讓平凡的生活多了一點色彩~~
今天嘗試要7點起床，但失敗了 XD
硬生生的賴床到9點半才勉勉強強爬起來
最近跟我媽一起在看一部叫做棒球大聯盟的卡通
看一看真的不懂為什麼主角的性格這麼令人討厭
主角的性格傲慢自大，然後說話又很沒禮貌.....
他有一個朋友是規畫好要進入一家棒球很有名的私立高中讀免錢的書
但是提供私立高中免費就讀的機會竟然是給了主角
主角就很跩的說他不要~~
結果也因為這個主角害他朋友沒辦法去讀免錢的書
所以這個朋友就跟這個主角約好說要一起去讀公立高中
但這個主角輸了一場球以後
突然又轉變心意說要讀私立高中......WTF =_=
(但已經不為他們提供免錢的書讀了....)
結果...最可憐的是主角的朋友 差點到手的鴨子就這樣飛了
就這樣，一起付錢讀書吧(明天的劇情
今天讀的文章...低血糖事件
單字
- intensify (v.) 強化
- epidemic (n.) 疫情/ (adj) 傳染性的
- inevitable(adj.) 必然的
- multipronged (adj) 多管齊下的
重點
- 施打胰島素所引起的低血糖在美國送急診是為數不少的案例，但是可以避免的。
- 65歲以上老人有1/49會發生低血糖送急診；80歲以上機率提高到1/8
最常導致施打胰島素以後發生低血糖的原因
- 打了以後忘記吃飯
- 打錯劑型(例如要打長效卻打成短效)
- 打錯劑量(病人自己加量或胰島素pump相關的錯誤)
- 發生低血糖送急診後，有1/3的老人會住院繼續治療
專家建議
- 對於施打胰島素的患者，一定要對他們強調施打後要吃飯，也要衛教他們低血糖的症狀
- 對廠商的建議，長效跟短效的胰島素做出更明顯更容易區分的裝置
- HbA1c 控制: 如果能控制在6.5-7.0%之間最好，如果低於6.4%也會比較容易發生低血糖事件
- 血糖控制的過度治療應該要被量化
- 不建議超過80歲非住院的老人打胰島素
原文...Insulin-Related Hypoglycemia: Common, Costly, Preventable
http://www.medscape.com/viewarticle/821764
Hypoglycemia — largely from taking insulin without eating properly or taking the wrong type or dose — leads to almost 100,000 visits to US hospital emergency rooms each year, a new study reveals. Diabetic patients over age 80 are at especially increased risk.
Over a 5-year period, the study authors calculate that emergency-room visits for hypoglycemia cost the US healthcare system an estimated $6 million — and this is not including hospitalization costs.
"This is important, because many of the ER visits for insulin-related hypoglycemia may be prevented," lead author Andrew I. Geller, MD, from the Centers for Disease Control and Prevention, in Atlanta, Georgia, told Medscape Medical News. Dr. Geller and colleagues publish their findings online March 10, 2014, in JAMA Internal Medicine.
In an accompanying invited commentary, Sei J. Lee, MD, from the division of geriatrics, University of California, San Francisco, says, "Occasional episodes of hypoglycemia have long been accepted as the price of good glycemic control.
"However, the findings reported by Geller et al show that insulin-related hypoglycemia is far too common to be an acceptable price for treatment," he emphasizes.
Very Elderly Almost Twice as Likely to Suffer Hypoglycemia
Previously, the same researchers have identified insulin "as one of the top causes of adverse drug events related to emergency-department visits in the US," Dr. Geller explained.
To examine this issue more closely, he and his colleagues used data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project to estimate the total number of emergency visits due to insulin and figures from the National Health Interview Survey to calculate the total number of Americans using insulin from 2007 through 2011.
Emergency-room visits were more common with increasing age, with those aged 80 years or older having nearly twice the risk for hypoglycemia as younger adults.
"Each year, 1 in 49 insulin-treated seniors age 65 or older visits the emergency room because of hypoglycemia while on insulin or because of a medical error related to insulin," Dr. Geller said. "Among those very elderly, 80 and older, that number is 1 in 8."
Factors leading to a visit to the emergency room with insulin-related hypoglycemia were known in 20.8% of cases in the study. The most common reasons (45.9% of cases) were related to meals — for example, taking insulin but being too busy to eat.
The next-most-common cause was inadvertently taking the wrong product (22.1% of cases). "Typically, a patient intended to take a long-acting insulin (such as insulin glargine or insulin detemir), but they instead took a rapid-acting insulin (such as insulin aspart or insulin lispro)," Dr. Geller explained.
Less commonly, patients had taken the wrong dose (12.2%) or an unintentional "added" dose (6%) or made a pump-related dosing error (1.5%).
Dr. Lee says in his commentary that another important finding from the study is the fact that, across all age groups, patients taking only insulin were several times more likely to have an emergency-department visit for hypoglycemia than were patients taking insulin with oral glucose-lowering medications.
Almost two-thirds of the patients with hypoglycemia presenting to the emergency department had severe, insulin-related adverse events, including shock, loss of consciousness, seizure, or injury due to fainting. About one-third were hospitalized.
Cautious Approach to Insulin Treatment is Needed
The results "suggest…a cautious approach when deciding whether to start or intensify insulin treatment among older adults, especially the very elderly," Dr. Geller and colleagues write. Clinicians need to check that patients can explain how they would manage their insulin if they missed a meal, for example.
And manufacturers should make packaging very different for long-acting vs short-acting insulin, they advise.
Dr. Lee goes further, laying the responsibility for some of the increase in insulin use at the foot of one particular manufacturer.
"The 50% increase in insulin use in the past decade noted by Geller and colleagues and the resultant epidemic of insulin-related hypoglycemia that they document is due in part to the all-too-effective efforts by [Sanofi] Aventis to encourage patients and providers to intensify glycemic treatment," he writes.
He proposes three changes. "First…the results of the ACCORD trial showed that when we treat to an overly aggressive HbA1c target (mean HbA1c, 6.4%), increased mortality rates may result. Recommending a target range (eg, 6.5%–7.0%) rather than a 'less-than' target (eg, <7%) would immediately send the message that too low can be dangerous and a happy medium is best.
"Second, quality indicators for glycemic overtreatment must be developed and reported.… Third, insulin should be avoided in most nonhospitalized adults older than 80 years."
Current Hypoglycemia Rates Not Inevitable; Balance Required
"We should not accept the current rates of hypoglycemia as inevitable. Rather, we should begin using a multipronged approach to decrease the overuse of insulin and minimize the risk of hypoglycemia," Dr. Lee concludes.
Dr. Geller agrees. "This study supports the more recent clinical guidelines to balance the short-term risk of tight glucose control — namely, hypoglycemia — with potential long-term benefits [by] taking into account the individual patient risk…[due to] chronic conditions and [the patient's] ability to manage insulin safely," he says.
And he and his colleagues note that reducing emergency-department visits for adverse events related to injectable antidiabetic agents is a national priority and a Healthy People 2020 goal.
"Reaching this goal will probably require balancing glycemic risks in vulnerable older patient populations and augmenting prevention efforts targeted at key [insulin-related hypoglycemia and error] precipitants, such as meal-related misadventures and insulin-product mix-ups."
The researchers and editorialist have reported no relevant financial relationships.
JAMA Intern Med. Published online March 10, 2014. Abstract Commentary
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