Glucose Estimation Research Articles

Accuracy enhancement of metabolic index-based blood glucose estimation with a screening process for low-quality data.

Many researchers have proposed various non-invasive glucose monitoring (NIGM) approaches using wearable or portable devices. However, due to the limited capacity of detectors for such compact devices and the movement of the body during measurement, the precision of the acquired data frequently diminishes, which can cause problems during actual use in daily life. In addition, intensive smoothing is often used in post-processing to mitigate the effects of erroneous values. However, this requires a considerable amount of data and results in a delay in the response to the actual blood glucose level (BGL). Instead of just applying data smoothing in the post-process of the data acquisition, we propose an active low-quality data screening method in the pre-process. In the proposal phase of the screening process, we employ an analytical approach to examine and formulate factors that might affect the BGL estimation accuracy. A signal quality index inspired by the standard deviation concept is introduced to detect visually apparent noise on signals. Furthermore, the total estimation error in the metabolic index (MI) is calculated based on potential perturbations defined by the signal-to-noise ratio (SNR) and the uncertainty due to discrete sampling. Thereafter, the acquired data were screened by these quality indices. By applying the proposed data screening process to the data obtained from a commercially available smartwatch device in the pre-process, the estimation accuracy of the MI-based BGL was improved significantly. Adopting the proposed screen process improves BGL estimation accuracy in the smartwatch-based prototype. Applying the proposed screen process will facilitate the integration of wearable and continuous BGL monitoring into size- and SNR-limited devices such as smartwatches and smart rings.

Optical Sensor Based Continuous Blood Glucose Estimation Using Lightweight Distributed Architecture

Optical Sensor Based Continuous Blood Glucose Estimation Using Lightweight Distributed Architecture

Noninvasive Monitoring of Glycemia Level in Diabetic Patients by Wearable Advanced Biosensors.

We report on the possibility of noninvasive diabetes monitoring through continuous analysis of sweat. The prediction of the blood glucose level in diabetic patients is possible on the basis of their sweat glucose content due to the positive correlation discovered. The ratio between the blood glucose and sweat glucose concentrations for a certain diabetic subject is stable within weeks, excluding requirements for frequent blood probing. The glucose variations in sweat display allometric (non-linear) dependence on those in blood, allowing more precise blood glucose estimation. Selective (avoiding false-positive responses) and sensitive (sweat glucose is on average 30-50 times lower) detection is possible with biosensors based on the glucose oxidase enzyme coupled with a Prussian Blue transducer. Reliable glucose detection in just secreted sweat would allow noninvasive monitoring of the glycemia level in diabetic patients.

Effect of Single Low-Dose Dexamethasone on Peri-operative Blood Glucose Levels

Background: Post-operative nausea and vomiting (PONV) is the second most common complaint reported after surgery with an incidence of 30%-80%. PONV is associated with numerous morbidities, hence prevention is beneficial. Dexamethasone is used as a prophylactic anti-emetic agent, however, being a corticosteroid, it could cause hyperglycaemia which is associated with a number of other adverse effects. Objectives: To study the effect of a single low-dose intravenous dexamethasone given as a prophylactic anti-emetic agent on perioperative blood glucose levels. Methods: Eighty-eight women who had elective myomectomy or hysterectomy under combined spinal-epidural (CSE) anaesthesia were randomised into two groups of 44 each. Following baseline blood glucose estimation, one group had 4 mg (1 ml) of intravenous dexamethasone 1-2 seconds after blood glucose check while the control group had 1 ml of normal saline. Blood glucose was measured every hour intra-operatively and two-hourly post-operatively till 12 hours after drug administration. Nausea, vomiting, dyspepsia, pain, motor block duration and urinary output were assessed hourly. Results: The mean maximum change in blood glucose from baseline in the dexamethasone group was statistically significantly higher than in the control group, 51.00±26.57 mg/dl vs. 35.80±25.71 mg/dl (p = 0.007) so also was the mean maximum blood glucose, 153.93±31.63 mg/dl vs. 139.52±28.95 mg/dl (p = 0.028) respectively. Conclusion: Intravenous dexamethasone at a single, low-dose (4 mg) used as a prophylaxis for nausea and vomiting is associated with significant increase in blood glucose concentration.

A randomized feasibility trial of time-restricted eating during pregnancy in people with increased risk of gestational diabetes

Time-restricted eating (TRE) is a nutritional intervention that confines the daily time-window for energy intake. TRE reduces fasting glucose concentrations in non-pregnant individuals, but whether this eating protocol is feasible and effective for glycemic control in pregnancy is unknown. The aim of this randomized controlled trial was to investigate the adherence to and effect of a 5-week TRE intervention (maximum 10 h daily eating window) among pregnant individuals at risk of gestational diabetes mellitus (GDM), compared with a usual-care control group. Participants underwent 2-h oral glucose tolerance tests and estimation of body composition, before and after the intervention. Interstitial glucose levels were continuously measured, and adherence rates and ratings of hunger were recorded daily. Thirty of 32 participants completed the trial. Participants allocated to TRE reduced their daily eating window from 12.3 (SD 1.3) to 9.9 (SD 1.0) h, but TRE did not affect glycemic measures, blood pressure, or body composition, compared with the control group. TRE increased hunger levels in the evening, but not in the morning, and induced only small changes in dietary intake. Adhering to a 5-week TRE intervention was feasible for pregnant individuals with increased risk of GDM but had no effect on cardiometabolic outcomes.

Co-crystals of thiobarbituric acid and N-heterocyclic compounds: Synthesis, structural, solubility, computational, and antilymphoma activity

Two new co-crystals (1–2) were prepared by the reaction of 2-thiobarbituric acid with N-heterocyclic compounds, and successfully characterized. X-ray analysis shows that 1 and 2 have zig-zag and ladder like supramolecular frameworks, respectively. HOMO-LUMO analysis of optimized geometries confirmed the lesser band gap of 1 and 2. Co-crystals 1–2 have solubility values of 19.737 and 25.652 mg/ml, respectively, and they may have good bioactivity. The cytotoxic activity of 1–2 indicated the tumor growth inhibitory ability of 1 and 2 against T cell lymphoma. Interestingly, apoptosis evaluation by Wright-Giemsa and DAPI staining suggested that 1 and 2 mediated tumor cell death through apoptosis induction. In addition, the estimation of glucose, pH, and NO also indicated the possible role of inhibited glucose uptake and augmented NO production in the cell death mediated by 1 and 2.

A comparative study of linear and nonlinear regression models for blood glucose estimation based on near-infrared facial images from 760 to 1650 nm wavelength

A comparative study of linear and nonlinear regression models for blood glucose estimation based on near-infrared facial images from 760 to 1650 nm wavelength

The Plasma Glucose Threshold Values Associated with Adverse Pregnancy Outcomes Among Asian Indian Pregnant Women: MAASTHI Birth Cohort Analysis.

To assess the association of adverse pregnancy and infant outcomes with different cut-off levels of glucose intolerance during pregnancy in the MAASTHI cohort. Pregnant women (n = 1470) underwent Oral glucose tolerance test between 24 and 36 weeks using a 75-g oral glucose load, with plasma glucose estimations measured at fasting and two hours later. Follow-up was done within 72 hours of delivery for recording type of delivery, infant weight, mid-upper arm circumference, and skinfold thickness. The odds of having higher skinfold thickness (>90th percentile) were 43% higher (AOR = 1.43; 95% CI: 1.18, 1.74) and the odds of being overweight at birth was 34% higher (AOR = 1.34; 95% CI: 1.09, 1.62) for every 1 standard deviation (9.9 mg/dL) increase in fasting plasma glucose (FPG) in male infants. The odds of delivering via caesarean section were 45% higher in women with female foetus (1.45,95% CI 1.15,1.82) for every one SD (23.4 mg/dl) increase in 2-h post-load Glucose. The impact of maternal glucose levels on infant and maternal outcomes differed notably between sex of the child. Compared to female infants, male infants exhibited a stronger association with elevated risks for adverse outcomes, including higher infant weight and increased skinfold thickness.

Generalization Performance Evaluation of a Blood Glucose Estimation Model Based on Near-Infrared Facial Images with Wavelengths Ranging from 760 nm to 1650 nm

Generalization Performance Evaluation of a Blood Glucose Estimation Model Based on Near-Infrared Facial Images with Wavelengths Ranging from 760 nm to 1650 nm

Impact of peripheral thyroid hormone balance on liver fat: insights from the NutriAct trial.

Hypothyroidism has been proposed as a potential contributor to steatotic liver disease (SLD), but existing data shows conflicting results in euthyroid subjects. Therefore, we investigated the association between thyroid function and intrahepatic lipids (IHLs) during a 36-month randomized controlled trial evaluating a diet known to reduce liver fat. 502 eligible subjects (aged 50-80 years, ≥1 risk factor for unhealthy aging) were randomly assigned to either follow a diet rich in unsaturated fatty acids, plant protein, and fiber (intervention group, IG), or dietary recommendations of the German Nutrition Society (control group, CG). Serum levels of thyroid hormones (THs) as well as IHLs, defined via magnetic resonance spectroscopy, were measured within an euthyroid subgroup without significant alcohol consumption at baseline (n = 332) and after 12 months (n = 243). A ratio of T3/T4 was used to assess whole-body deiodinase activity. Estimates of glucose and lipid metabolism were analyzed. Only fT3 and T3/T4 ratios showed a significant positive correlation with IHL at baseline. We observed a significant decline in fT3, T3, fT3/fT4 ratio, and T3/T4 ratio in CG and IG after 12 months without significant differences between groups. TSH, fT4, and T4 remained stable. A larger improvement of IHL during dietary intervention was seen in those subjects with a lower decline in T3 concentrations. Altered TH balance indicates a possible compensatory upregulation of whole-body TH activity in subjects with increased liver fat. This might be also relevant during the improvement of hepatic steatosis.

The Effect of Maternal Blood Glucose on Umbilical Cord Blood Fibrinogen in Women With Gestational Diabetes.

Gestational diabetes mellitus (GDM) is delineated by the presence of glucose intolerance at any level that manifests or is initially identified during pregnancy. Factor I fibrinogen is among the most essential blood coagulation proteins. The concentration of fibrinogen influences platelet aggregation and blood viscosity. This study aimed to determine the correlation between fetal cord blood fibrinogen and plasma fibrinogen in pregnant women with GDM and between fetal cord blood fibrinogen and maternal blood sugar. A cross-sectional study was executed at Al-Elwiya Maternity Teaching Hospital in the obstetrics and gynecology department. The sample included 90 term pregnant women: 45 were confirmed to have GDM, and 45 healthy pregnant women served as control. Estimation of prelabor maternal fasting and random plasma glucose and plasma fibrinogen was performed. During delivery, blood was drawn from the umbilical cord to estimate neonatal plasma glucose and fibrinogen levels. The mean maternal plasma fibrinogen level exhibited a notable increase in women with GDM compared to the control (330.11 ± 56.92 mg/dl versus 254.89 ± 41.01 mg/dl). The infants of diabetic mothers had significantly lower mean cord plasma glucose levels (65.71 ± 14.63 mg/dl versus 77.80 ± 7.81 mg/dl) and higher mean cord plasma fibrinogen levels (269.42 ± 25.91 mg/dl versus 229.69 ± 21.29 mg/dl). Umbilical cord plasma fibrinogen was correlated positively with maternal plasma sugar and fibrinogen. A positive correlation between maternal and fetal cord fibrinogen levels was determined in women with GDM. Monitoring plasma fibrinogen levels in neonates of mothers with GDM could be facilitated by longitudinal, large-scale validation studies enabled by artificial intelligence as a new, evolving technique that contributes to more valuable outcomes. This would shed additional light on the course and function of plasma fibrinogen for a more comprehensive analysis of the fetal clotting system.

A Novel Reversed Phase HPLC Assay Method for Simultaneous Estimation of Glucose, Sodium Citrate and Chlorides in Pharmaceutical Formulations and Drug Solution for Oral Rehydration

A rapid, straightforward, sensitive, efficient, and cost-effective reverse-phase high-performance liquid chromatographic method was employed to simultaneously determine Glucose, Sodium Citrate, and chloride in a drug solution for oral solution. Glucose, Sodium Citrate, and Chlorides are all listed in the USP monograph. While various assay methods are available, titrimetric methods are ineffective for trace-level quantification. Although IC, AAS, and ICP-MS offer high accuracy, they are expensive and often inaccessible to many testing facilities. When selecting methods, it’s crucial to consider quality control requirements and user-friendly techniques. A simple proprietary HPLC method has been developed to simultaneously quantify Chlorides, Glucose, and Sodium Citrate, with a shorter run time. The separation was carried out using a Shim-pack SCR-102(H) ion exclusion analytical column (7.9 mm x 300 mm, 7 µm) with a flow rate of 0.6 mL/min. The column compartment was kept at 40°C, and the injection volume was 10 µL, with detection at 200 nm. All measurements were performed in a 0.1% phosphoric acid solution. The analytical curves showed excellent linearity (r > 0.9999) within the concentration ranges of 0.74 to 1.74 mg/mL for Sodium Citrate (SC), 1.0 to 2.5 mg/mL for Sodium Chloride (SC), and 3.0 to 7.3 mg/mL for Glucose. The method was validated according to the guidelines of the International Conference on Harmonization (ICH Q2B) and USP<1225>. The method demonstrated precision, robustness, accuracy, and selectivity. During accelerated stability testing over six months, no significant variations were observed in organoleptic analysis and pH. Consequently, the developed method is considered suitable for routine quality control analyses, enabling the simultaneous determination of Sodium Citrate, Chloride, and Glucose in pharmaceutical formulations and solutions for oral rehydration.

Antidiabetic Effects of Foeniculum vulgare in Alloxan-induced Diabetic Male Rats

Background & objective: Diabetes mellitus (DM) has become one of the most challenging health problems of the 21st century. Foeniculum vulgare (Mouri in Bengali), an ancient culinary herb, is known to reduce blood glucose levels thus reducing the risk of diabetes. This study was done to observe the antidiabetic role of Mouri in alloxan-induced diabetic male rats. Methods: This experimental study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka from July 2018 to June 2019. A total of 30 healthy Wistar albino male rats, 90-120 days old, weighing between 150-180g were included in the study. After acclimatization for 14 days, they were divided into two groups: the control group (Group A) and the experimental group (Group B – diabetic rats treated with Mouri). The control group was again subdivided into Group A1 (normal control group) and Group A2 (alloxan-induced diabetic control group). Each of these groups consisted of 10 rats. All the rats received a basal diet for 21 days. In addition to the basal diet, Group A2 and Group B received a single intraperitoneal injection of alloxan 140 mg/kg on day 1 to induce diabetes. Moreover, Group B received Mouri extract 150 mg/kg/day orally for 21 consecutive days starting from day 1 of the study period. After 12 hours of fasting, blood samples were collected from the tail veins of every rat on day 1 for estimation of Fasting Blood Glucose (FBG) and serum ALT levels. On day 4 FBG levels of all the rats were measured once again. Then all the rats were sacrificed on day 22 and their blood samples were collected from the heart. The outcome variables, such as FBG level, serum levels of insulin, were measured and compared among the study groups. The pancreatic tissue was also collected and histopathology was done by standard laboratory procedure to study their histologic architecture. Result: In this study, fasting blood glucose level in diabetic rats treated with Mouri at the endpoint of the study (on day 22) was significantly lower (5.51 ± 0.47 mmol/L) than that in alloxan-induced diabetic control (13.52 ± 0.76 mmol/L) (p < 0.001) and was almost equal to that in normal control (5.38 ± 0.55 mmol/L) (p = 0.891). The serum insulin level in diabetic rats treated with Mouri (11.52 ± 0.84 mmol/L) was almost similar to that of normal control (12.46 ± 1.07 mmol/L) on day 22, whereas it was much higher than that in alloxan-induced diabetic control (8.51 ± 0.68 mmol/L) (p < 0.001). Histological study of pancreases of the rats, revealed extravasation of blood in the pancreatic acini, reduced area of islets of Langerhans with atrophy, vacuolation, degeneration, and pyknosis of β-cell nuclei and centrilobular necrosis in the alloxan-induced diabetic control rats. Conclusion: Mouri (Foeniculum vulgare) improves the glycemic status of the alloxan-induced diabetic rats. Ibrahim Card Med J 2023; 13 (1&2): 53-59

929-P: A Study to Evaluate Clinical and Metabolic Profile of Type 2 Diabetes Patients Receiving SGLT2 Inhibitors

Aim: The aim of the study was to determine the efficacy of SGLT2i and its impact on metabolic profile of type 2 diabetes (T2DM) patients with reference to serum glucagon and blood ketones. Methodology: The study was conducted in T2DM patients with inadequate glycemic control on a background therapy of either metformin and sulphonylurea (Group A) or metformin and DPP4 inhibitor(Group B) Blood samples were taken for estimation of fasting plasma glucose (FPG), post prandial plasma glucose (PPPG), HbA1c, beta-hydroxybutyrate (β-HB) and glucagon levels. Empagliflozin 10mg, was added to the existing anti-diabetic medication. The metabolic parameters were reassessed after 12 weeks. Results: At the end of 12 weeks glucagon levels increased significantly (28.8 ± 28.74 at baseline vs 108 ± 74 pg/ml; p<0.001). A significant increase in β-HB levels was also observed (0.1 ± 0.07 mmol/L at baseline versus 0.12 ± 0.07 mmol/L (p=0.03). FPG, PPPG and HbA1c decreased significantly by 30.33mg%, 53.16mg% and 1.05% respectively(p<0.01) In group A, FPG and PPPG decreased by 34.43 mg/dl and 51.71mg/dl respectively (p<0.001) with a mean HbA1c reduction of 1.09% (p<0.001) Serum glucagon and β-HB levels increased significantly [82.63 pg/ml (p<0.001) and 0.04 mmol/L (p<0.01) respectively]. In group B, there was decrease in FPG (mean difference 23.6mg %; p=0.003) and PPPG (mean difference 55.5mg%; p<0.001) at 12 weeks. HbA1c reduction of 0.99% was observed. (p=0.003) There was a significant increase in glucagon levels (mean difference +73.52 pg/ml; p<0.001). Conclusion: Addition of Empagliflozin to T2DM patients with inadequate glycemic control on either metformin and sulphonylurea or metformin and DPP4 inhibitors significantly improved efficacy. Plasma glucagon and β-HB levels increased with chronic empagliflozin treatment suggesting a change in substrate utilization towards fat. Disclosure S. Kandula: None. M.A. Meshram: None. A.C. Sonwane: None.

Protocol for the study of bedside CSF analysis by urinary reagent strips and comparison with traditional laboratory measurements in a tertiary care centre in rural India

Abstract* Background Meningitis is an infection of leptomeninges. It is an emergency life-threatening condition that requires prompt treatment initiation. Diagnosis is the rate-limiting step because cerebrospinal fluid (CSF) analysis requires experienced personnel. Therefore, this study was conducted to assess the utility of urinary reagent strips for the rapid bedside diagnosis of CSF glucose, proteins, and leukocytes. Objective To determine the efficacy of a urinary reagent strip for bedside analysis of cerebrospinal fluid (CSF) samples. Methods This prospective comparative study will be conducted in the Department of Neonatology and Pediatrics, Jawaharlal Nehru Medical College, Sawangi, Wardha. CSF samples from patients suspected of infection of the central nervous system (CNS) and awaiting diagnosis will be subjected to semi-quantitative analysis using a urinary reagent strip (for glucose, proteins, and leukocytes). The results were compared with the laboratory results of the individual samples. Result After completing the study, we determined the efficacy of the urinary reagent strips in bedside estimation of CSF glucose, protein, and leukocyte levels in terms of sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. Conclusion This study provides insight into the utility of urinary reagent strips for rapid bedside diagnosis of CSF samples from patients suspected of having an infection.

Neuroprotective Potential of Hygrophila auriculata Targeting Oxidative Stress-Mediated Deficits in Streptozotocin-Induced Sciatic Nerve Injury

Abstract Objective Diabetic neuropathy, a microvascular complication of diabetes, affects 50% of individuals. Addressing this challenge is challenging due to its poorly understood origin and existing therapeutic approaches. This study used a methanolic extract from Hygrophila auriculata (MEHA) to treat oxidative stress-induced sciatic nerve injury in diabetic rats. Materials and Methods A study was conducted to assess the nociceptive reflex after a single streptozotocin (STZ) (45 mg/kg intraperitoneal.) injection. The rats were divided into six groups (n = 6 rats per group). Group I nondiabetic (ND) rats received oral gavage of 1% carboxymethyl cellulose (CMC). The diabetic rats in groups II to VI were given 1% CMC, 100, 200, and 400 mg/kg of MEHA, and 180 mg/kg of metformin (MET). The freshly prepared 1% (w/v) CMC suspension of both MEHA and MET was administered over a 4-week period, commencing from the 28th day through the 56th day post-STZ injection. The impact of STZ-induced sciatic nerve injury was analyzed through the estimation of serum glucose and glycohemoglobin levels, paw withdrawal and tail-flick latencies, oxidative stress markers, and neural histoarchitecture. Results Diabetic (STZ) control group II showed significantly altered serum glucose and glycohemoglobin levels, a reduced paw withdrawal threshold, and reduced paw withdrawal and tail-flick latencies in contrast to ND group I. Furthermore, increased oxidative stress in the sciatic nerve correlates with a reduced nociceptive threshold and disrupted neural histoarchitecture in diabetic rats. These behavioral, biochemical, and molecular changes were markedly and dose-dependently reduced by MEHA and MET treatments. Conclusion The antioxidant efficacy of MEHA modulated oxidative stress in STZ-sensitized diabetic rats and corrected neuropathic pain by attenuating hyperglycemia.

Checking For Reliability and Accuracy Measuring Point of Care Capillary Blood Glucose Using Glucometers Vs Venous Blood Glucose in Intensive Care Unit Patients: Hospital Based Cross-sectional Study

Abstract Background: Health-care professionals routinely measure blood glucose of all critically ill patients in intensive care unit (ICU). The traditional reference standard, venous blood glucose requires venipuncture, and laboratories usually return the test results after 60 min. We wondered if a point of care (POC) capillary glucose measured by glucometer could be as accurate and reliable as blood venous glucose. Methods: We studied consecutive patients admitted to an ICU between May 1, 2009, and May 10, 2009. We compared the diagnostic accuracy of two-POC glucometers with laboratory venous glucose, the reference standard. We used Bland–Altman plots and the Clark error grid method to analyze the results. Results: This study included a total of 110 patients 38 (34%) women; mean age 52.1 years (standard deviation [SD] =17.3); range = 14–85 years. Fourteen patients (12%) were known to have diabetes. The mean glucose value (glucometer 1) was 152.9 mg/dL (SD = 83.1); range = 48–501 mg/dL; that by glucometer 2 was 152.2 mg/dL (SD = 76.2); range = 30–458 mg/dL and by the laboratory was 148.6 mg/dL (SD = 81.5); range = 52–480 mg/dL. Of the 110 subjects, 2 (2%) had blood glucose below 70 mg/dL; 85 (77%) between 70 and 180 mg/dL; and 23 (21%) had blood glucose exceeding 180 mg/dL. The Bland–Altman plot showed a bias of 4 mg% (95% confidence intervals = −9.8–+1.1); and the limits of agreement were −63 and +54 mg%. The area under the receiver operating characteristic curve for the two glucometers was 0.92 and 0.93, respectively. The error grid analysis showed that 80% (78/110) of samples lay within Zone A, 22 (110) in Zone B, and 1% (1/110) in Zone C. Conclusions: POC glucose, measured by glucometers was in agreement with the venous glucose estimation. Both glucometers were equally accurate and performed uniformly well across the wide range of blood glucose values.

Insulin:Glucagon Bipolar Axis in Obesity With a Glimpse Into Its Association With Insulin Resistance in Different Glucose Tolerance States.

Dysregulation of insulin and glucagon secretion alters the normal insulin:glucagon ratio (IGR) in type 2 diabetes mellitus, obesity, and metabolic syndrome. This study explores the scope of construing the role of these two diametrically opposing hormones on the glucose level not just in obesity but in different glucose tolerance states by looking at the hormone levels and at the insulin glucagon bipolar axis itself. This is an analytical cross-sectional study of 60 healthy adults consisting of an equal number of adults who are lean and adults who are obese. It was conducted at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), located in Shillong City, Meghalaya, India. Fasting glucose, insulin, glucagon, and lipids were estimated. Postprandial estimation of glucose was done two hours after oral administration of 75 grams of glucose solution. The study demonstrated a state of hyperinsulinemia and hyperglucagonemia prevailing in obesity and all sub-categories of the group of persons who are obese. The study showed a higher fasting IGRin the group consisting of adults who were obese (with a mean of 4.11) when compared with the group of adults who are lean (with a mean of 2.24). Fasting IGRwas seen to increase with increasing levels of insulin resistance and increasing impairment in glucose tolerance. IGR showed a positive correlation with the homeostatic model assessment for insulin resistance (HOMA-IR) in the impaired fasting glucose (IFG) category and strongly in the impaired glucose tolerance (IGT) category. Hyperglucagonemia in the group of adult persons who are obese indicates a decreased sensitivity of alpha cells to insulin failing insulin to adequately suppress the secretion of glucagon. The study also demonstrated a positive correlation between IGR and HOMA-IR in obesity and all glucose tolerance states of the group of adults who are obese. It is telltale that the sturdier the insulin resistance, the higher the IGR.

Effect of Immediate Kangaroo Mother Care on Pain in Sick Low Birth Weight Neonates During Heel Prick in Mother–Newborn Intensive Care Unit

Introduction: In the Mother-Newborn Intensive Care Unit(M–NICU), sick, low birth weight(LBW) neonates are cared for along with their mothers with facilities of level-II newborn care and postnatal care for mothers. Babies weighing 1–1.8 kg are admitted and Kangaroo Mother Care (KMC) is started after birth without waiting for stabilization. This is immediate Kangaroo Mother Care (iKMC). There are studies on analgesic effect of KMC, but no studies on analgesic effect of iKMC in sick neonates; therefore, the present study was planned. Aims and objectives: To compare pain score and recovery time from pain following heel prick in sick LBW neonates weighing 1–1.8 kg in iKMC and under radiant warmer. Materials and methods: In the M-NICU, neonates are in iKMC for 12–18 hours. If iKMC is not possible, the baby is placed under radiant-warmer. LBW neonates are screened for hypoglycemia at 2, 6, 12, 24, 48-hour intervals by heel prick. Pain scoring was done by the Premature Infant Pain Profile (PIPP) score and the recovery time (time for heart rate to return to baseline) noted following heel prick in iKMC and under radiant warmer. Results: 75 babies enrolled, 150 episodes of glucose estimation in iKMC and 150 in radiant warmer included. Mean(SD) baby weight(Kg) was 1512.93(171.10). Mean(SD) gestational age(Weeks) was 33.77(2.54). In the iKMC group, mean pain score(SD) was 7.59(2.27) and median(IQR) was 8.00(2.75). In the radiant warmer group, mean pain score(SD) was 14.41(2.04) and median(IQR) was 15.00(3.00). Mean recovery time(seconds)(SD) was 33.3(20.22) in the iKMC group and 92.43(49.68) in the radiant warmer group. The difference was statistically significant( P = <0.001). Conclusion: In sick LBW neonates, painful procedures must be done in KMC, whenever possible.

Neonatal Hypoglycemia How common is Hypoglycemia in Newborns Weighing Less Than 2500 gms: A Hospital Based Study

Objective:To determine the frequency of hypoglycemia in neonates weighing less than 2500 grams in first 48 hours of life presented to CMH Abbottabad.
 Study Design: Cross Sectional Study.
 
 Setting: Department of Pediatrics, Combined Military Hospital, Abbottabad.
 
 Duration of Study: This study was conducted from 1st July 2020 to 1st January 2021
 
 Subjects and Methods:
 
 A total of 110 neonates of both genders with birth weight less than 2500 grams using consecutive non-probability sampling technique were included in the study. Capillary blood was collected by heel prick after proper aseptic measure for blood glucose estimation by Glucometer at 0, 1, 2, 3, 6 and every 6 hours till 48 hours of birth. All hypoglycemic neonates were managed with intravenous administration of 10%glucose.
 Results:
 
 Gestational age range in this study was from 34 to 42 weeks with mean gestational age of 38.663±1.55 weeks, mean birth weight 1622.818±409.23 grams and mean blood glucose level was 54.763±9.55 mg/dl. Total 80% neonates were male. Hypoglycemia was observed in 27.3% neonates. No significant difference was seen comparing frequency of hypoglycemia among pre-term and term neonates (p-value 0.52), male vs female neonates (p-value 1.00) and different modes of delivery. (p-value 0.6). While frequency of hypoglycemia was significantly high in extremely low birth neonates as compared to low and very low birth weight. (p-value <0.01).
 
 
 Conclusion:
 
 Our study concluded that frequency of hypoglycemia was 27.3% in newborns weighing less than 2500 grams in first 48 hours of life. Extremely low birth weight (less than 1000gms) is a significant determinant for hypoglycemia.
 Keywords:
 
 First 48 hours, frequency, low birth weight, hypoglycemia, new borns