idea to insist to come to the forum.
Great idea of ​​the guide.Very practical.
In addition, you can correct the medical errors that we can have, which will not be few.

Health

Alea Ke is convenient for a hahahaha, you know that you owe me a feisbu-birra hahahaha.If Maimonide lifted the head of the maimon hahahahaha, he died of envy for having an ale in your life hahahaha.Ball hahahaha
Well the mess that I go for the cosine, I attach a list of medications that can hyperglucemiar.

Medications with hypoglycemic action

These pharmacists are:

Aspirin (care with the antigripal that are associated with several products, including aspirin. Diabetes is used at children40 years with some other cardiovascular risk factor)
Amphetamines
Clofibrate (used to lower cholesterol and triglyceride levels)
Ciproheptadine (it is a stimulating antihistaminic appetite, widely used in Pediatria to "open the desire to eat)
Ethanol (it is the alcohol that is used in drinks, its abuse produces ethylic poisoning and depending on the excess you can reach the hypoglycemic coma)
Phenfluramine (it is a appetite suppressor used for the short -term treatment of obesity)
Guanetidine (it is a medication that is used in arterial hypertension)
Haloperidol (it is a psychopharmacus that is used in certain psychiatric diseases, of frequent use in the geriatric patient)
IMAO (another psychopharmacus that is used in certain psychiatric disorders)
DOPE
Oxytetracycline (an antibiotic that belongs to tetracyclines
Propranolol (it is a medication that is used for hypertension and for certain arrhythmias)

Hypoglycemic action medications II

1) of aspirin also remember that all salicylates can also cause hypoglycemia.
The salicylates are: Acetylsalicilate of lysine (Inyesprin), the aforementioned acetylsalicylic acid (aspirin), the difflunisal (Dolobid) and the phosphosal (Disdolen).
2) Of the antibiotics, include in addition to oxytetracycline to ketoconazole, chloramphenicol, sulfonamides and meticillin
3) of the aforementioned Propranolol that is a beta blocker, which is used in arterial hypertension and ischemic heart disease, remember that every beta blocker can cause hypoglycemia.These are: Athenolol, Bisoprolol, Izolol, Metoprolol, Carvedilol, Labetalol, Nadolol, Oxprenolol and Sotalol.
4) IECAS that are used in the already established diabetic nephropathy or as a prevention when there is discreet microalbuminuria and also in hypertension can cause hypoglycemia.The list of IECAS, the most used: captoprile, enalapril, lisinoprilo, quinapril, ramipril and bringing
5) Some of the so -called rheumatological such as mattchicin (for gout), indomethacin, phenylbutazone and penicilamine
6) Two stomach protectors that are currently used: ranitidine and cimetidine
7) And I have left two pharmacists for the end that can obviously cause hypoglycemia: insulin and oral antidiabetics in diabetes 2
Of all commented medications those who have a powerful hypoglycemic effect are:
Insulin and sulfonylureas (diabetes 2)
ALCOHOL
Salicylates
"The rest have a mild and occasional hypoglycemic effect" for your tranquility.

Medications that can cause hyperglycemia

Then I put a list, but remember mainly that it is corticosteroids and Betamimetics (pharmacists used in asthma and chronic bronchitis) which can produce a transitory increase in glucose.
Remember that when long -term treatment is necessary or with high doses of corticosteroids, it is necessary to readjust insulin.

Medications that can cause hyperglycemia

1) glucagon (obvious, this is only used in rescue before severe hypoglycemia, but there areWhat to name it)

2) Corticosteroids and Betamimetics mentioned above

3) Diuretics: acetazolamide, thiazides, furosemide and ethacrinic acid

4) SICOPHARMACOS: Lithium, tricyclic antidepressants phenotiazines

5) Estrogens

6) morphine

7) Antibiotics: Nalidixico acid, nitrofurantoin

8) Heparin

9) Cocaina is a hyperglycemic drug (because it releases catecholamines, adrenaline type)

This procedure was carried out by a colleague, Felechosa, who was very little time in the forum (in Mayamin's).He is an ORL specialist who began to move around the world of diabetes when his little son debuted.
As I think it's very complete, I hang it here.Always open to criticism and add what has been forgotten, that Aki nobody is a prophet.Po ok, to the mess

Management of type diabetes during acute diseases (in patients without insulin pump)

Felechosa did it for pediatric age but can overlap with any age

The ideal for the days of illness is to have a glycemia meter that also measures ketonemia (eg the opium xceed) since the appearance of acetone (ketone bodies) in urine is less accurate and something late.If it is not available to use urine strips.Do not stop administering basal insulin except for medical prescription (very rare).It is common that during the appearance of acute diseases increase insulin resistance and need to increase the dose of both the basal and the rapid, with exceptions, for example.If there is gastroenteritis in which it is often necessary to reduce insulin between 20 and 50%.
Steps to follow:
1. Go to the pediatrician to make a correct diagnosis of the disease and treat it if it needs.
2. Manage symptomatic treatment, that is, treat fever, headache, general discomfort (ibuprofen, paracetamol).This will make the child be better and have more appetite.
3. Do not send the kid to school.
4. Administer abundant fluids if you have a fever, and especially if you have high glycemia values ​​(greater than 200) since this will cause more orine and lose, therefore, more liquids.Of course, even more important if you have vomiting (read below), and diarrhea.
5. It is important to administer insulin, carbohydrates and other nutrients.

- If there are nausea and vomiting take into account that they can be the first symptoms of lack of insulin (high glycemia) or secondary to the disease that causes the process (gastroenteritis, flu ...: low glycemias due to lack of carbohydrate intake):
or measure blood glucose every 2-4 hours until the situation is resolved (if there is a risk of hypoglycemia even every hour).Never stop giving basal insulin, since ketoacidosis can be triggered.Fast insulin must vary and manage on demand according to what it ingested and glycemia.
Or measure glucosuria every time you go to the bathroom, and ideally, if you have a blood ketone bodies meter, measure ketonemia at the same time as blood glucose every 2-4 hours.
o Measure the amount of liquids administered throughout the day, as well as its sugar content.
or if the blood glucose is above 240 mg/dl (13mmol/l) and has a marked ketonemia, giving correction bowling according to the insulin/carbohydrates index that you usually use (if it is unknown to administer between 1-1.5 insulin unitsEvery 15 gr of carbohydrates consumed, unless it is on a honeymoon, since the needs can be much lower).ID immediately later to emergencies to rule out ketoacidosis.
or if the glucose is above 240 and the acetone is scarce or absent, give an insulin bolus (according to the relationship you use of insulin/carbohydrate, and taking into account that often in the disease phase you will have to end up givingsome more insulin than usual) of correction every 2-4 hours and drinking non-caloric liquids (water for eg, and even if it is going to take it better, cocacola light or other light product that you like so that it does not send youto fry asparagus for the insistence of which drinks), until the situation improves.
or if the glucose is below 240 and there is acetone marked in blood or urine, give insulin bowling ofcorrection every 2-4 hours and consume abundant caloric fluids (juice, normal cola, normal fanta, sugary, and better gatorade or similar since it restores potassium levels, until the situation is resolved; between 0.6-1.2 liters pertime in children and 1.2-1.8 in adults).
or if after 4 hours the situation is not improving or is simply an overflowing and with many doubts it is best to go to emergency or call your doctor.
Or if you appear vomiting just after putting the rapid insulin in the morning, giving sips (every 10-15 minutes) of sugary liquids (juice, sugar water, normal cocacola, normal fanta, gatorade, ice cream, let's go what you like the most) to try to maintain blood glucose levels between 100 and 180 (5.7-10 mmol/l).If vomiting persists and blood glucose falls below 100 (5.6), you have to take the hospital to administer intravenous glucose.Even if you live far from the hospital go prepared with the glucagon in case you have to give it to the way.
Or if you have to make fast insulin changes (it needs to be increased): if the usual dose is less than 3 increase 0.5, if it is between 4-9 increase 1 unit, and if it is greater than 9 increase 2 units.

In general it is advisable to go to the hospital in the following situations:

1. Very abundant or very repetitive vomiting.
2. Acetone in blood or moderate or high urine, or associated with difficult breath.
3. The blood glucose levels remain high despite increasing insulin doses.
4. It is not clear what the trigger cause of the problem is.
5. Unusual or very intense abdominal pain.
6. Deterioration of the general state.
7. In the event that the child is small (2-3 years or minor) or has another disease associated with diabetes.
8. If those who care for the child (parents or other relatives) are very tired or surpassed by the situation.
At least always call by phone if you are not sure how to handle the situation

Well, squirrel (another Forera of the Forum-Mayamin) made a very practical guide for school, because in school most of the teaching staff/students because no idea of ​​diabetes, unless it has been instructed in this regard.

Thanks to squirrel, it remains:

She started with this subsection "I remind you that this guide," is a personalized for my daughter, you must adapt her to your circumstances "

What is diabetes?
It is a chronic auto disease that causes the pancreas to stop manufacturing insulin, which raises blood glucose level.

People with diabetes should perform blood glucose controls, carry a healthy diet, exercise regularly and follow their insulin therapy.

The student with diabetes at school

A student with diabetes can and should perform and enjoy all school and extracurricular activities, respecting their differences:

(Name of the Child/A) You should always carry with you:
A glucose meter (which knows how to use)
A bruck of fruit juice and cereal bars (to trace mild hypoglycemia)

In the fridge of the teacher's room there are:
A glucagon ampoule (to inject into the improbable case of severe hypoglycemia)

Situations that can occur in class:

Mild hypoglycemia: it is a decrease in blood glucose.
· Symptoms: feeling of hunger, stomach pain, paleness, headache ...
· How to act: Measure glucose, if it is less than 70, a fruit juice and a cereal barrite should be taken, you should not perform any physical activity until the symptoms have referred.

Severe hypoglycemia: it is very unlikely but it could happen.
· Symptoms: loss of consciousness, seizures
· How to act: Do not feed or drink, call 112 and then inject the glucagon blister.

(Name of the Child/A) Identify the symptoms of hypoglycemia, but if you observe it something turned off, it does not hurt to ask if it is well.

Hyperglycemia: It is an elevation of blood glucose.
· Symptoms: hyperactivity, desire to urinate, thirst, headache ...
· How to act: From 250 mg it is not convenient to perform physical activity.It is not a situation that requires an immediate action, in addition, (Name of the child) does not stay in the dining room, and it is not necessary to do anything, just remind you to tell us when leaving.

Physical education:

The insulin guideline that we apply at home always takes into account the sports activities that will be carried out on the school day.

Before performing the physical education class, glucose must be measured and act as follows:
· Less than 70 mg: Act according to mild hypoglycemia protocol and start exercise 10 minutes later and gently
· Less than 90 mg: eat a cereal bar and perform the class normally
· Greater than 250 mg: Do not perform physical activity (a high blood glucose can cause diabetes decompensation)

Excursions, extracurricular outputs:

At home we always take into account extraordinary activities.The life of a child with diabetes must be as "standardized" as possible and therefore, we promote in (child's name) that his illness is never an excuse to stay at home.The emotions that cause extracurricular outputs often slightly raise glucose.The insulin guideline that we apply is usually lower so that hypoglycemia are not produced and she can enjoy more confidence in the activity.

(Name of the child) always carries the glucometer as well as sufficient foods to trace hypoglycemia, it also carries a bracelet indicating that it is diabetic with our mobile phone number.

How to inject glucagon
It is very unlikely that we need to do it, but if (child's name) loses knowledge due to a low glucose descent, we must first call 112 and then inject theGlucagon

1. Inject the syringe fluid into the ampoule
2. Shake the blister so that the liquid and dust are mixed
3. Load the syringe with the mixture
4. Inject any part of the body (buttocks, legs, arms, abdomen ...)

AUTHORIZATION
I, (Mother's/father name), mother of (child's name) I give my authorization to be given glucagon to my daughter.

Signature

Thanks a lot!!!!

Let's see, Maimonides, that I am a descendant of the same viriato (use, fight but rather brutita) :)) I thank you for illustrious, especially for emergency situations, that we are not free.
It is great to have a quick guide, not to have to be thinking "Where did I read this?"

Well, that a Lusitanian in the land of Astures thanks Híspalis Averroes from his wise advice :)) :)) :)) :))

Health

spectacular...

I'm taking note of everything ............ Thank you.

What a good idea .... Thank you ...

Aki again Hispali's Averroe with the Bukaro behind the back porke makes a quajajajajaja quoton, the phrase brings them in the wide sense hahahahaha
Alea your viriata and peleona?He is already for the love of the Guena Chikilla that you are hahaha.

Well change and short and the mess that this is serious.

Let's go with glycosilada

Glycosylated Hemoglobin: Formula to calculate the quarterly average glycemia

Many times we do not know what average glucose value corresponds to such glycosylated hemoglobin value.

In order not to have to consult tables, there is a very simple formula that results in the value of such glycemia, the quarterly average glucose.

It is easy to remember: the value of glycosylated hemoglobin multiplies it by 30 and you subtract 60

glycosylated hemoglobin x 30 - 60

Okay, if you do not remember the formula for a casual, or you are from those who like to consult tables, because comfortable for everyone:

HBA1C 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9
GLUCOSA 60 63 66 69 72 75 78 81 84 87

HBA1C 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9
GLUCOSA 90 93 96 99 102 105 108 111 114 117

HBA1C 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9
Glucose 120 123 126 129 132 135 138 141 144 147

HBA1C 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9
GLUCOSA 150 153 156 159 162 165 168 171 174 177

HBA1C 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9
GLUCOSA 180 183 186 189 192 195 198 201 204 207

HBA1C 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9
GLUCOSA 210 213 216 219 222 225 228 231 234 237

HBA1C 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9
GLUCOSA 240 243 246 249 252 255 258 261 264 267

HBA1C 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9
GLUCOSA 270 273 276 279 282 285 288 291 294 297

HBA1C 12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9
Glucose 300 303 306 309 312 315 318 321 324 327

HBA1C 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9
GLUCOSA 330 333 336 339 342 345 348 351 354

As simple as possible, a forero at that time (I don't know if I walk or not), Aranus (an eminence in the field), described how to stop hypoglycemia
Strike the comment, it is for everyone known, but it never hurts for those who face after the debut make a reminder in this didactic way

The most effective way to trace hypoglycemia is:

a) Provide rapid absorption carbohydrates, in the form of sugary liquids: soda with sugar, sugar water, sugary juices or honey (1-2 tablespoons of honey equal to something more than a sugary tail glassand are quickly assimilated by the body).You can also go to pure glucose (2 glucose pills "Glucosport"). and, after this:

b) Eat slow absorption carbohydratesor a number of cereals;or a piece of bread;Or, even a glass of milk or a yogurt can stabilize glucose once it rises due to the action of rapid absorption sugars.

As always, if you see that you have to add something else you already know, the chuleario is open

And finally today

How to readjust the dose of insulin lantus

Also extracted from our old forum, it was also a post from Aranus, from which I kept some post because they are clear and blunt.The advice of people like him and as others with a lot of experience in the subject helped me a lot.

Some annotations about Lantus

When to readjust the dose of Lantus?- An optimal control -

Keys:

1.- If our basal glycems are greater than 130 for more than 3 days in a row and, in addition, we are "high" (& GT; 130-140) prior to one of the main meals of the day (& GT; 130-140 of preprandial), This is a sign that the Lantus dose is not covering the basal insulin needs.The dose will have to be increased

2.- If, on the contrary, there are episodes of nocturnal hypoglycemia (glycemias & lt; 70), we will have to go down the dose of Lantus.

3.- A glycemia below 110 in the critical period (around 3 in the morning) does not mean, in all cases, that hypoglycemia will occur, but it can be a warning signal.The incidents that are developed will end up providing a more clarifying criterion.

4.- Postprandial glycemias: The "management" of glycemia peaks - which occur as a consequence of HC + proteins + fat intake - regular insulin or ultra -grape is responsible.The objective to be achieved is that these glycemia are included in the 100-160 interval, according to the recommendations of the ADA.

5.- Preprandial and basal glycemia: Lantus is the "responsible" (in addition to us) of the regulation of glucose values ​​before meals and during the period of inactivity or rest of the organism.Objective: 70-80/130-140.

6.- Better injection point: the "culete".

7.- Tips on guidelines, etc: your endocrine.

wise advice that I hope is useful

Good afternoon, we continue with the chops

A letter that Ibapatri (Patricia) wrote about diabetes at school

Patri commented: I transcribe the letter to the teachers that the doctor of Anabel gave me for the school when she debuted.

It should be clarified that the schools in Argentina, in general, do not have nursing, and the Holiness (public or private) system does not contemplate that a nurse attends the diabetic child at school.

...

Nutrition section

Children's Hospital

Of Bs.ACE.«R. Gutierrez».

Letter to teachers

Dear Master:

You have in your hands the education of .................................................. .......... that has diabetes melitus and that as all children require their love, wisdom and understanding.

You will ask: How is a diabetic child?He is a child capable of developing physically and psychically like his classmates, therefore:

§ It can and should receive normal schooling and attend the school regularly.

§ You can and should receive, if not obese, a normal, healthy and balanced diet, identical to that of your classmates.

§ You can and should carry out all physical activities and sports that are practiced in school.

§ You can and should receive the same vaccines as your companions.

However, it is important that you know some of the characteristics of this disease.

What is diabetes?It is a disease that is caused by insufficiency in insulin secretion by the pancreas.This hormone regulates the use of sugar by the body, producing, when lacking, increased blood sugar and its urine elimination.Because of this, the child suffering from diabetes presents before its treatment the following symptoms of thirst, excess urine, thinning and progressively dehydration and acidosis.

How is diabetes about the child?The treatment of this disease is based on the daily application of an insulin injection in the morning permanently.As insulin requirements vary from one day to another for multiple reasons.The dose to be applied is regulated by performing a capillary blood analysis by means of a glucometer, performed by the parents or the child.With this treatment, the symptoms retrograde and the child returns to normal.However, even if it performs a good treatment, there are certain eventualities that can occur during the school day that the teacher must know and that are due to an insufficiency of the insulin administered or more often, to an excess of insulin.

a) If for any reason, the dose of insulin administered has been insufficient, the child may feel imperious desire to urinate and thirst excessive.In this case it is necessary to assume a comprehensive attitude that allows the child to relieve those needs.

b) Inversely, it can be seen that due to the excess of the dose of insulin, discomforts due to abrupt descent of the blood sugar appear.These symptoms, called hypoglycemia, are variable in their appearance from one person to the other, but in general constant in the same person.

In some: dizziness, headache, paleness, abundant sweat, tremors, looseness.

In others: imperative hunger, abdominal cramps.

In others: sudden change of behavior, unusual indifference or excitement, (crying, screaming, lack of concentration, writing disorders, wobble march, balance or word disorders) drunkenness), etc.)

In others: sleep, extreme weakness (for example, stop playing and sits at recess away).

Rarely: loss of knowledge or seizures.

These symptoms can occur more frequent during periods of intense physical activity and are quickly solved by giving the child sugary substances of rapid absorption (several terrons of sugar embedded in water,Sweaty fruit juice, jam, coca-cola, sugary infusions, etc.), in general this is enough for the disappearance of these discomforts, the child can be integrated into their tasks.

Exceptionally, if the child is unconscious or has seizures and cannot ingest sugary substances, he must immediately move to an emergency medical service to apply hypertonic glucose serum in the end of the endovenous route.

In short, this brief information that we reach is to achieve the maximum well -being of ..................................................

We hope that this letter is the beginning of an exchange between you. Educators and we pediatricians concerned with the health of this child that we attend in common.

For type 2 diabetes there are control objectives of the American Diabetes Association (2007) that are:

Control objectives

HBA1C (%) & lt; 7 intensify interventions & GT; 8

Basal and Prepandrial Glycemia * 90-130 Intensify interventions & GT; 130

Postprandial blood glucose * & lt;180 intensify interventions & GT; 180

Total cholesterol (mg/dl) & lt; 185 intensify interventions & GT; 200

LDL (mg/dl) & lt; 100 intensify interventions & GT; 130

HDL (mg/dl) & gt; 40 intensify interventions & lt; 35

Triglycerides (mg/dl) & lt; 150 intensify interventions & GT; 200

Blood pressure (mmHg) & lt; 130/80 intensify interventions & GT; 140/90

Weight (BMI = kg/m2) BMI & lt; 25 Intensify Imc & GT interventions; 27

Waist (cm) & lt; 94 h;& lt; 80 m intensify interventions & GT; 102 h;& GT; 88 m

Tobacco consumption does not intensify interventions yes

(*) Capillary blood glucose.The postprandial will be determined between 90-120 minutes after intake

More about diabetes at school

In the letter to the teachers, who wrote Patri, I tried to help with this other work that I also bring you:

Decalogue about how to recognize hypoglycemia with advice for nursery, schools, institutes and faculties with simple terms to understand, so that teachers and tutors knew how to identify the symptoms of hypoglycema in children and young people.

We could do it among all and in the end once finished it could be printed and taken to the schools where they had it in a visible place whenever in that classroom there was a diabetic child/adolescent

I could start this way:

Diabetes at school: What are the signs and symptoms of hypoglycemia?

Put aside the unconscious person

The control objectives for insulin diabetes would be:

The control objectives attached again:

Control Objectives 2007 American Diabetes Association

HBA1C & LT glycemic control; 7.0%
Preprandial capillary plasma glucose 90–130 mg/dl
Postprandial capillary plasma glucose (1-2 hr.) & Lt; 180 mg/dl
Blood pressure & lt; 130/80 mmHg
Lipids
Ldl cholesterol & lt; 100 mg/dl (& lt; minor)
Triglycerides & lt; 150 mg/dl
HDL cholesterol & gt; 40 mg/dl (woman & gt; 50mg/dl) (& gt; older)

IDF 2005 (type 2 diabetes) International Diabetes Federation

Glycemic control & lt; 6.5%1
Preprandial capillary plasma glucose & lt; 110 mg/dl
Postprandial capillary plasma glucose (1-2 hr.) & Lt; 145 mg/dl
Blood pressure & lt; 130/80 mmHg
Lipids
LDL cholesterol & lt; 95 mg/dl
Triglycerides & lt; 200 mg/dl
HDL cholesterol & gt; 39 mg/dl

HBA1C is the main objective for glycemia control

Well, today we could see the importance of rotations in the injection areas of insulin :

We must make rotations in the injection zones, because otherwise it can be produced lipohhypertrophies , with the consequent bad absorption of insulin

The lipohypertrophy are prominences that may appear in the areas where insulin is administered.( search Bultitos where you click )
There are factors that predispose to lipohhypertrophy such as:

1) insulin itself

2) The microtrauma produced by the needles, especially when " reuse the needles "

3) Injecting the insulin always in the same area

It is very important to take this into account because:

" Insulin injected into the hypertrophy zone (hardening) will have an erratic absorption, which translates into a deterioration of glucose control, and often increases daily insulin needs "

How are we going to prevent this?

1) with an adequate rotation of the Punction Zone (arms, abdomen, legs and buttocks).And that there is at least a distance of 2 centimeters between each puncture

2.You are going to click more (Intensive Therapy

linking with the previous post

Is the length of insulin needles important?

We must take into account the following:

1) Assess the needle length , the injection zone and the insulin administration technique are key points to ensure the subcutaneous absorption of insulin

2) The subcutaneous thickness can vary according to the injection zones (abdomen, thigh, buttocks or arm), also according to sex, body mass index and morphology and distribution of abdominal fat .

3) The insulin administration technique with or without fold, at an angle of 90º or 45º must be customized to achieve a correct absorption of insulin
A review article on insulin administration techniques and systems published in the magazine “Advances in Diabetology” 2008;24 (3): 255-269.advises the following :

6 and 8 mm needles have similar characteristics and could be used by the vast majority of people with diabetes, regardless of their age and body mass index, always resorting to the technique of "fold" and with an angle of 45º inChildren and, "fold" and 90º angle in adults with normal, overweight and obesity (in the latter case, without fold in the abdominal zone).

For correct individualization, all needle lengths should be available:

5 mm needles, especially indicated in children, thin adults, athletes or overweight-obesity in which it is necessaryThe fold.

6 and/or 8 mm needles as basic needles, as indicated before.

12 mm needles, especially indicated in the buttocks and abdominal area for patients with central and/or morbid obesity.