Self-monitoring blood glucose (SMBG) systems have the potential to play an important role in the management of diabetes and in the reduction of risk of serious secondary clinical complications. This review describes the transition from simple urine sugar screening tests to sophisticated meter and reagent strip systems to monitor blood glucose. Significant developments in design and technology over the past four decades are described since the first meter was introduced in 1970. Factors that have influenced this evolution and the challenges to improve analytical performance are discussed. Current issues in the role of SMBG from the clinical, patient and manufacturer perspectives, notably adherence, costs and regulations, are also considered.

Diabetic ketoacidosis (DKA) is a state of severe insulin deficiency, either absolute or relative, resulting in hyperglycemia and ketonemia. Although possibly underappreciated, up to 10% of cases of intracerebral complications associated with an episode of DKA, and/or its treatment, in children and youth are due to hemorrhage or ischemic brain infarction. Systemic inflammation is present in DKA, with resultant vascular endothelial perturbation that may result in coagulopathy and increased hemorrhagic risk. Thrombotic risk during DKA is elevated by abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. DKA-associated cerebral edema may also predispose to ischemic injury and hemorrhage, though cases of stroke without concomitant cerebral edema have been identified. We review the current literature regarding the pathogenesis of stroke during an episode of DKA in children and youth.

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Explain the importance of checking for pressure ulcers. 2. Identify areas of high risk for skin breakdown. 3. Enumerate advantages of wearing a full-face mask.To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue. " No CE test fee for AACN members.Background Device-related pressure ulcers from noninvasive ventilation masks alter skin integrity and cause patients discomfort. Objective To examine the incidence, location, and stage of pressure ulcers and patients' comfort with a nasal-oral mask compared with a full-face mask. Methods A before-after study of a convenience sample of patients with noninvasive ventilation orders in 5 intensive care units was conducted. Two groups of 100 patients each received either the nasal-oral mask or the full-face mask. Skin was assessed before the mask was applied and every 12 hours after that or upon mask removal. Comfort levels were assessed every 12 hours on a Likert scale of 1 to 5 (1, most comfortable). Results A pressure ulcer developed in 20% of patients in the nasal-oral mask group and 2% of patients in the full-face mask group (P < .001). Comfort scores were significantly lower (more comfortable) with the full-face mask (mean [SD], 1.9 [1.1]) than with the nasal-oral mask (mean [SD], 2.7 [1.2], P < .001). Neither mean hours worn nor percentage adherence differed significantly: 28.9 (SD, 27.2) hours and 92% for full-face mask and 25 (SD, 20.7) and 92% for nasal-oral mask. No patients who had a pressure ulcer develop with the nasal-oral mask had a pressure ulcer develop with the full-face mask. Conclusion The full-face mask resulted in significantly fewer pressure ulcers and was more comfortable for patients. The full-face mask is a reasonable alternative to traditional nasal-oral masks for patients receiving noninvasive ventilation. (American Journal of Critical Care. 2015;24:349-357) 1 The goal of noninvasive ventilation is to relieve symptoms associated with hypoventilation, exacerbation of chronic obstructive pulmonary disease, or impending respiratory failure; enhance gas exchange; maximize patients' comfort; and avoid intubation and invasive ventilation.1,2 Use of noninvasive ventilation is associated with device-related development of pressure ulcers under the mask. Published rates for the incidence of facial pressure ulcers associated with noninvasive ventilation masks range from 10% to 31%.3-5 Identification of device-related pressure ulcers, such as those associated with noninvasive ventilation masks, is becoming more common. [6][7][8] No research related to interventions to reduce the incidence or severity of pressure ulcers associated with noninvasive ventilation was found. However, several non-research-based recommendations were found in the literature. The Minnesota Hospital Association and recently the National Pressure Ulcer Advisory Panel (NPUAP) recommended consideration o...