Introdução: No âmbito da assistência ao paciente crítico, ainda persiste uma intensa e controversa discussão acerca da dificuldade da manutenção da normoglicemia, especialmente a fim de evitar episódios hipoglicêmicos. A hipoglicemia consiste em importante evento adverso e fator limitante para o controle glicêmico (CG) ideal. Objetivo: Este trabalho teve por objetivo analisar a hipoglicemia e os fatores associados em pacientes críticos. Método: Coorte retrospectiva conduzida com pacientes críticos internados nas unidades de terapia intensiva, e clínica semi-intensiva do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 106 adultos, que apresentaram CG, por, pelo menos, 48 h, e cujo seguimento foi de 72 h. A variável dependente foi hipoglicemia (70mg/dl) e independentes foram idade, dieta, uso de insulina, catecolaminas, hemodiálise, carga de trabalho de enfermagem e SAPSII. Na análise dos dados utilizaram-se os testes t de student, Exato de Fisher e regressão logística, com significância de p 0,05. Resultados: A incidência de hipoglicemia 70mg/dl foi de 14,2%. A média de idade foi 63,3 anos, com internação clínica em 67% dos casos, cerca de 40% dos pacientes tinham diabetes mellitus 39% insuficiência renal e 8% insuficiência hepática. A hipoglicemia foi associada a média da glicemia (p=0,013) variabilidade glicêmica (p=0,000), uso de catecolaminas (p=0,040), óbito na UTI (p=0,008). Foram fatores de risco a ausência de dieta via oral, OR 5,11; IC 1,04 -25,10, e a realização de hemodiálise OR 4,28; IC 1,16-15,76. O intervalo de medida glicêmica mais frequente foi de 6/6h, com poucas medidas em horários de troca de turno de trabalho e no período das 4 h às 7 h. A correlação entre medidas glicêmicas prescritas e realizadas foi de 0,880 (p=0,000). Conclusão: A hipoglicemia persiste como evento adverso no contexto das unidades críticas. A prescrição do CG, com maior ênfase na monitorização nos grupos de risco, ou seja, nos pacientes submetidos a hemodiálise e aqueles que não recebem dieta VO, pode ajudar a prevenir episódios hipoglicêmicos / Introduction: Within the context of critical patients care, there remains an intense and controversial discussion over the difficulty of maintaining normoglycemia, especially to avoid hypoglycemic episodes. Hypoglycemia is an important adverse event and a limiting factor for an ideal glycemic control (GC). Objective: This study aimed to analyze the factors associated to hypoglycemia in critically ill patients. Methods: Retrospective cohort study conducted in critically ill patients from intensive and semi-intensive care units, of the University Hospital University of São Paulo. The sample consisted of 106 adults who had GC, for at least 48 h, and whose follow-up was 72 h. The dependent variable was hypoglycemia (70mg / dl) and independent variables were age, diet, insulin, catecholamines, hemodialysis, nursing workload and SAPSII. In the data analysis we used Students t and Fishers Exact tests and logistic regression, with significance of p 0,05. Results: The incidence of hypoglycemia 70mg / dl was 14.2%. The average age was 63.3 years, 67% were clinical patients, about 40% had diabetes mellitus, 39% had renal failure and 8% liver failure. Hypoglycemia was associated with mean blood glucose (p = 0.013) glycemic variability (p = 0.000), use of catecholamines (p = 0.040), and death in the ICU (p = 0.008). Risk factors were the absence of oral diet, OR 5.11; CI 1.04 -25.10, and hemodialysis OR 4.28; CI 1.16 to 15.76. The most frequent range of glucose measurement was 6 / 6 h, with few readings in the hours of the nursing work shift change, and from 4 h to 7 h am. The correlation between prescribed and performed glucose measurements was 0.880 (p = 0.000). Conclusion: Hypoglycemia persists as an adverse event in the context of critical units. Prescription of GC, with greater emphasis on monitoring in risk groups, namely, patients undergoing hemodialysis and those not receiving VO diet, can help prevent hypoglycemic episodes

There exist a wide variety of metabolic responses to different types of carbohydrates and their influence on metabolism during endurance training. Recent studies revealed that the physiological responses to food are far more complex than was previously appreciated. The rapid release of insulin and the decline in blood sugar levels during the first stages of endurance training are linked to the Glycemic Index of foods. Researchers cannot still make use of the old distinction between starchy and sugary food or simple and complex carbohydrates. These distinctions are based on the chemical analysis of the food, which does not totally reflect the effects of these foods on the body. The Glycemic Index is a more reliable guideline to apply in nutritional management for endurance athletes. The major object of the study was to indicate the importance of utilizing the Glycemic Index (GI) as part of the nutritional preparation for endurance events. The study investigated the advantages of ingesting a Low Glycemic Index meal prior to exercise and compared it with the ingestion of a High Glycemic Index meal. A pretest-posttest design was used. Twelve healthy, male and female cyclists participated in the study. Subjects were selected according to their level of training. The total test period consisted of 14 days, which included two different dietary interventions of 7 days each. Diet -and training analysis were done on the subjects prior to the commencement of the study. Each subject completed three exercise trials. The first exercise trial consisted of a V02max test until exhaustion. Two submaximal trials (65 - 70 % of V02max) followed and were preceded by two dietary interventions. The dietary interventions (7 days each) had the same amount of CHO, fat and protein but differed in the Glycemic Index of the pre-exercise meals. The first pre-exercise meal was a High Glycemic Index (HGI) meal. The second pre-exercise meal was a Low Glycemic Index (LGI) meal. The results of the study indicated the advantages of ingesting a Low Glycemic Index meal prior to endurance exercise. The drop in blood glucose levels significantly differed (p<0.05) with an average of 0.68 mmol/L between the two tests after 10 minutes of cycling. It took 20 minutes for the blood sugar level of the first testto reach the same level of the blood sugar level of the second test. After the ingestion of the High Glycemic Index meal in Test 1, the blood lactate levels were significantly higher (p<0.05) during the first 15 minutes. The total distance covered by the subjects was 22.86 km after the first dietary intervention (High glycemic Index food) and 27.43 km after the second dietary intervention (Low glycemic Index food) although it is not statistically significant due to the small sample size. The difference in the distance covered of the two tests is 4.57 km in a period of 50 minutes. Subjects indicated that they experienced more physical strain (higher RPE values) in Test 1 (High Glycemic Index food) than in Test 2 (Low Glycemic Index food) (p<0.05). The study results support the fact that Low glycemic index food may confer an advantage when eaten prior to prolonged strenuous exercise by providing a slow¬releasing source of glucose to the blood without causing extensive hypoglycemia. Proper preparation and the correct choice of the pre-exercise meal can exclude the occurrence of sudden drops in the blood sugar levels. The Glycemic Index can also be successfully applied during and after events to improve performance. / Dissertation (MA (MHS))--University of Pretoria, 2007. / Arts, Languages and Human Movement Studies Education / unrestricted

Introdução: O controle glicêmico estrito com múltiplas injeções diárias de insulina é o foco do tratamento para diabetes mellitus tipo 1 (DM1), mas geralmente está associado a um aumento no número de episódios de hipoglicemia, e o estresse de conviver com esse evento pode estar associado a prejuízos para a saúde mental do paciente. Embora os análogos de insulina de ação prolongada tenham propriedades farmacológicas para imitar o perfil fisiológico de insulina, a literatura não é unânime em demonstrar esse efeito em comparação à insulina humana. No Brasil, apenas alguns estados, incluindo o Rio Grande do Sul (RS), fornecem análogos de insulina para pacientes com DM1. O objetivo deste estudo foi avaliar a frequência de hipoglicemias e a satisfação dos pacientes com DM1 que recebem análogos de insulina de curta e longa ação após sua introdução no Rio Grande do Sul (RS). Materiais e métodos: Estudo transversal, retrospectivo, realizado com pacientes adultos com diabetes tipo 1, residentes de 38 cidades do estado do Rio Grande do Sul, que recebiam análogos de insulina via Secretaria Estadual de Saúde. Os dados clínicos e demográficos foram avaliados por formulário auto-respondido, a satisfação dos pacientes com o tratamento através do Questionário de satisfação com o tratamento do diabetes (DTSQs) e os transtornos mentais comuns (TMC) através do Questionário sobre saúde geral (QSG-12). Resultados: Um total de 507 pacientes foram incluídos, com idade média de 38,6±13,7 anos, 52% feminino, com duração do DM 18 [IQR25-75 = 11-25] anos e 36,8% com ensino superior completo. A pontuação mediana de satisfação com o tratamento (DTSQs) foi de 32 [IQR25-75 = 29 -35]. A satisfação dos pacientes não reduziu a longo prazo. A taxa de pacientes com hipoglicemias, incluindo grave e noturna, não alterou com o tempo de uso dos análogos de insulina. Apesar de taxas altas de hipoglicemias e com a maioria dos pacientes com triagem positiva para transtornos mentais comuns os pacientes mantiveram altos escores de satisfação com o tratamento, o que não reduziu em longo prazo como em outras intervenções em doenças crônicas. / Introduction: Strict glycemic control with multiple daily insulin injections is the focus of treatment for type 1 diabetes (T1D), but it is usually associated with an increase in the number of hypoglycemia episodes, and the stress of living with this event may be associated with damages to the mental health of the patient. Although long-acting insulin analogues have pharmacological properties to mimic physiologic insulin profile, literature is not unanimous in showing this effect in comparison to human insulin. In Brazil, only some states, including Rio Grande do Sul (RS), provide insulin analogues for T1D patients. The purpose of this study was to evaluate the frequency of hypoglycemia and the satisfaction of T1D patients who receive short and long acting insulin analogues after their introduction in RS. Methods: A cross-sectional, retrospective study was conducted with adult patients with T1D, residents of 38 cities in Rio Grande do Sul state, who received insulin analogues via the State Department of Health. Demographic and clinical data was evaluated through a self-responded questionnaire; satisfaction, analyzed using the Diabetes Treatment Satisfaction Questionnaire (DTSQs), and Common Mental Disorders (CMD), analyzed using the General Health Questionnaire (QSG-12). Results: A total of 507 T1D patients were included, with a mean age of 38.6 ± 13.7 years, 52% female, with diabetes duration of 18 (11-25) years and 36.8% with complete higher education. The medium score of satisfaction with the treatment (DTSQs) was 32 [IQR25-75 = 29 -35]. Patient satisfaction was not reduced in the long term. The rate of patients with hypoglycemia, including severe and nocturnal hypoglycemia, was not changed with the time use insulin analogues. Although high rates of hypoglycaemia and with most patients with positive 14 screening for common mental disorders patients maintained high satisfaction scores with treatment, which did not reduce in the long term as in other interventions in chronic diseases.

Bakgrund: Typ 1 diabetes är en obotlig autoimmun sjukdom där immunförsvaret angriper och förstör de insulinproducerande ß-cellerna i bukspottkörteln. Detta leder tillslut till total insulinbrist vilket är ett dödligt tillstånd. Genom att öka mängden fysisk aktivitet hos individer med typ 1 diabetes minskar risken för följdsjukdomar. Syfte: Syftet med studien var att undersöka de barriärer som finns till fysisk aktivitet hos individer med typ 1 diabetes. Metod: Den metod som valdes var kvantitativ metod där enkäten “Barriers to Physical Activity in Diabetes type 1” (BAPAD1) valdes ut. Totalt svarade 66 individer med typ 1 diabetes på enkäten. Resultatet analyserades sedan med hjälp av Excel. Resultat: Den vanligaste barriären till fysisk aktivitet var “rädslan för hypoglykemi” följt av “Att du tappar kontrollen över din diabetes under fysisk aktivitet” och “att du tappar kontrollen över din diabetes efter fysisk aktivitet”. Konklusion: Sammanfattningsvis fick vi vår frågeställning besvarad. Tidigare studier visar att rädsla för hypoglykemi är den vanligaste barriären till fysisk aktivitet och det bekräftades även i denna studie. / Background: Type 1 diabetes is an autoimmune disorder where the immune system destroys the insulin-producing pancreatic-ß cells. This eventually leads to total insulin deficiency which is a fatal condition. By increasing the amount of physical activity in individuals with type 1 diabetes the risk of sequelae reduces. Objective: The aim of this study was to investigate the barriers to physical activity in individuals with type 1 diabetes. Method: The chosen method to this study was the questionnaire “Barriers to Physical Activity in Diabetes type 1” (BAPAD1). A total of 66 individuals with type 1 diabetes filled the questionnaire according to their own barriers to physical activity. The answers were later analysed in Excel. Result: The most common barrier to physical activity was “the fear of hypoglycemia” followed by “The loss of control over your diabetes during physical activity” and “The loss of control over your diabetes after physical activity”. Conclusion: Over all the result of the study got our question answered. Previous studies show that fear of hypoglycemia is the most common barrier to physical activity, and this was also confirmed in this study

Managing diabetes in the geriatric long-term care population can be challenging, yet important because diabetes is a chronic, progressive disease. The purpose of this project was to identify clinical practice guidelines for managing Type 2 diabetes in geriatric veterans and to develop a class to educate providers on diabetes management in the geriatric long-term care population at a community living and rehabilitation center. The practice focused question asked if providing education to providers about the clinical practice guidelines for managing Type 2 diabetes in geriatric long-term care veterans would improve knowledge as measured by a pre- and posttest. The project was based on the stage theory of organizational change and focused on the goal of improving diabetes management in the long-term care geriatric population by using clinical practice guidelines. The American Medical Directors Association's and Diabetes Association's updated clinical practice guidelines and systematic review literature on diabetes provided the evidence to support the educational project. A pretest, posttest, and summative evaluation were used to evaluate the project. A paired t test was used to compare the pretest and posttest scores for all participants. Posttest results showed a significant improvement in provider knowledge compared to pretest scores (t = -4.416, df = 12, p < .01). Participant evaluation of the program showed that the goals and objectives were met, content was understandable, and presentation was professional. The findings of the project may be beneficial at the organizational level to promote positive social change by improved management of diabetes in the geriatric long-term care population, thus potentially decreasing unwanted side effects and improving geriatric veteran health.

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Bakgrund Rädsla för hypoglykemi hos föräldrar med barn som har diabetes mellitus typ 1 är ett folkhälsoproblem. Hypoglykemi är en vanlig komplikation vid insulinbehandling och kan leda till allvarliga konsekvenser om det inte behandlas. Detta kan skapa en stor rädsla hos föräldrarna som gör allt för att förhindra att det inträffar. Det finns därför ett behov av att sammanställa aktuell forskning för att öka vårdpersonalens kunskap och förståelse för föräldrars rädsla för hypoglykemi hos barn med diabetes mellitus typ 1. Syfte Syftet med denna litteraturöversikt var att belysa hur föräldrar upplevde att leva med rädsla för hypoglykemi när barnet hade diabetes mellitus typ 1. Metod En icke-systematisk litteraturöversikt som baserades på 14 vetenskapliga originalartiklar med både en kvantitativ och kvalitativ ansats har skrivits. De vetenskapliga artiklarna inhämtades från PubMed och CINAHL med hjälp av olika sökordskombinationer, samt att en artikel hittades via manuell sökning. De vetenskapliga artiklarna har genomgått kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet sammanställdes och analyserades utifrån integrerad dataanalys. Resultat I sammanställningen av resultatet identifierades två huvudteman: “Rädslans påverkan på föräldrars livskvalitet” samt “Rädslans påverkan på föräldrars sjukdomshantering”. Resultatet visade att föräldrars rädsla var ett omfattande problem som baserades på en bristande kunskap från vården vid diagnostiseringen. Det resulterade i att föräldrarna själva skapade hanteringsstrategier för att undvika att barnet skulle få hypoglykemi. Slutsats Litteraturöversikten belyste hur föräldrar upplevde att leva med rädsla för hypoglykemi när barnet hade diabetes mellitus typ 1. Rädslan hade en stor påverkan på föräldrarnas liv och rädslan berodde på flera faktorer. Föräldrarna lindrade sin rädsla genom att utveckla egna hanteringsstrategier. Sjuksköterskor med rätt kunskap kan minska föräldrarnas rädsla och förbättra deras hantering av barnets sjukdom, vilket minskar långsiktiga komplikationer. / Background Fear of hypoglycemia among parents of children with diabetes mellitus type 1 is a public health concern. Hypoglycemia is a common complication of insulin therapy and could lead to serious consequences if left untreated. This creates a great fear in parents who do everything to prevent it from happening. Therefore, there is a need to gather and compile current research to increase healthcare professionals’ knowledge and understanding of parents’ fear of hypoglycemia when the child diabetes mellitus type 1. Aim The aim of this literature review was to elucidate how parents experienced living with fear of hypoglycemia when their child had diabetes mellitus type 1. Method A non-systematic literature review based on 14 scientific original articles with quantitative and qualitative approaches has been written. The scientific articles were collected from PubMed and CINAHL using combinations of search terms. One article was found through manual search. The scientific articles underwent quality assessment based on Sophiahemmet University’s criteria for scientific classification and quality. The results were gathered and analyzed using integrated data analysis. Results In aggregating the results, two main themes were identified: “The impact of fear on parents’ quality of life”, and “The impact of fear on parents’ disease management”. The results showed that parental fear was a significant issue, based on a lack of knowledge from healthcare professionals at the time of diagnosis. This resulted in parents creating their own management strategies to avoid their child experiencing hypoglycemia. Conclusions The literature review highlighted how parents experienced living with fear of hypoglycemia when the child had diabetes mellitus type 1. The fear had a substantial impact on the parents’ lives and the fear was due to various factors. The parents alleviated their fear by developing their own coping strategies. Nurses with appropriate knowledge can reduce parents’ fear and enhance the management of children’s illness, thereby reducing long term complications.

O presente estudo teve como objetivo relacionar os níveis de indicadores sanguíneos energéticos e de cálcio na ocorrência de afecções uterinas, mastite clínica e mastite subclínica em vacas de raça Holandesa. A presença de mastite foi monitorada através do California Mastitis Test (CMT) e da contagem de células somáticas, para a identificação de mastite subclínica, e do Teste da Caneca de Fundo Preta (TCFP), para identificação de mastite clínica. A presença das afecções uterinas foi identificada mediante exame clínico. Foram feitas coletas de sangue para a determinação dos níveis de cálcio (Ca), glicose e β-hidroxi-butirato (BHB). O CMT foi realizado nas duas primeiras semanas após o parto, o TCFP foi realizado conforme a rotina de ordenha, estabelecida pela propriedade, e as coletas de sangue foram realizadas na semana anterior ao parto e duas coletas até os 21 dias posteriores ao parto. A ocorrência de hipocalcemia subclínica foi determinada quando o Ca no soro atingiu valores ≤ 8,00 mg/dL, hipoglicemia com valores de glicose ≤ 50 mg/dL e hipercetonemia com valores de BHB ≥ 1,2 mmol/L. Nas vacas com mastite clínica foi realizado tratamento conforme estabelecido pelo protocolo de ordenha e tratamentos da fazenda. Os dados de mastite subclínica obtidos através do teste de CMT, por quarto mamário, foram validados através de cultura microbiológica realizada em laboratório de referência e em laboratório na fazenda para identificar crescimento bacteriano, bem como através da contagem de células somáticas (CCS) e da contagem bacteriana total (CBT). Não foi encontrada relação significativa entre a hipocalcemia subclínica, a hipoglicemia e a hipercetonemia com afecções uterinas e da glandula mamária nas vacas após o parto. / This study aimed to relate the levels of energy and calcium in the occurence of both uterine diseases, clinic and subclinic mastitis in Holstein cows. The presence of mastitis was monitored through California Mastitis Test (CMT) and the counting of somatic cells (CSC), for the identification of subclinic mastitis, and strip cup test, for the identification of clinic mastitis. The presence of uterine disorders was identified by clinical examination. Blood collections were made for determining calcium, glicose and β-hydroxy-butyrate (BHB). CMT was realized in the first two weeks after calving, BBMT was realized according to the routine of milking settled by the farm and the blood collections were made in the week before the calving and also two collections were made after it. The occurrence of subclinic hypocalcemia was determined when serum Ca reached ≤ 8,00 mg/dL, hypoglycemia with glucose values ≤ 50 mg/dL and hyperketonemia values with BHB BHB ≥ 1,2 mmol/L. Data of clinic mastitis were obtained through the identification of altered milk in BBMT and subsequently realized treatment as settled by the milking protocol and treatments of the farm. Data of subclinic mastitis were obtained through CMT test, for mammary quarter, and validated by microbiological culture in reference laboratory, culture in the farm for identifying the bacterial growth, counting of somatic cells (CSC) and total bacterial counting (TBC). It was not identified in the study any relationship between subclinical hypocalcemia and uterine and mammary gland diseases in cows after calving.

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