Limits...
Pseudohypoglycemia or hyperglycemia caused by interference with self-monitoring blood glucose measurements in anticancer ascorbic acid therapy.

Kimura T, Kozawa J, Matsui M, Nishizawa H, Yasuda T, Otsuki M, Iwahashi H, Kaneto H, Funahashi T, Hidaka Y, Imagawa A, Shimomura I - J Diabetes Investig (2013)

View Article: PubMed Central - PubMed

Affiliation: Department of Metabolic Medicine Graduate School of Medicine Osaka University Suita Japan.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Self‐monitoring blood glucose (SMBG) meters are now commonly used in diabetes management1... However, so far, misdiagnosis caused by interference has rarely occurred at the conventional doses... Recently, intravenous high‐dose ascorbic acid treatment has been widely used in 11,233 patients in 2006 and 8,876 patients in 2008 in the USA as one of the complementary and alternative medicines for infection and fatigue, as well as various cancers3... At the first visit, her glycosylated hemoglobin level was 8.8%... SMBG was carried out using the Medisafe meter (TERUMO Corp., Tokyo, Japan) to determine the dosage of regular insulin before every meal... One day, she was given a high ascorbic acid dose (50 g) in another hospital... Her blood ascorbic acid concentration just after administration was 342 μg/mL (normal range 4.7–17.8 μg/mL), and her blood glucose level determined with the Medisafe meter was below 1.1 mmol/L, which was ‘low’... According to the Glucocard meter, her blood glucose level was above 33.3 mmol/L, which was “high. ” She had neither hypoglycemic nor hyperglycemic symptoms... The fasting blood glucose level (9.3 mmol/L) determined with the Medisafe meter 2 days after administration was close to the level (9.2 mmol/L) determined using the intra‐hospital laboratory test based on the hexokinase method (Quickauto‐Neo GLU‐HK; SHINO‐TEST Corp., Tokyo, Japan) and using an automated analyzer (JCA‐BM6050; JEOL Ltd., Tokyo, Japan)... Then, the treatment with intravenous high‐dose ascorbic acid was discontinued with her consent... We need to understand that this type of interference occurs at the bedside; therefore, blood glucose levels just after intravenous administration of high‐dose ascorbic acid should be measured using the hexokinase method, not with these SMBG meters.

No MeSH data available.


Glucose measurement interference after administration of various concentrations of ascorbic acid. Glucose concentrations were measured using Medisafe® (diamond symbols) and Glucocard® (triangular symbols) blood glucose meters, and an intra‐hospital laboratory test that was based on the hexokinase method (square symbols) in various concentrations of ascorbic acid. Blood samples were prepared at concentrations of 4.4 mmol/L (solid line) and 11.1 mmol/L (dotted line) glucose. The upper and the lower measurement limits using these glucose meters were 33.3 mmol/L and 1.1 mmol/L glucose, respectively.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4020267&req=5

jdi12108-fig-0001: Glucose measurement interference after administration of various concentrations of ascorbic acid. Glucose concentrations were measured using Medisafe® (diamond symbols) and Glucocard® (triangular symbols) blood glucose meters, and an intra‐hospital laboratory test that was based on the hexokinase method (square symbols) in various concentrations of ascorbic acid. Blood samples were prepared at concentrations of 4.4 mmol/L (solid line) and 11.1 mmol/L (dotted line) glucose. The upper and the lower measurement limits using these glucose meters were 33.3 mmol/L and 1.1 mmol/L glucose, respectively.

Mentions: A 71‐year‐old woman with advanced esophageal cancer and diabetes presented to the Department of Metabolic Medicine, Osaka University Hospital, Suita, Japan, for glycemic control in November 2012. At the first visit, her glycosylated hemoglobin level was 8.8%. SMBG was carried out using the Medisafe® meter (TERUMO Corp., Tokyo, Japan) to determine the dosage of regular insulin before every meal. One day, she was given a high ascorbic acid dose (50 g) in another hospital. Her blood ascorbic acid concentration just after administration was 342 μg/mL (normal range 4.7–17.8 μg/mL), and her blood glucose level determined with the Medisafe® meter was below 1.1 mmol/L, which was ‘low’. Simultaneously, glucose levels were measured using the Glucocard® meter (ARKRAY Inc., Kyoto, Japan). According to the Glucocard® meter, her blood glucose level was above 33.3 mmol/L, which was “high.” She had neither hypoglycemic nor hyperglycemic symptoms. The fasting blood glucose level (9.3 mmol/L) determined with the Medisafe® meter 2 days after administration was close to the level (9.2 mmol/L) determined using the intra‐hospital laboratory test based on the hexokinase method (Quickauto‐Neo GLU‐HK; SHINO‐TEST Corp., Tokyo, Japan) and using an automated analyzer (JCA‐BM6050; JEOL Ltd., Tokyo, Japan). Then, the treatment with intravenous high‐dose ascorbic acid was discontinued with her consent. We prepared blood samples that contained 4.4 and 11.1 mmol/L glucose, and 0–500 μg/mL ascorbic acid. The glucose levels increased in accordance with the increased ascorbic acid concentrations using the Glucocard® meter, whereas they decreased using the Medisafe® meter. However, the glucose levels measured using the intrahospital laboratory test did not change in response to any ascorbic acid concentration (Figure 1).


Pseudohypoglycemia or hyperglycemia caused by interference with self-monitoring blood glucose measurements in anticancer ascorbic acid therapy.

Kimura T, Kozawa J, Matsui M, Nishizawa H, Yasuda T, Otsuki M, Iwahashi H, Kaneto H, Funahashi T, Hidaka Y, Imagawa A, Shimomura I - J Diabetes Investig (2013)

Glucose measurement interference after administration of various concentrations of ascorbic acid. Glucose concentrations were measured using Medisafe® (diamond symbols) and Glucocard® (triangular symbols) blood glucose meters, and an intra‐hospital laboratory test that was based on the hexokinase method (square symbols) in various concentrations of ascorbic acid. Blood samples were prepared at concentrations of 4.4 mmol/L (solid line) and 11.1 mmol/L (dotted line) glucose. The upper and the lower measurement limits using these glucose meters were 33.3 mmol/L and 1.1 mmol/L glucose, respectively.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020267&req=5

jdi12108-fig-0001: Glucose measurement interference after administration of various concentrations of ascorbic acid. Glucose concentrations were measured using Medisafe® (diamond symbols) and Glucocard® (triangular symbols) blood glucose meters, and an intra‐hospital laboratory test that was based on the hexokinase method (square symbols) in various concentrations of ascorbic acid. Blood samples were prepared at concentrations of 4.4 mmol/L (solid line) and 11.1 mmol/L (dotted line) glucose. The upper and the lower measurement limits using these glucose meters were 33.3 mmol/L and 1.1 mmol/L glucose, respectively.
Mentions: A 71‐year‐old woman with advanced esophageal cancer and diabetes presented to the Department of Metabolic Medicine, Osaka University Hospital, Suita, Japan, for glycemic control in November 2012. At the first visit, her glycosylated hemoglobin level was 8.8%. SMBG was carried out using the Medisafe® meter (TERUMO Corp., Tokyo, Japan) to determine the dosage of regular insulin before every meal. One day, she was given a high ascorbic acid dose (50 g) in another hospital. Her blood ascorbic acid concentration just after administration was 342 μg/mL (normal range 4.7–17.8 μg/mL), and her blood glucose level determined with the Medisafe® meter was below 1.1 mmol/L, which was ‘low’. Simultaneously, glucose levels were measured using the Glucocard® meter (ARKRAY Inc., Kyoto, Japan). According to the Glucocard® meter, her blood glucose level was above 33.3 mmol/L, which was “high.” She had neither hypoglycemic nor hyperglycemic symptoms. The fasting blood glucose level (9.3 mmol/L) determined with the Medisafe® meter 2 days after administration was close to the level (9.2 mmol/L) determined using the intra‐hospital laboratory test based on the hexokinase method (Quickauto‐Neo GLU‐HK; SHINO‐TEST Corp., Tokyo, Japan) and using an automated analyzer (JCA‐BM6050; JEOL Ltd., Tokyo, Japan). Then, the treatment with intravenous high‐dose ascorbic acid was discontinued with her consent. We prepared blood samples that contained 4.4 and 11.1 mmol/L glucose, and 0–500 μg/mL ascorbic acid. The glucose levels increased in accordance with the increased ascorbic acid concentrations using the Glucocard® meter, whereas they decreased using the Medisafe® meter. However, the glucose levels measured using the intrahospital laboratory test did not change in response to any ascorbic acid concentration (Figure 1).

View Article: PubMed Central - PubMed

Affiliation: Department of Metabolic Medicine Graduate School of Medicine Osaka University Suita Japan.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Self‐monitoring blood glucose (SMBG) meters are now commonly used in diabetes management1... However, so far, misdiagnosis caused by interference has rarely occurred at the conventional doses... Recently, intravenous high‐dose ascorbic acid treatment has been widely used in 11,233 patients in 2006 and 8,876 patients in 2008 in the USA as one of the complementary and alternative medicines for infection and fatigue, as well as various cancers3... At the first visit, her glycosylated hemoglobin level was 8.8%... SMBG was carried out using the Medisafe meter (TERUMO Corp., Tokyo, Japan) to determine the dosage of regular insulin before every meal... One day, she was given a high ascorbic acid dose (50 g) in another hospital... Her blood ascorbic acid concentration just after administration was 342 μg/mL (normal range 4.7–17.8 μg/mL), and her blood glucose level determined with the Medisafe meter was below 1.1 mmol/L, which was ‘low’... According to the Glucocard meter, her blood glucose level was above 33.3 mmol/L, which was “high. ” She had neither hypoglycemic nor hyperglycemic symptoms... The fasting blood glucose level (9.3 mmol/L) determined with the Medisafe meter 2 days after administration was close to the level (9.2 mmol/L) determined using the intra‐hospital laboratory test based on the hexokinase method (Quickauto‐Neo GLU‐HK; SHINO‐TEST Corp., Tokyo, Japan) and using an automated analyzer (JCA‐BM6050; JEOL Ltd., Tokyo, Japan)... Then, the treatment with intravenous high‐dose ascorbic acid was discontinued with her consent... We need to understand that this type of interference occurs at the bedside; therefore, blood glucose levels just after intravenous administration of high‐dose ascorbic acid should be measured using the hexokinase method, not with these SMBG meters.

No MeSH data available.