Acute effects of night work and meals on blood glucose levels

Insulin regulates the phosphorylation and activities of Akt and glycogen synthase kinase-3 (GSK3) in peripheral tissues, but in the brain it is less clear how this signaling pathway is regulated in vivo and whether it is affected by diabetes. We found that Akt and GSK3 are sensitive to glucose, because fasting decreased and glucose administration increased by severalfold the phosphorylation of Akt and GSK3 in the cerebral cortex and hippocampus of non-diabetic mice. Brain Akt and GSK3 phosphorylation also increased after streptozotocin administration (3 days), which increased blood glucose and depleted blood insulin, indicating regulation by glucose availability even with deficient insulin. Changes in Akt and GSK3 phosphorylation and activities in epididymal fat were opposite to those of brain after streptozotocin treatment. Streptozotocin-induced hyperglycemia and increased brain Akt and GSK3 phosphorylation were reversed by lowering blood glucose with insulin administration. Long term hyperglycemia also increased brain Akt and GSK3 phosphorylation, both 4 weeks after streptozotocin and in db/db insulin-resistant mice. Thus, the Akt-GSK3 signaling pathway is regulated in mouse brain in vivo in response to physiological and pathological changes in insulin and glucose.

The postprandial state can negatively influence flow mediated dilation (FMD), a predictor of atherosclerosis and cardiovascular disease. This investigation was designed to determine the effect of regular aerobic and/or resistance exercise on postprandial FMD after a high sugar or high fat mixed meal. Forty-five healthy participants were recruited from one of four groups: lean sedentary (SED), runners, weight lifters, and cross-trainers. Participants were randomly crossed over to a high sugar meal (HSM) and a high fat mixed meal (HFMM; both fat and carbohydrate). Pre-and postprandial endothelial function was assessed for both meals using brachial artery FMD. Plasma lipids, insulin, glucose, hs-CRP, and SOD were also measured with both meals. Endothelium-independent dilation was determined via sublingual nitroglycerin. Brachial artery FMD was reduced in SED following the HSM (9.9 ± 0.9% at baseline, peak reduction at 60 min 6.5 ± 1.0%) and the HFMM (9.4 ± 0.9% at baseline, peak reduction at 120 min 5.9 ± 1.2%; P < 0.05 for both, Mean ± SEM). There was no change in FMD after either HSM or HFMM in runners, weight lifters, and cross-trainers. Post-prandial increases in blood glucose, insulin and triglycerides were less pronounced in the exercisers compared to SED. In addition, exercisers presented lower baseline plasma hs-CRP and higher SOD activity. Nitroglycerin responses were similar among groups. These results suggest that endothelial function is reduced in sedentary adults after a HSM or HFMM, but not in regular aerobic or resistance exercisers. This response may be due to favorable postprandial metabolic responses or lower postprandial levels of inflammation and oxidative stress. These findings may help to explain the cardioprotective effect of exercise.

To achieve intensive glucose control for avoiding diabetic complications, it is necessary for diabetic patients to measure their blood glucose levels frequently. However, all currently available methods for blood glucose monitoring, including the finger prick method, are invasive. One of the possible noninvasive glucose monitoring approaches is tear glucose monitoring. Previous studies have showed the correlations between blood and tear glucose concentrations. But these correlations were not accurate sufficiently because the methods for tear sample collection were not standardized. For clinical development of tear glucose monitoring as a tool for predicting the blood glucose concentrations, we recruited 10 nondiabetic subjects and 20 diabetic subjects, observed the daily blood and tear glucose dynamics using samples collected under the standardized method, and determined the correlation between the blood and tear glucose concentrations. Preprandial blood glucose levels of diabetic subjects were significantly higher than those of nondiabetic subjects (p &amp;lt; 0.001), and preprandial tear glucose levels of diabetic subjects had a higher tendency than those of nondiabetic subjects (p = 0.051). Two hours postprandial blood and tear glucose levels of diabetic subjects were significantly higher than those of nondiabetic subjects (p &amp;lt; 0.001, p &amp;lt; 0.05, respectively). The blood and tear glucose dynamics showed that the behavior of the tear glucose concentrations paralleled that of the blood glucose concentrations. A linear mixed model for diabetic subjects revealed the existence of a significant association between the blood glucose concentrations and tear glucose concentrations (p &amp;lt; 0.001), and the association consisted even after adjusting for HbA1c levels and conditions of meals. In conclusion, tear glucose monitoring would be a tool for predicting the blood glucose levels noninvasively for various diabetic patients. Disclosure M. Aihara: None. N. Kubota: None. T. Kadowaki: Consultant; Self; Novo Nordisk A/S, AstraZeneca, Merck Sharp &amp; Dohme Corp.. Research Support; Self; Kissei Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Sanofi, Kyowa Hakko Kirin Co., Ltd., Novo Nordisk A/S, Astellas Pharma, Daiichi Sankyo Company, Limited, Takeda, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Merck Sharp &amp; Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd.. Speaker's Bureau; Self; Astellas Pharma, AstraZeneca, Merck Sharp &amp; Dohme Corp., Ono Pharmaceutical Co., Ltd., Takeda, Eli Lilly and Company, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk A/S.

To investigate how refraction and visual acuity may vary in patients with diabetes under routine care. Fifty-three eyes of 53 patients with various degrees of diabetic retinopathy were examined prospectively on four different occasions within a month. Refraction, best-corrected visual acuity (expressed as logMAR score) and blood glucose were measured on each occasion. Intraindividual variability was calculated as the range between the highest and lowest measurements. Associations between blood glucose levels and each of the other variables were tested by linear regression analysis for each patient. Refraction was completely stable in 43 patients and changed only slightly in 10, in whom the mean intraindividual variability of the spherical equivalent was 0.4 dioptres. Visual acuity test results were also highly reproducible. Mean intraindividual variability in visual acuity was 0.08 logMAR. Mean haemoglobin A1c (HbA1c) was 7.3 ± 1.5% but individual blood glucose levels ranged from 2.8 to > 22.2 mmol/l. Intraindividual variability ranged from 0.5 to 18.1 mmol/l, with a median of 6.0 mmol/l for the entire group. There were no associations between refraction or visual acuity and blood glucose levels or inter- or intraindividual glucose variations. Refraction and visual acuity test results were highly reproducible and stable in patients with reasonably well controlled diabetes but variable blood glucose levels under routine care.

Nectar-feeding bats (Glossophaga soricina) have a high sugar diet and consequently high blood sugar levels. Despite their sweet tooth, these bats do not suffer detrimental sugar-related health effects as would other mammals, including humans, and they are especially long lived – about five times longer than a similar sized rodent. Detlev Kelm, at the Leibniz Institute for Zoo and Wildlife Research, and a team of German researchers were curious as to how these bats regulate their blood sugar during rest and flight, wondering how they avoid the adverse effects of a high sugar diet. Their fascinating findings were published in a recent issue of PNAS.The team first measured the bats’ blood glucose levels at rest during a meal similar to that consumed in the wild. Interestingly, the bats’ blood glucose levels after the meal far exceeded normal values for mammals of similar size and were among the highest ever recorded in mammals. The researchers speculate that the bats have evolved a physiological tolerance to glucose, avoiding the damaging effects of a high sugar diet and the shorter life span usually associated with it.Next, the researchers set out to determine the role exercise has on regulating blood glucose by using three different exercise regimes after consuming either one big meal or several smaller meals. Overall, flying reduced the severity of blood glucose peaks seen in the resting bats. Moreover, the bats that spent more time flying after a meal had lower blood glucose peaks and their blood glucose returned to pre-feeding values faster. This suggests that bats use flight as a strategy to prevent blood glucose from rising to extremely high and potentially damaging levels.In the wild, nectar-feeding bats spend up to 12 h a night feeding, flying about 60% of the time. As Kelm and his colleagues suggest, flying helps the bats not only to regulate blood glucose levels but also to devote more energy to searching for roosts or new food sources, perhaps providing a selective benefit to bats that spend more time flying between meals.Lastly, the researchers wanted to know how high the bats’ blood glucose concentrations were over a longer period of time (weeks) whilst being fed a diet similar to that found naturally. Blood glucose irreversibly reacts with haemoglobin in the blood to form glycated haemoglobin depending on the amount of glucose in the blood and on the lifetime of the red blood cells. Kelm took blood samples from bats and measured the amount of glycated haemoglobin. The nectar-feeding bats had normal levels of glycated haemoglobin in their blood in comparison to other mammals. Thus, the bats had low blood glucose levels over long periods of time and consequently were not chronically exposed to high blood sugar levels and their damaging effects.Although the nectar-feeding bats’ secret to a long life was not entirely revealed, Kelm and his colleagues used elegantly designed experiments to figure out how the nectar-feeding bats use flight to take advantage of a high sugar diet and avoid its harmful effects. So perhaps we can all eat our cake, as long as we run a marathon right after.

High levels of blood lipid and glucose predict adverse prognosis in patients with aneurysmal subarachnoid hemorrhage

1. Justin M. Gregory, MD* 2. Daniel J. Moore, MD, PhD† 3. Jill H. Simmons, MD‡ 1. *Pediatric Endocrinology Clinical Fellow, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. 2. †Assistant Professor of Pediatrics, Assistant Professor of Pathology, Microbiology, and Immunology, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. 3. ‡Assistant Professor of Pediatrics, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. * ADA: : American Diabetes Association DKA: : diabetic ketoacidosis HbA1c: : glycosylated hemoglobin I:C ratio: : insulin-to-carbohydrate ratio IV: : intravenous TDD: : total daily dose T1DM: : type 1 diabetes mellitus T2DM: : type 2 diabetes mellitus 1. All children with type 1 diabetes mellitus (T1DM) should have their blood sugar managed with basal-bolus insulin treatment by either multiple daily injections or an insulin pump. 2. All children with T1DM should have access to a pediatric endocrinologist with a diabetes management team with resources to support patients and families. 3. All children with T1DM should be monitored for symptoms and/or screened for commonly associated conditions such as thyroid and celiac disease. After completing this article, readers should be able to: 1. Recognize the presenting signs and symptoms of type 1 diabetes mellitus (T1DM). 2. Know the key principles of effective diabetes self-management and the diabetes care team’s role in facilitating effective self-management. 3. Know the acute and chronic complications of (T1DM). 4. Identify how different categories of insulin analogues are used in daily insulin regimens. True, it is a fight, but there is pleasure in the struggle. Victory comes to the courageous; and without courage and common sense, success awaits no one. I look upon the diabetic as charioteer and his chariot as drawn by three steeds named Diet, Insulin, and Exercise. It takes skill to drive one horse, intelligence to manage a team of two, but a man must be a very good teamster who can get all three to pull together.EP Joslin, 1933 Type 1 diabetes mellitus (T1DM) is a disorder of glucose homeostasis characterized by autoimmune destruction of the insulin-producing pancreatic β-cell that progressively leads to insulin deficiency and resultant hyperglycemia. If left untreated, insulin deficiency leads to progressive metabolic derangement, with worsening hyperglycemia, ketoacidosis, starvation, and death. In …

Type 1 Diabetes Mellitus

Background: Cows in perinatal period are prone to ketosis, characterized by increased ketone bodies and decreased blood sugar. Study found that cows with type II ketosis had higher blood glucose levels. This type of ketosis exhibits insulin resistance and impaired glucose tolerance that are similar to type 2 diabetes. The purpose of this study was to investigate the role of insulin resistance(IR) in type II ketosis in dairy cows.Materials, Methods &amp; Results: In one intensive cattle farm, eight cows with ketosis and eight healthy cows that were 14-21 days postpartum were selected. The plasma of experimental dairy cows was collected and tested for the concentration of glucose concentration. Glucose tolerance of blood glucose levels in 120 min was used as the cut-off point to divide the dairy cows into three groups: the abnormal glucose tolerance ketosis group (TH), the normal glucose tolerance ketosis (TL), and the healthy control group. Simultaneously, the indexes of plasma liver function, oxidative stress, and insulin resistance were detected. The results showed that after intravenous glucose injection, there was no significant difference in blood glucose concentration between the TL and control group, while the blood glucose levels in the TH group were always higher than in the other two groups. The insulin sensitivity index (RQUICKI) value was significantly lower in the TH group than in the other two groups. Liver function abnormalities in the TH group were more severe than in the TL and control group. Oxidative stress was higher in the TH group than in the TL and control groups.Discussion: Postpartum dairy cows, with high lactation, consume large amounts of sugar, resulting in a lower blood sugar, and the postnatal dry matter intake peak is later than the peak lactation, which further decreases blood sugar and leads to a negative energy balance in cows. Such ketosis is associated with NEB caused by hypoglycemia, However, a survey of blood glucose concentration in cows with ketosis shows that ketosis can still occur in cows with high blood sugar levels. The pathogenesis of hyperglycemic ketosis is still unclear. Insulin Resistance (IR) refers to tissue sensitivity to insulin decreases, compensatory Islet beta cells secreting insulin thus producing hyperinsulinemia. AST is a typical indicator of liver damage, plasma AST levels in Group TH were significantly higher than the other two groups.The RQUICKI is a key indicator determining whether the body has developed insulin resistance. the plasma insulin sensitivity index of group TH was significantly lower than Group TL and C. BHBA levels in serum is the gold standard for the diagnosis of cow ketosis.The concentration of NEFA and BHBA in the blood is a sign of negative energy balance. The concentration of BHBA and NEFA in the TH group was significantly higher than in the group C, and the concentration of BHBA was higher than the critical value of ketosis. SOD is a metal antioxidant enzyme and its level are key indicators in measuring the removal of oxidizing substances. T-AOC is a measuring indicator for total antioxidant function. The reduction of SOD and T-AOC concentrations in the TH group indicated that the antioxidant capacity of ketone cows with abnormal glucose tolerance was reduced. The above results show that the TH group is severely impaired in liver function, and has a disorder of glucose metabolism, abnormal glucose tolerance and hyperinsulinemi, which also have severe IR. Moreover, the antioxidant capacity of the TH cows with ketosis declined, the body was in a state of oxidative stress. Thus, the occurrence of ketosis in some cows is related to a glucose utilization disorder caused by insulin resistance, and abnormal liver function and oxidative stress are the causes of insulin resistance.

In certain disease states, such as epilepsy, the elevation of blood ketone levels with ketogenic diets (KDs) has beneficial effects, while exogenous ketone supplements (EKSs) were shown to increase the level of blood ketone bodies (such as β-hydroxybutyrate, βHB) and decrease blood glucose levels without dietary restrictions. It has been suggested that ketone body and glucose utilization of the body may be modified by age and gender resulting in changes in blood βHB and glucose levels, but it was not investigated through several months yet. Thus, we investigated whether the effect of an EKS on blood βHB and glucose level is modulated by age and sex in Wistar Albino Glaxo Rijswijk (WAG/Rij) rats, a model animal of human absence epilepsy. We used KEMCT (1:1 mix of ketone ester/KE and medium-chain triglyceride/MCT oil) by oral gavage in female and male WAG/Rij rats. Animals were fed with standard diet, which was supplemented by KEMCT (2.5 g/kg) once per month by oral gavage for 17 months. One hour after KEMCT treatment, changes in blood R-beta-hydroxybutyrate (R-βHB) and glucose levels were measured. KEMCT gavage significantly increased blood R-βHB and decreased blood glucose levels, in both male and female rats, compared with the controls. In male rats, the KEMCT-induced increase in blood R-βHB levels was lower at the 7th and 8th months and higher at the 16th and 17th months, compared with the results at the 1st month. KEMCT-generated increase in R-βHB levels was higher in female rats, compared with male rats between the 2nd and 11th months, but older (between the 14th and 17th months) female rats showed lower levels than males. KEMCT gavage induced significantly lower glucose levels at the 4th, 9th, 10th, 12th, and 13th months in both sexes, but between the 14th and 17th months, only males showed significantly lower levels, compared with the results at the 1st month. KEMCT treatment induced lower blood glucose levels in female than in male rats between the 1st and 8th months, but higher glucose levels were measured in female rats at the 17th month than in males. These findings suggest that age and sex can modify the EKS-evoked effects on blood R-βHB and glucose concentrations.

AIMTo determine blood glucose levels in a population of healthy, breast fed, term infants of appropriate size for gestational age.METHODSIn a cross sectional study, the blood glucose concentration of 223...

The present study investigated the effect of an antianxiety drug, buspirone on blood glucose and plasma insulin level concerning the role of 5-HT(1A) receptors in blood glucose regulation in healthy humans. Twelve healthy male volunteers were administered single oral doses of buspirone (10 mg) or placebo, in a randomized, crossover way, followed by oral glucose load (75 gm in 200 ml) at reported T(max) i.e. the time of peak plasma concentration of the respective administered drug. The blood samples were collected as predose, postdose and post oral glucose load at 0.5, 1.0, 1.5, 2.0, 2.5 and 3.0 hr to investigate the effect of buspirone or placebo at basal blood glucose and plasma insulin level and after oral glucose load induced (postprandial) blood glucose and plasma insulin level. Blood glucose and plasma insulin concentrations were estimated by glucose hexokinase method and enzyme linked immunosorbent assay (ELISA) method respectively. The concentration of blood glucose was significantly (p<0.05) decreased after oral glucose load following administration of buspirone in comparison with placebo however no significant change was observed in the fasting blood glucose and plasma insulin (fasting and oral glucose load induced) level. In conclusions, the present study findings show that buspirone produced a significant alteration in blood glucose level in healthy humans. In addition, study results also indicate that the involvement of serotonergic (5-HT, receptors) mechanism of blood glucose regulation in humans is different from animals.

In order to test the effect of stress on injection-site blood flow and blood glucose control, 16 C-peptide negative patients were studied on a stress day, when a 30-min Stroop Colour-Word Test was completed, and a control day, when a cartoon was shown. Unmodified insulin was injected subcutaneously into the thigh before the test, and injection-site blood flow measured throughout the experiment with a thermal clearance probe. Blood glucose and plasma free insulin, glucagon, growth hormone, cortisol, and catecholamines were measured at intervals before, during, and after stress. Patients showed a significant overall rise in injection-site blood flow with the Stroop test from 4.1 (SD 1.6) to 5.2 (1.8) ml 100-g-1 min-1 (increase 38.1 (37.8) %, p less than 0.001). There was no overall significant difference between stress and control days in blood glucose or plasma free insulin levels, with differences in mean blood glucose levels during stress between the 2 days varying from -4.2 mmol l-1 to +6.3 mmol l-1 in individual patients. The increase in injection-site blood flow with stress correlated significantly with the increase in plasma free insulin concentration both during (r = 0.55) and after stress (r = 0.71). Differences in blood glucose concentration between stress and control day for each patient showed strong correlation with differences in plasma free insulin both during (r = -0.73) and after stress (r = -0.79). Differences in counter-regulatory hormones occurred but correlated poorly with blood glucose difference. Thus, stress affects the blood flow at the injection site, and this in turn affects insulin absorption. Most of the blood glucose response to stress is explained by changes in free insulin concentration.

INTRODUCTION: Mammals are almost constantly exposed to a variety of stressors. The changes in the concentration of corticosterone and the level of glucose in blood of animals under such conditions seems relevant for understanding the influence of repeated stress effects on endocrine and metabolic processes. AIM: To study the concentrations of corticosterone and glucose in blood of rats in different time periods of prolonged low-intensity unpredictable stress. MATERIALS AND METHODS: Experiments were carried out on 42 male Wistar rats. Individuals of the experimental groups were subjected to 7-day cycles of alternating stressors using a modified model of chronic unpredictable mild stress with presentation of different stressors. The concentration of corticosterone and glucose in blood was determined at 1, 2, 3 and 4 weeks of observation. RESULTS: A pronounced decrease in corticosterone levels was found in rats at 1 week of stress exposure, followed by a slow recovery by the end of 4th week. Blood glucose level increased at 2 weeks of exposure. CONCLUSION: The data obtained illustrate the specificity of changes in the levels of glucose and corticosterone in the blood of mammals in different time periods of chronic stress. These changes characterize the dysregulation of the integrative physiological systems in relatively early periods of chronic stress with the subsequent development of adaptation in the later stages of repeated stress exposures.

People with diabetes are told that drinking alcohol may increase their risk of hypoglycaemia. To report the effects of alcohol consumption on glycaemic control in people with diabetes mellitus. Medline, EMBASE and the Cochrane Library databases were searched in 2015 to identify randomized trials that compared alcohol consumption with no alcohol use, reporting glycaemic control in people with diabetes. Data on blood glucose, HbA1c and numbers of hypoglycaemic episodes were pooled using random effects meta-analysis. Pooled data from nine short-term studies showed no difference in blood glucose concentrations between those who drank alcohol in doses of 16-80 g (median 20 g, 2.5 units) compared with those who did not drink alcohol at 0.5, 2, 4 and 24 h after alcohol consumption. Pooled data from five medium-term studies showed that there was no difference in blood glucose or HbA1c concentrations at the end of the study between those who drank 11-18 g alcohol/day (median 13 g/day, 1.5 units/day) for 4-104 weeks and those who did not. We found no evidence of a difference in number of hypoglycaemic episodes or in withdrawal rates between randomized groups. Studies to date have not provided evidence that drinking light to moderate amounts of alcohol, with or without a meal, affects any measure of glycaemic control in people with Type 2 diabetes. These results suggest that current advice that people with diabetes do not need to refrain from drinking moderate quantities of alcohol does not need to be changed; risks to those with Type 1 diabetes remain uncertain.