Summary: Background: Type 1 diabetes is a chronic disease and Sweden tops the statistics for the worst affected countries in the world. The main part of treatment takes place alone in the home when the sufferer administers insulin to the body via an injection or pump. The sufferer must adapt their lifestyle to supplying

Self-monitoring of blood glucose (SMBG) can be effective in preventing poor outcomes associated with diabetes mellitus but previous research has identified that SMBG is not being undertaken in line with current recommendations. Guidance informs health professionals to educate patients on how they should self-monitor but very little is know about how patients self-monitor in the real world. In this thesis, a quantitative scoping study is first presented. This study used routine data sources to examine the levels and patterns of self-montoring in different population groups and then proceeded to a larger qualitative study to explore and question what patients are doing in practice in relation to self-monitoring, and why. This involved a qualitative multi-case study of patients, their support people, health care practitioners (HCPs) and patient diaries. Ten individuals and their nominated support people and HCPs formed ten cases among whom 21 in-depth semi-structured interviews were carried out and six patient diaries analysed. The exploratory work was framed around Stones’ version of structuration theory and uncovered a complex linkage of individual motives for monitoring, associated responses and behaviours in relation to the motive, and the underpinning attitudes and beliefs behind the motive. The following key points emerged from the analysis. People have differing relationships with their diabetes and this links with the level of engagement they have with their condition. Resistance to support people and health services was commonly observed. Experiences of diabetes reviews were important, with an identified need for them to feel more like collaboration and less like surveillance. A significant factor was the gaps and limitations in knowledge and understanding around diabetes for patients, relatives, support people and HCPs; and, finally, there was a noted maintenance of blood glucose levels higher than recommended through SMBG in several participants, which stemmed from a fear of hypoglycemic episode. The analysis concluded that although self-monitoring of blood glucose, in theory, and when considered in isolation, is a simple process to undertake, its application in the wider context of self-management and the individual is much more complicated. The process is influenced by many complex factors and generates a variety of responses and behaviours, some not in keeping with good diabetes self-management. There was a significant lack of person-centered approaches to managing diabetes which was, in part, due to existing health systems and processes. Therefore, there is a need to raise awareness of the gaps that exist in terms of such approaches as well as the gaps in knowledge and understanding of individuals with diabetes and those caring for and supporting them. In more specific terms, it is essential to develop and evaluate individual approaches to patients in relation to their self-monitoring and associated self-management in the context of their own lives, which involves the assessment of engagement and understanding around self-monitoring.

The purpose of this research was to design a blood glucose sensing system based on the induced shift in the resonant frequency of an antenna patch operating in the ISM band (5.725 – 5.875 GHz). The underlying concept is the fact that when a person has variations in their blood glucose levels, the permittivity of their blood varies accordingly. This research analyzed the feasibility of using an antenna patch as a blood glucose sensing device in three configurations: 1) as an implantable active sensor, 2) as an implantable passive antenna sensor, and 3) as a non-invasive sensor. In the first arrangement, the antenna is to be implanted inside the body as an active antenna, requiring that its power supply and internal circuitry to be implanted. In the second arrangement, the antenna is also implanted, but would not require a power supply or internal circuity since it would be passive. For the third arrangement, the non-invasive sensing approach, the antenna is placed facing the upper arm while mounted outside the body. In order to evaluate the best approach all the three approaches were simulated using the electromagnetic field tool simulator ANSYS EM15.0 HFSSTM, along with a human tissue model. The tissue model included physiological and electrical characteristics of the human abdomen for simulating the active and passive approaches, and the upper arm for the non-invasive approach. The electromagnetic boundaries were set with perfectly matched layers to eliminate any reflections which would cause a non-physical resonance in the results. Simulation of the active sensing configuration resulted in a resonant frequency shift from 5.76 to 5.78GHz (i.e., a 20 MHz shift) for a simulated blood permittivity variation of 62.0 to 63.6. This corresponds, theoretically, to an approximate glucose shift of 500 mg/dL. The passive configuration simulations did not yield conclusive variations in resonant frequency and this approach was abandoned early on in this research. Thirdly, the non-invasive approach resulted in a simulated shift of resonant frequency from 5.797 to 5.807 (i.e., a 10MHz shift) for simulated blood permittivity variation of 51.397 to 52.642 (an approximate variation of 2000 mg/dL in glucose). In the literature planar, continuous blood-rich layers are used to simulate RF sensing of glucose, which is not applicable when measuring glucose in actual human veins, which are tubular in geometry and of finite extent. Therefore the model employed assumed a 1.8 mm diameter blood vessel, buried under a fatty layer that was capped with skin. The above results, both simulated and verified experimentally, used this more realistic model which is further proof that a practical non-invasive blood glucose measurement system should be possible. The non-invasive approach was tested experimentally by using oil in gel phantoms to mimic the electrical properties of skin, fat, blood and muscle. A fat phantom was placed over a muscle phantom, with a strip of blood phantom within and a skin phantom was placed on top. The blood phantom had a 2000mg/dL variation of D-glucose in the phantom mixture which decreased the relative permittivity from 52.635 to 51.482 and resulted in a shift of resonant frequency from 5.855 to 5.842 (i.e., a 13MHz shift). This is consistent with the non-invasive simulated results thus validating our model of the non-invasive sensing approach. While this variation in blood glucose is non-physical (typical human glucose range can range in the extremes from 30 to 400 mg/dL, where healthy glucose levels vary from 70mg/dL to 180mg/dL) it was necessary to provide a high confidence fit between the simulated and experimental data. This is because the level of precision with which the physical phantoms could be fabricated with was insufficient to match the highly precise simulated data. Analysis on the effect of lateral displacement of the antenna from the blood vessel, its elevation above the skin and variations caused by different skin thickness, and blood vessel depth were evaluated. A calibration technique to correct physical misalignment by the user is proposed in which two additional antennas, located diagonally with respect to the sensing antenna, serve as reference point for placement over the upper arm in line of sight with the blood vessel. Once the non-invasive sensor approach was shown to be viable for continuous glucose monitoring, a sensor platform was designed whereby an RF generator was used to drive the antenna with a frequency sweep between 5.725 to 5.875GHz. A fraction of its output power was coupled to both the antenna and the system analysis circuitry through a directional coupler. The transmitted and received power were then processed with demodulating logarithmic amplifiers which convert the RF signal to a corresponding voltage for downstream processing. Both inputs were then fed into a microcontroller and the measured shift in resonant frequency, fO, converted to glucose concentration which was displayed on glucose meter display.

No description available.

Emotionella reaktioner bidrar till kroppsligt stresspåslag vilketpåverkar blodsockernivåerna. Syftet med studien var att undersökaskillnaden i tillämpning av kognitiv omstrukturering bland typ1-diabetiker vid lågt respektive högt blodsocker samt skillnaden itillämpningen beroende på antal år av sjukdomen(sjukdomsförloppet). Vi undersökte även sambandet mellan kognitivomstruktureringen och diabetesrelaterad stress generellt och vid lågtoch högt blodsocker. En enkätundersökning genomfördes därdeltagarna (N = 69) fick besvara frågor om kognitiv omstruktureringvid antingen lågt eller högt blodsocker samt diabetesrelaterad stress.Resultaten visade att det inte fanns en skillnad i tillämpning avkognitiv omstrukturering vid lågt respektive högt blodsocker eller vidsjukdomsförloppet. Resultatet visade inget samband mellan kognitivomstrukturering och diabetesrelaterad stress generellt eller vid lågtoch högt blodsocker. Sammanfattningsvis påvisar studien attdiabetiker tillämpar kognitiv omstrukturering i låg utsträckningoavsett blodsockernivå och sjukdomsförlopp samt upplevde högdiabetesrelaterad stress. / Emotional reaction contributes bodily stress, which affects bloodsugar levels. This study examined differences in application ofcognitive restructuring among type 1-diabetics in low and high bloodsugar and the differences in application depending on the number ofyears with disease (disease course). We examined the relationshipbetween cognitive restructuring and diabetes-related distress ingeneral and low and high blood sugar. A survey conducted in whichparticipants (N = 69) answered questions about cognitiverestructuring in low or high blood sugar and diabetes-relateddistress. Results showed no difference in application of cognitiverestructuring in low and high blood sugar or in disease course.Results showed no connection between cognitive restructuring anddiabetes-related distress in general or in low and high blood sugar.Thus, this study shows that diabetics applied cognitive restructuringto a low extent regardless of blood sugar levels, disease course andexperienced high diabetes-related distress.

Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Type 2 diabetes mellitus (T2DM) is a costly and burdensome lifelong disease, and without proper glycemic control, severe life-threatening complications result. In Southeast Asia, the prevalence of T2DM is forecast to increase markedly from 2000 to 2030. Although literature reviews on lifestyle modification for glycemic control are available, these are mainly for the Western context, and there is a dearth of evidence for Southeast Asians who are at greater risk of T2DM and have differing patterns of diet, physical activity and body composition than Western populations. Objective: To systematically review literature on the effectiveness of lifestyle modification interventions for glycemic control in T2DM patients from Southeast Asia. Methods: Randomized controlled trials (RCT) with interventions ≥ 8 weeks that compared HbA1c or blood glucose for intervention (lifestyle modification) versus control groups were identified from searches in Cochrane Library, CINAHL, PubMed, ProQuest, Science Direct, SPORTDiscus, Scopus and Web of Science. Results: Seven RCTs (679 participants) meeting inclusion and exclusion criteria were identified. There was a significant reduction in HbA1c% (MD = -0.56%; 95% CI = -0.95,-0.16%; p = 0.006; n = 5 studies) and in blood glucose mg/dl (MD = -16.76 mg/dl; 95% CI = -31.36, -2.17 mg/dl; p = 0.02; n = 4 studies) over 3 months for lifestyle modification intervention groups. Lifestyle interventions included diet (n = 2), exercise (n = 2), and general lifestyle interventions (n = 3). Duration of interventions ranged from 12 weeks to 6 months. Studies included populations from Thailand (n = 5) and Malaysia (n = 2). Conclusion: Overall, lifestyle modification interventions are effective for the glycemic control of T2DM patients in countries of Southeast Asia.

Diabetes mellitus is a chronic disease affecting millions of people worldwide. The degenerative changes caused by diabetes can, however, be controlled through the correct treatment. The outcome of diabetes mellitus depends mainly on the patient's self-management. Health professionals therefore have a major responsibility to assist patients to acquire the essential knowledge, skills and attitudes for self-management. The purpose of this study was to identify diabetic patients and family members' knowledge and views about diabetes mellitus and its treatment regimen. A quantitative descriptive survey design was used. Questionnaires were used to collect data from a convenient sample of diabetic patients and family members. Data was analysed by a computer program called Statistical Package for Social Sciences. Findings revealed that patients and family members lack adequate knowledge on diabetes mellitus and its treatment. Recommendations regarding the required information and assistance to be given to diabetic patients and their family members were formulated. / Health Studies / (MA (Health Studies))

Forage of beta-carotene-fortified orange-fleshed sweet potato is essential for alleviation cattle malnutrition. The study aims were to determine effects of supplementing sweet potato (SP) roots and sun dried forage on degradation of dietary legumes, intake and milk yield in dairy cattle. Mature SP roots were oven dried and forage vines and leaves (V&L) sun dried. Lactating dairy were supplied meals with total mixed ration (TMR) constituting varying levels of sweet potato forage and concentrate. The SP flour was rapidly and completely degraded In Sacco while degradability of V&L was comparable to that of Lucerne hay. Rumen degradation of Lucerne was reduced when the legume was incubated proximal to SP. Substitution of TMR with fresh SP forage and flour meal increased degradability of diets. Glucose post-feeding was increased (P<0.05) by SP roots but no change in milk yield. Orange-fleshed SP forage is recommended for improving energy supply in lactating cow diets / Agriculture and  Animal Health / M. Sc. (Agriculture)

Kwan, Yee Mei. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 152-171). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese.

Exercise has a wide range of benefits for patients with type 1 diabetes, including improvements in body composition, cardiovascular risk profile and glycaemic control. Unfortunately, exercise also increases the risk of hypoglycaemia in children with type 1 diabetes, both at the time of exercise and for many hours afterwards. The availability of clear, evidence-based guidelines regarding appropriate adjustments in carbohydrate intake or insulin doses may help to prevent this exercise associated hypoglycaemia. However, current guidelines regarding exercise in children with type 1 diabetes rely heavily on adult literature or the consensus of experts. Therefore, further studies are needed in young people with diabetes to document the metabolic responses during and following exercise. In particular, the mechanisms underlying hypoglycaemia occurring many hours after exercise require further exploration. In addition, as children often exercise in the afternoon, studies performed at this time of the day are more likely to be transferrable to a real life situation. For this reason, we studied adolescents with type 1 diabetes to investigate physiological responses to exercise, focusing on afternoon activity and employing a novel variation of the euglycaemic insulin clamp technique. The core experiments involved studying diabetic adolescents on two occasions in a counterbalanced, paired design during and after afternoon exercise. Insulin was infused at a constant rate based on the subjects' usual daily insulin dose and glucose was infused to maintain euglycaemia. At 1600 hrs subjects either exercised at a moderate intensity (95% of their lactate threshold) for 45 minutes on a cycle ergometer (exercise study), or sat on the ergometer without exercising (rest study). Using this experimental design, it was found that glucose infusion rates (GIR) to maintain euglycaemia were elevated during and shortly following exercise and again from 7-11 hours after exercise compared with the rest study. Counterregulatory hormone levels were similar between the exercise and rest studies except for peaks in noradrenaline, cortisol and growth hormone levels at the end of exercise. Glucagon and adrenaline levels did not increase with exercise. The observed biphasic increase in glucose requirements paralleled the observed clinical risk of hypoglycaemia immediately during exercise and the delayed risk of hypoglycaemia which often occurs overnight.