RESUMO
INTRODUCTION: Hospitalized patients with diabetes receiving corticosteroids are at risk of developing hyperglycemia and related complications. This study evaluated a neutral protamine Hagedorn (NPH) insulin-based protocol in improving glycemic control in hospitalized patients receiving corticosteroids. METHODS: This was a randomized, prospective, non-blinded study in an inpatient setting involving patients with diabetes who were hospitalized and receiving prednisone ≥ 10 mg per day or equivalent. High dose corticosteroids group (prednisone > 40 mg/day or equivalent) received NPH insulin 0.3 U/kg between 0600 and 2000 hours if eating or 0.2 U/kg between 2000 and 0600 hours if not eating. Low dose corticosteroids group (prednisone 10-40 mg/day or equivalent) received 0.15 U/kg between 0600 and 2000 hours if eating or 0.1 U/kg between 2000 and 0600 hours if not eating. Primary outcome measure was mean blood glucose level measured pre-meal and at bedtime for days 1-5. RESULTS: Mean blood glucose level was lower in the intervention (n = 29) than in the usual care (n = 31) group [226.12 vs. 268.57 mg/dL, respectively, (95% CI for difference - 63.195 to - 21.695), p < 0.0001]. Significant differences in mean glucose level were noted at fasting [170.96 vs. 221.13 mg/dL, respectively, (95% CI for difference - 72.70 to - 27.63), p < 0.0001] and pre-lunch [208 vs. 266.48 mg/dL, respectively, (95% CI for difference - 86.61 to - 30.36), p < 0.0001]. CONCLUSION: In hospitalized patients with diabetes receiving corticosteroids, an NPH insulin-based protocol improves glycemic control. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01970241. FUNDING: Eli Lilly and Company.
RESUMO
INTRODUCTION: Tick-borne diseases present a special problem in Connecticut and the Northeastern United States. The tick species Ixodes scapularis known for Lyme disease may also infect humans with anaplasmosis, while other tick species [Amblyomma spp.] may transmit ehrlichiosis. These illnesses may present in various ways depending on the virulence of the organism and variable host factors. CASE PRESENTATION: Our patient presented as a motor vehicle trauma presumably from encephalopathy secondary to anaplasmosis. Unusual features of the patient's case led to the causative diagnosis on peripheral blood smear examination. CONCLUSION: Tick-borne diseases are endemic in Connecticut. The astute clinician should maintain a healthy vigilance for these illnesses. Although our patient presented as a trauma, the presumed precipitating disease could have been treated. Physician awareness and patient education may lessen the impact of these diseases.
