EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

Home

Abstracts

Contact

Disclaimer

Nowadays the continuous long-term monitoring of blood glucose for diabetics is widely used in that scientific sphere as well as in every day clinic practice of endocrinologists and diabetologists. There is no doubt that this revolutionary clinic approach to measure quantity of sugar in blood permits to achieve carbohydrate exchange compensation faster as it has become inalienable instrument in use for optimization of type 1 and 2 diabetes monitoring.

It is a well-known fact that the level of glucose in blood is generally being controlled with the help of individual glucometers but according to the recently obtained data of international researches the routine spot measurements taken in the day time do not allow us to evaluate the fluctuations of sugar in blood adequately for the whole(full) day. Moreover, it should be noted here that glycomy level estimation during the night time turns out to be the most complicated problem. The system of continuous glucose monitoring – CGM Mini Med – consists of monitor (apparatus), computer connecting block, soft-wear unit and one-off sensor. The sensor is fixed under the skin for 3 or 4 days and glucose testing is accomplished automatically within interstitial liquid 288 times a day. A small device with the sensor switched to a patient will be made fast on his belt and will not disturb the habitual order of patient’s life or limit the freedom of his movements as well as the place of his location (at home, at work out of town). The patient will enter all the necessary data into the apparatus memory: insulation injection time, meals, physical loads, stresses, changes of daily diet and so on. After the apparatus has been activated (put in operation) the sensor readings will be taken off as real information of glucose level every ten seconds. Before the installation of the sensor device the doctor enters the values of acceptable limits of glycomy fluctuations individually (in other words, the range of compensations). The results will be registered in the monitor memory and the doctor, after having analyzed the information, will correct doses of sugar-decreasing therapy and the treatment chart (plan). When the data are interpreted (deciphered) both the doctor and the patient receive the charts of glycomy changes during the whole day (day and night) and on the base of those data the computer program will calculate the percentage of the glucose registered parameter deviations.

We have also conducted the research work to estimate daily monitoring of blood glucose for 98 patients with diabetes of type 1 and 2. The index value of glycosilirated hemoglobin for 12 patients was not more than 6,3% (normal) before examination and their condition was estimated as compensation state of diabetes. It was really interesting to discover that the patients who used frequent measurements of blood glycose during the whole day and seemed to receive good sugar-decreasing therapy appeared to be within the normal glycomy range only about 65% of the day and only 25% of the day-time those patients were in the state when blood glycose exceeded the norm considerably (10-15 mmol/^).

We greatly regret that this phenomenon was not revealed earlier when the traditional research method of blood glucose control was used with the help of glucometer. Besides we obtained the data the periods of hypoglycomy which lasted about 10% of the total time. It is also very important that the periods of low sugar in blood are found to take place at night and were not fixed by the patients by their glucometers.

We have noted that even if the frequency of control is 4 – 6 times a day using the glucometer some unsystematic night hypoglycomy as well as maximum rise of glycomy after meals.

About 86% of patients had diabetes in the state of decompensation and were in need of sugar-decreasing therapy correction. 10 patients were examined in the condition when diabetes was revealed for the first time. We have undertaken an attempt to prolong our investigations up to 7 – 8 days and during that period of observation beginning from the second day of observation to correct sugar-decreasing therapy. This gave us a possibility to bring in some correction into sugar-decreasing therapy and control the changes introduced in treatment process within several days. In all the research works that describe daily monitoring of blood glucose at first the investigations had been done for 2-3 days followed by the sugar-decreasing therapy correction without monitoring and after that but not earlier than 2-3 weeks the investigation was repeated.

It is a very important fact that all the patients who were examined received a new motivation to follow the recommendations for their nourishment and excluding or limiting some products. For example, some patients after they had understood that food based on ciliates and sorbets increased blood glucose about 4-8 mmol/^ for a short period of time stopped to take such kind of food.

Conclusions:

Daily monitoring gives the following possibilities both to doctor and patient:

1. to obtain real picture of blood glucose fluctuations during several days and to reveal the problems which actually disturb diabetes compensation
2. to correct sugar-decreasing therapy (diet therapy, insulin therapy, to dose sugar-decreasing medicine in tablets) taking into consideration the patients particularities and their ways of life
3. to help in compensation of carbohydrate exchange of pregnant women and those who are planning pregnancy
4. specific therapy selection may include transfer to the usage of the other sugar-decreasing medicine, alteration of carbohydrate contain of nourishment, mode of insulin injections or even send the patient for consultation to a psychologist to strengthen his motivation to follow the prescribed treatment and regimen.