Blood Sugar Fluctuations Research Articles

Factors related to the uncontrolled fasting blood sugar among type 2 diabetic patients attending Kopang Health Center, Central Lombok Regency, Indonesia

Background: Prevalence of DMT2 is increasing every year, becoming a significant global health problem. Many DMT2 sufferers are not well controlled, prone to serious complications such as heart, kidney, and nervous system. Purpose: To determine Blood Sugar fluctuations in Diabetes Mellitus Type-2 (DMT2) to improve knowledge, positive attitudes, and healthy behaviors to achieve optimal blood sugar control. Method: Quantitative observational analytical research with Cross Sectional design. The population is 349 people with a sample of 186 respondents which is determined by simple random side. Data collection uses interview guidelines/questionnaires that have been tested for validity and reliability. Bivariate data analysis used Chi Square and Multivariate analysis multiple logistic regression. Results: P value of knowledge 0.000 < 0.05, had a significant effect. The p-value of attitude was 0.002 < 0.05, Positive attitude had a significant effect on stabilizing blood sugar. An optimistic, confident, and highly motivated attitude is important to control diabetes. The behavioral p value of 0.003 < 0.05 had a stabilizing effect on blood sugar. Conclusion: Good knowledge has a significant effect on stabilizing blood sugar. An important understanding affects diabetes control. Accurate information empowers informed long-term health decisions. A positive attitude greatly affects blood sugar control. Optimistic, high spirits achieve better health control. Decisions of the right actions stabilize blood sugar is important for DMT2 health, prevent complications improve quality of life.

Selection of dialysis methods for end-stage kidney disease patients with diabetes.

The increasing prevalence of diabetes has led to a growing population of end-stage kidney disease (ESKD) patients with diabetes. Currently, kidney transplantation is the best treatment option for ESKD patients; however, it is limited by the lack of donors. Therefore, dialysis has become the standard treatment for ESKD patients. However, the optimal dialysis method for diabetic ESKD patients remains controversial. ESKD patients with diabetes often present with complex conditions and numerous complications. Furthermore, these patients face a high risk of infection and technical failure, are more susceptible to malnutrition, have difficulty establishing vascular access, and experience more frequent blood sugar fluctuations than the general population. Therefore, this article reviews nine critical aspects: Survival rate, glucose metabolism disorder, infectious complications, cardiovascular events, residual renal function, quality of life, economic benefits, malnutrition, and volume load. This study aims to assist clinicians in selecting individualized treatment methods by comparing the advantages and disadvantages of hemodialysis and peritoneal dialysis, thereby improving patients' quality of life and survival rates.

How Canines Can Assist Our Patients with Diabetes: Diabetes Alert Dogs: What Are Their Capabilities?

The canine olfactory system is used for tasks that greatly aid society, such as detecting explosives, finding lost persons, and detecting many diseases and abnormal blood sugar levels early. However, the reliability of detection of glycemic fluctuations is questionable. We reviewed the literature on the capability of canines in detecting significant variations in blood sugar. Traditional studies and anecdotal reports were assessed. Articles and resources that outline the available training and certification process were included. Publications included studies of canines' ability to detect scents associated with hyperglycemia and hypoglycemia as well as behavioral changes associated with blood sugar abnormalities. Several anecdotal reports denoted excellent canine performance in detection. Perusal of literature and Web-based resources found a range of available training, from formal (with certification) to do-it-yourself home training. Evidence supporting improved mental/physical health in persons using service dogs was robust. Canines have the capability to detect numerous medical conditions, including dangerous fluctuations in blood sugar in persons with diabetes, especially hypoglycemia. Most studies on the reliability and performance of diabetes alert dogs report potential lifesaving benefits but demonstrate notable variability and inconsistencies, which may be due to lack of required formal training or a certification process. Most owners believe their dogs are highly effective and greatly improve their life and safety. Due to the improving technology seen with continuous glucose monitoring devices, many believe diabetes alert dogs will become obsolete. Aside from an early warning system, diabetes alert dogs can play a significant role in overall quality of life, especially in benefiting physical and mental health.

Pasting, rheology, structural properties and in vitro digestibility of potato starch complexes co-gelatinized with squash polysaccharides

The effects of extraction of squash polysaccharide from water (WESP) and subcritical water (SWESP) on gelatinization, rheology, thermodynamic, micro-structure, freeze-thaw stability and digestibility of potato starch (PS) were studied. The WESP and SWESP decreased peak viscosity, trough viscosity, breakdown viscosity, final viscosity, storage modulus and loss modulus of PS. Conversely, the setback viscosity, pasting temperature and peak time increased. All gel samples belonged to the weak gel system. The thermodynamic and fourier spectroscopic results demonstrated a significant retardation of PS retrogradation in the presence of WESP and SWESP. It was consistent with the microstructure characterization detected by scanning electron microscopy that both WESP and SWESP had a significant inhibitory effect on the formation of the PS gel structure. Moreover, the existence of WESP and SWESP compromised the freeze-thaw stability of PS gel. Meanwhile, WESP and SWESP also affected the digestibility of PS and reduced the eGI value of PS, which was conducive to stabilizing blood sugar fluctuations. This study helped to better understand the interaction of PS with WESP/SWESP in the gel system, and supplied a way to improve the quality of PS-related products. In addition, it also contributed to the industrial production and application of WESP and SWESP.

Evaluation of the quality and safety of sugar substitutes

High sugar consumption leads to such socially significant diseases as type 2 diabetes, osteoporosis, obesity, metabolic syndrome, and cardiovascular diseases. The problem of replacing sugar in food products and finished culinary products is always acute for food manufacturers. In the future the demand for intense sweeteners and sugar substitutes is expected to increase, as the demand for dietary preventive, sports and diabetic nutrition products in the Russian Federation is steadily growing. The wide selection of sugar substitutes available on the market is due to their significant economic advantages, high sweetness factor, ease of use and the absence of negative effects on the human body, since they do not contain glucose and do not lead to sharp fluctuations in blood sugar. Their use allows us to create innovative products, take into account the needs of different consumer groups and follow modern requirements for a healthy lifestyle. An important indicator in the production of sugar substitutes is their quality characteristics. The purpose of the research is commodity assessment of the quality of four most popular liquid sugar substitutes for compliance with labeling in accordance with the technical regulations TR CU 021/2012, microbiological indicators, examination of samples for the presence of sweeteners, and preservative content. It has been established that all the studied samples violate the requirements of the current legislation, starting with typos in the declaration of conformity (Slastya-super), ending with unreliable information on the label («Mastershape»TM, «Nosugar», «Sladkiy pshik»TM), excess concentration of preservatives above the permitted limits («Sladkiy pshik»TM) and microbiological purity («Mastershape» and «Nosugar»).

The classical Biomarkers to Predict Diabetes Mellitus

Diabetes mellitus is metabolic disorders; depicted by elevated blood glucose levels ascribed to a futile, scanty or sojourns production of insulin. Enduring complications of the disease have been related to peripheral vascular problems, steering to cardiovascular diseases, stroke, diabetic retinopathy, nephropathy and foot. Precise monitoring of these complications and early therapy stages will allow improvement in prevention and treatment approaches. The availability of measurable, accurate and reproducible biomarkers allow the patient to receive timely enactment of personalized therapies and circumventing harmful blood sugar fluctuations that ultimately progress to life-threatening impediments. Profound knowledge of these biomarkers released by extracellular vesicles in metabolic diseases and other disease condition may guide the development of novel therapeutic approaches to restore the affected pathogenesis, rather than merely treating the symptoms. With advent of method that can isolate (ultracentrifugation, affinity-based capture, size exclusion chromatography/filtration, polymer precipitation) and characterize (protein quantification, transmission electron microscopy, atomic force microscopy, ELISA, nanoparticles tracking analysis, flow cytometry, western blot) from body fluids have become a major diagnostic and prognostic biomarkers not only in diabetes, in other conditions like cancer, neurodegradative disease.

Morning and Evening Exercise with or without High-Pressure Intervals have Different Effects on Controlling Blood Sugar and Glucose Fluctuations in People with Type 1 and Type 2 Diabetes

Summary: Exercise is recommended for the treatment and prevention of type 2 diabetes. Also, to control and reduce glucose fluctuations in people with type 1 diabetes. However, the most appropriate time and the most effective intensity of exercise is still unknown, and various studies provide different results and different recommendations, and none of the studies provide a comprehensive and practical result. We conducted our studies to examine the results and determine the effect of time and intensity of exercise on blood sugar control and glucose fluctuations during the day. Methods: search in PubMed and Google Scholar with keywords morning, evening, type 1 and 2 diabetes, exercise, interval, periodic, aerobic, and glucose and blood sugar fluctuations were performed. A total of 31 articles were reviewed and finally, 10 articles that were most related to each other or had complementary information were selected. Conclusion: HIIT exercises are useful for type 2 diabetes, but they are recommended for type 1 diabetes with less pressure. Morning exercise increases glucose and evening exercise is applicable for type 1 and 2 diabetes.

Efficient synthesis of sugar alcohols using a composite trimetallic Pt–Ni–Sn/MWCNTs catalyst based on metal element coordination and valence regulation

Functional sugar alcohols are a kind of burgeoning food additives to substitute saccharose due to the prominent biofunctions including moderate sweetness, low calorific values and no influence on blood sugar fluctuation, thus applied widely in food, medical, health protection as well as chemical production. Traditional synthesis of functional sugar alcohols required high temperature and H2 pressure, as well as leading to low reaction efficiency, side reactions and leaching of toxic metal ions. In the present work, Pt–Ni–Sn/MWCNTs catalyst was obtained using a liquid phase reduction method with the transition metals loading of Pt 3.4%, Ni 0.7%, Sn 0.4%, respectively. The catalyst catalyzed the preparation of xylitol, sorbitol, mannitol and galactitol with the high monosaccharide conversion (>99.5%) and yield (>99.1%) under relatively mild conditions (100 °C, 3.0 MPa H2), which were lower than ever reported. For the 13-batch reuse of Pt–Ni–Sn/MWCNTs, the total conversion of xylose was 99.4% and the total yield of xylitol was 99.2%, the productivity of 103.2 g xylitol per gram of catalyst was also obtained. Besides, no side reactions, no metal ions as well as no changes of pH were observed in the reaction process. Our trimetallic catalyst exhibited valuable potential in functional sugar alcohols production.

Effects of glargine on hyperglycemia in patients with diabetes mellitus type II undergoing off-pump coronary artery bypass graft: A randomized, controlled, double-blind clinical trial.

Introduction: In this trial, effects of glargine on hyperglycemia in patients with diabetes mellitus type II who were undergoing off-pump coronary artery bypass graft (CAGB), were examined. Methods: Seventy diabetic patients who were candidate for off-pump CABG were randomly divided into the following two groups (1) Control group who were treated with normal saline+regular insulin and (2) Glargine group who received glargine+regular insulin. Normal saline and glargine were administered subcutaneously 2 hours before surgery, and regular insulin was injected before, during and after the surgery in the intensive care unit (ICU) in both groups. Finally, levels of blood sugar before, 2 hours after starting the surgery and at the end of the surgery, were recorded. Blood sugar levels during ICU stay were also measured every 4 hours for 36 hours. Results: There were no significant differences in blood sugar levels between the groups at the three time points (i.e. before, 2 hours after starting the surgery and at the end of the surgery). In addition, during 36 hours of ICU stay, blood sugar levels did not show significant variations between the groups; however, 20 hours after ICU admission, blood sugar level was significantly higher in the glargine group (P=0.04). Conclusion: The results indicated that both glargine and regular insulin effectively control the blood glucose in diabetic patients undergoing CABG. However, the blood sugar fluctuation was less in the glargine group than control group.

Analgesic effect of a new "cocktail" of local infiltration analgesia after total hip arthroplasty-A prospective randomized controlled study

To study the analgesic effect of a new "cocktail" of local infiltration analgesia (LIA) with Deprosone after total hip arthroplasty (THA). In a prospective randomized controlled study, 100 patients with hip joint disease requiring unilateral primary THA in West China Hospital of Sichuan University between January 2018 and December 2018 were enrolled and randomly divided into observation group and control group, with 50 cases in each group. There was no significant difference in age, gender, operative side, disease type, body mass index, American Society of Anesthesiologists (ASA) classification, preoperative rest and activity visual analogue scale (VAS) score, hip Harris score (HHS), quality of life scale (SF-12) score, and other general data between the two groups ( P>0.05). The patients in the observation group were treated with a new "cocktail" LIA around the hip joint before suturing the incision, and the drug formula was ropivacaine 200 mg, Diprospan 1 mL, morphine 10 mg, and added normal saline to 80 mL; the patients in the control group were not treated with LIA. The operation time, postoperative hospital stay, the amount of morphine used during hospitalization, and the range of motion of hip joint at discharge were recorded, and the complications were counted. The VAS score at rest and activity, HHS score, and SF-12 score [physiological score (PCS) and psychological score (MCS)] of the hip joint were recorded before and after operation, and the postoperative analgesic effect and the recovery of hip joint function were evaluated. There was no significant difference in the operation time between the two groups ( P>0.05), and the postoperative hospital stay in the observation group was significantly shorter than that in the control group ( P<0.05). The postoperative morphine consumption in the observation group was significantly less than that in the control group ( P<0.05), and the total morphine consumption in the observation group was less than that in the control group during hospitalization, but the difference was not significant ( P>0.05). Patients in both groups were followed up to 6 months after operation. The resting VAS scores of the observation group were significantly lower than those of the control group at 2, 6, 12 hours after operation and in the morning and afternoon of the first day after operation, and the active VAS scores of the observation group were significantly lower than those of the control group at 6, 12 hours after operation and in the morning of the first day after operation, and the differences were significant ( P<0.05). There was no significant difference in the resting and active VAS scores between the two groups on the day of discharge and at 3 and 6 months after operation ( P>0.05). At discharge, the flexion range of motion of hip joint in the observation group was significantly greater than that in the control group ( P<0.05), but there was no significant difference in the abduction range of motion of hip joint between the two groups ( P>0.05). There was no significant difference in HHS score and SF-12 score between the two groups at 3 and 6 months after operation ( P>0.05). There was no significant difference in analgesic satisfaction and functional satisfaction between the two groups at last follow-up ( P>0.05). There was no complication such as skin pruritus, superficial and deep infection of incision, skin necrosis, deep venous thrombosis of lower extremity, and pulmonary embolism in both groups. There was no significant difference in the incidence of complications such as nausea and vomiting, urine retention, fat liquefaction of incision, local hematoma, and large fluctuation of blood sugar between the two groups ( P>0.05). The new "cocktail" LIA with Diprospan can effectively reduce the early postoperative pain of THA, reduce the dosage of opioids, shorten the length of hospital stay, and is conducive to the early functional rehabilitation of patients.

Impact of glycemic variability on cognitive impairment, disordered eating behaviors and self-management skills in patients with type 1 diabetes: study protocol for a cross-sectional online study, the Sugar Swing study

BackgroundPeople living with type 1 diabetes (PWT1D) are at increased risk for impairments in brain function, which may impact on daily life. Cognitive impairments in PWT1D might contribute to increasing eating disorders, reducing self-management skills, and deteriorating glycemic control. Glycemic variability may be a key determinant of disordered eating behaviors, as well as of cognitive impairments. The main objective of this study is to better understand the impact of glycemic variability in disordered eating behaviors and cognitive impairment, and its consequences on self-management skills in PWT1D.MethodWe aim to recruit 150 PWT1D with 50% of men and women in this cross-sectional study. Participants will record their glycemic variability over a 10-day period using a continuous glucose monitoring system (CGMS) and track their dietary intakes using image-assisted food tracking mobile application (2 days). Over four online visits, eating behaviors, diabetes self-management’s skills, anxiety disorders, depression disorder, diabetes literacy and numeracy skills, cognitive flexibility, attention deficit, level of interoception, and impulsivity behaviors will be assessed using self-reported questionnaires. Cognitive functions (i.e., attention, executive functions, impulsivity, inhibition and temporal discounting), will be measured. Finally, medical, biological and sociodemographic data will be collected. To further our understanding of the PWT1D experience and factors impacting glycemic self-management, 50 PWT1D will also participate in the qualitative phase of the protocol which consist of individual in-depth face-to-face (virtual) interviews, led by a trained investigator using a semi-structured interview.DiscussionThis study will contribute to highlighting the consequences of blood sugar fluctuations (i.e., "sugar swings"), in daily life, especially how they disrupt eating behaviors and brain functioning. A better understanding of the mechanisms involved could eventually allow for early detection and management of these problems. Our study will also seek to understand the patients' point of view, which will allow the design of appropriate and meaningful recommendations.Trial registrationClinicalTrials.gov, NCT05487534. Registered 4 August 2022.

Study on the Effect of Early Comprehensive Intervention of Skin Contact Combined with Breastfeeding on Improving Blood Glucose in Early Birth of Newborns with Gestational Diabetes Mellitus.

Objective To explore the value of early comprehensive intervention of skin contact combined with breastfeeding on improving early blood glucose in newborns with gestational diabetes mellitus (GDM). Methods A total of 300 newborns from pregnant women with gestational diabetes who were hospitalized in Wuxi People's Hospital from January 2021 to December 2021 were randomly assigned into the observation group (n = 150) and the control group (n = 150). The former group received early comprehensive intervention of skin contact combined with breastfeeding, and the latter group received postnatal naked contact, physical examination after late navel severing, and routine nursing intervention such as early contact and early sucking in 30 min. The peripheral blood microglucose value at 1 and 2 hours after birth, neonatal hospitalization rate, ear temperature of 30 min, 60 min, 90 min, and 120 min after birth, neonatal crying, incidence of postpartum hemorrhage, uterine contraction/wound pain index, lactation before delivery, immediately after delivery, early sucking 15 min, and 2 hours postpartum were observed. Results Compared to the control group, the values of trace blood glucose at 1 hour and 2 hours after birth in the observation group were higher, and the difference between groups was statistically significant (P < 0.05), the neonatal hospitalization rate in the observation group was lower, and the difference between groups was statistically significant (P < 0.05); the ear temperature of 30 min, 60 min, 90 min and 120 min after birth in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). The crying frequency of newborns in the observation group was lower, and the difference between groups was statistically significant (P < 0.05). The incidence of postpartum hemorrhage in the observation group was lower, and the difference between groups was statistically significant (P < 0.05). The rate of uterine contraction/wound pain index grade 1 in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). The rates of uterine contraction/wound pain index grade 2 and grade 3 in the observation group were lower, and the difference between groups was statistically significant (P < 0.05). The rate of lactation at 2 hours postpartum in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). Conclusion Early comprehensive intervention of skin contact combined with breastfeeding can significantly increase the early blood glucose of newborns with GDM, effectively promote the occurrence of early hypoglycemia of GDM newborns, avoid a series of serious complications caused by excessive fluctuation of blood sugar, promote the stability of vital signs of newborns, reduce the hospitalization rate of newborns, improve the success rate of breastfeeding, reduce uterine contraction/wound pain, and reduce the incidence of postpartum hemorrhage. My clinical registration number is chictr220059454.

Comparative Analysis of Clinical Effects of Insulin Aspart Combined with Acarbose and Metformin in the Treatment of Diabetes Mellitus.

Objective To investigate the clinical effect of Insulin aspart 30 combined with acarbose and metformin enteric-coated tablets in the treatment of diabetes mellitus. Methods 90 diabetic patients admitted to our hospital from January 2019 to December 2021 were selected as the research subjects, and the patients were randomly divided into group A (n = 30, using insulin aspart 30 alone), group B (n = 30, using insulin aspart 30 combined with metformin enteric-coated tablets), and group C (n = 30, using insulin aspart 30 combined with acarbose). The blood glucose balance before meals and before going to bed was maintained in the three groups of patients, and the blood glucose fluctuations, time to target, hypoglycemia, insulin dosage, and daily consumption of the three groups were compared. Results There was no significant difference in blood glucose and average blood glucose at each time point before treatment in the 3 groups of patients (P > 0.05); compared with the blood glucose and average blood glucose at each time point after reaching the target in the three groups, the blood glucose after dinner in group A was significantly higher than that in groups B and C; at 2 : 00, the blood glucose of group A was significantly higher than that of group B (P < 0.05); there was no significant difference in blood glucose and average blood glucose at other time points (P > 0.05). There was no significant difference in blood glucose standard deviation, LAGE, and PPGE at each point in the three groups before treatment (P > 0.05); the standard deviation of blood glucose, LAGE, and PPGE at each point of the three groups of patients after reaching the standard were compared with those in the same group before treatment, and the differences were statistically significant (P < 0.05); there were statistically significant differences in blood glucose standard deviation, LAGE, and PPGE among the 3 groups after reaching the standard (P < 0.05). Compared among the three groups, the standard deviation of blood glucose and LAGE level at each point after reaching the standard, the difference between group B, group C, and group A was statistically significant (P < 0.05); however, there was no significant difference between the patients in group B and group C (P > 0.05); the level of PPGE in group A was higher than that in group B, which was higher than group C, and between group C and group A, the difference was statistically significant (P < 0.05). The time of reaching the standard in 3 groups was statistically significant (P < 0.05); there was no significant difference in the time of reaching the standard between group B and group C (P > 0.05). There was no significant difference in the incidence of hypoglycemia among the 3 groups (P > 0.05); there were significant differences in the proportion of insulin twice a day among the three groups (P < 0.05); there were statistically significant differences in daily insulin dosage among the 3 groups after reaching the standard (P < 0.05). The daily consumption of the three groups of patients after reaching the standard was compared, the difference was statistically significant (P < 0.05), and there was no significant difference between group A and group B (P > 0.05). Conclusion The effect of insulin aspart 30 alone in the treatment of diabetic patients is not good, it will lead to a large fluctuation of blood sugar in the patient's body, and the time required to reach the standard is relatively long; the use of insulin aspart 30 combined with metformin enteric-coated tablets or acarbose can effectively reduce the blood sugar fluctuation range of diabetic patients and reduce the number of insulin injections, and insulin aspart 30 combined with metformin en teric-coated tablets can also greatly reduce the daily insulin dosage and daily consumption cost of diabetic patients.

Effect of green wheat flour addition on the dough, gluten properties, and quality of steamed bread

In this work, different proportions of green wheat flour were used instead of flour to make steamed bread and the physicochemical and nutritional properties of different mixed flours were compared. The effect of green wheat on the quality of dough and steamed bread was evaluated, and a new staple food of green wheat steamed bread was developed. The gluten and elasticity of green wheat flour dough will decrease and the gluten network structure of the dough appeared holes and became uneven. Compared with full wheat steamed bread, as the addition of green wheat flour increased, the sensory quality, specific volume, and elasticity of steamed bread decreased, while firmness, gumminess, and chewiness increased and the flavor had a significant change. Meanwhile, the addition of green wheat flour can significantly reduce the glycemic index of steamed bread, which was beneficial to hinder the violent fluctuation of blood sugar. After adding 20% green wheat flour, the GI value decreased from 81.253 to 73.237. Furthermore, when the green wheat flour was added at 10%, the overall quality of the steamed bread was ideal, which laid a theoretical foundation for industrial production and application. Novelty Impact Statement The application of the green wheat flour to the preparation of steamed bread can improve the nutrition and reduce the predicted glycemic index of steamed bread, which will provide a theoretical reference for the industrial production of green wheat flour for steamed bread making.

Effect of mulberry galacto-oligosaccharide isolated from mulberry on glucose metabolism and gut microbiota in a type 2 diabetic mice

• Mulberry galacto-oligosaccharide (MGO) could reduce blood sugar fluctuations in type 2 diabetic mice. • MGO alleviates the oxidative stress. • MGO up-regulates PI3K/Akt pathways in type 2 diabetic mice. • MGO displayed a positive effect in the liver glucose metabolism pathways. • MGO was able to change the fecal microbiota in type 2 diabetic mice. Mulberry possesses many biological characteristics, such as reduce blood sugar and antioxidant properties, but whether mulberry galacto-oligosaccharide (MGO) can impact the characteristics of the gut microbiota is not yet clear. The objective of this work was to investigate the protective effects of MGO in type 2 diabetic (T2D) mice. The analysis of typical diabetic symptoms and serum status showed that oral MGO alleviated hyperglycemia, insulin resistance and oxidative stress in diabetic mice. These changes were caused by up-regulating the expression of key proteins in the PI3K/Akt pathway, involved in the control of liver glycolysis and gluconeogenesis, and liver glucose metabolism having a positive hypoglycemic effect. Additionally, the gut microbiota indicated that MGO treatment could positively modulate the microbiome composition to decrease the blood glucose in diabetic mice by promoting the growth of Prevotellaceae and Lactobacillus, whereas decreasing the abundance of Lachnospiraceae .

Fluctuations in blood sugar with different types of breathing

Fluctuations in blood sugar with different types of breathing

Meglitinide (repaglinide) therapy in permanent neonatal diabetes mellitus: two\xa0case reports

BackgroundPermanent neonatal diabetes mellitus (PNDM) presents with dehydration and hyperglycemia, which usually occurs during the first 12 months of life. Activating mutations of beta-cell adenosine triphosphate-sensitive potassium [KATP] channel subunits that cause opening of the channel are associated with PNDM. Some patients with PNDM respond to administration of a sulfonylurea derivative, which has long action on blood glucose even during hypoglycemia and has an apoptotic effect on beta cells. However, there have been no reports regarding treatment with meglitinide (repaglinide), which has rapid and short duration of action during the rise in blood glucose after meals that is more similar to beta cell function. It has no effects during hypoglycemia, so it does not cause neurological damage, and has no apoptotic effect on beta cells. We report herein the effects of repaglinide administration in the management and clinical outcome of two patients with PNDM during 9 and 10 years of follow-up.Case presentationTwo Iranian infants were brought to our institution with poor general condition, dehydration, lethargy, and poor feeding. They had diabetic ketoacidosis at 52 days and 3.5 months of age, respectively. Their genetic analysis revealed mutations in the KCNJ11 gene encoding KIR6.2, so they both had PNDM. After treatment of diabetic ketoacidosis with insulin, they responded to sulfonylurea (glibenclamide) treatment, but were switched to repaglinide because of blood sugar fluctuations in terms of hyper- and hypoglycemia. Repaglinide was administered with the dosage of 0.04 mg/kg/day divided before every meal.ResultsThe patients were 10 and 9 years old at the last visit, with normal growth parameters. The values of self-monitored blood glucose were well-controlled, and the hemoglobin A1C (HbA1C) levels ranged from 3.6 to 6.4% during the follow-up period. There was no complication of diabetes, neurological disorder, or adverse effects related to repaglinide.ConclusionIn every neonate or infant < 6 months of age with diabetes mellitus, PNDM should be considered. A trial of oral repaglinide can be performed and substituted for glibenclamide for prevention of hypoglycemia, neurological damage, and apoptosis of beta cells during long-term administration.

ANALYSIS OF PERI-OPERATIVE BLOOD SUGAR LEVELS IN VARIOUS ANESTHETIC APPROACHES IN NON-DIABETIC AND DIABETIC PATIENTS: COMPARATIVE STUDY FROM CENTRAL INDIA

Surgical procedures cause a stress response, which results in biochemical and hormonal changes. Elevated blood sugar is the most well-known metabolic disorder. Inadequate glycemic regulation affects perioperative morbidity and mortality. The hyperglycemic reaction varies depending on the anesthetic agent and technique used. The study's aim is to compare non-diabetics and diabetics in terms of the degree to which blood sugar levels rise as a measure of stress during anesthesia and surgery under different anesthetic techniques (controlled). Ninety adult patients (30 to 55 years old) underwent various elective surgeries lasting 60 to 90 minutes under three anesthetic techniques (general (GA), epidural (EA), and spinal (SA)) at a tertiary healthcare center in Central India. 45 of the patients were not diabetic and 45 were diabetics under care. Blood sugar levels were compared between three techniques in each group and between similar techniques in both groups. Blood sugar fluctuation is less with regional techniques and much less with spinal analgesia in diabetics and non-diabetics. Wherever possible, regional techniques can reduce a diabetic's response to surgical stress. The need for an intraoperative insulin regimen may not be required in all procedures, but it is more dependent on the length and severity of the procedure. Glycemic regulation is easier in spinal anesthesia than in general anesthesia since the stress response to surgery is comparatively lower. Where necessary, we prefer spinal anesthesia to epidural and general anesthesia for minimizing surgical stress response.

Preliminary prospective study of real-time post-gastrectomy glycemic fluctuations during dumping symptoms using continuous glucose monitoring.

BACKGROUNDAlthough dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life, the causes, including blood sugar fluctuations, are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIMTo investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODSPatients receiving distal gastrectomy with Billroth-I (DG-BI) or Roux-en-Y reconstruction (DG-RY) and total gastrectomy with RY (TG-RY) for gastric cancer (March 2018-January 2020) were prospectively enrolled. Interstitial tissue glycemic profiles were measured every 15 min, up to 14 d, by continuous glucose monitoring. Dumping episodes were recorded on 5 patient-selected days by diary. Within 3 h postprandially, dumping-associated glycemic changes were defined as a dumping profile, those without symptoms as a control profile. These profiles were compared.RESULTSThirty patients were enrolled (10 DG-BI, 10 DG-RY, 10 TG-RY). The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal, which 47 control profiles did not (P < 0.05). Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles, with lower glycemic levels. DG-RY and TG-RY late dumping profiles (7 and 13, respectively) showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia, with a steeper drop in TG-RY than in DG-RY. CONCLUSIONPostprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer. Furthermore, glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.

Effect of Yogic technique Shavasana in T2DM patients on BP, blood sugar fluctuations and Sleep Quality

Effect of Yogic technique Shavasana in T2DM patients on BP, blood sugar fluctuations and Sleep Quality