Grams Of Glucose Research Articles

Use of neutral protamine lispro insulin (NPL) in patients with hyperglycemia receiving parenteral nutrition.

Nutritional support with parenteral nutrition (PN), a key component in the care of critically ill patients, usually requires insulin therapy in patients with diabetes or may require insulin treatment in patients not known to be diabetic. We wanted verify whether it is possible to use neutral protamine lispro (NPL) in double administration monotherapy in patients receiving artificial nutrition (AN) and if the same NPL is capable of obtaining and maintaining acceptable glycemic control without inducing hypoglycemia. We studied 18 consecutive patients, who were not taking insulin, they needed to start artificial nutrition, and presenting at least two consecutive blood glucose > 120 mg/dL. Each patient was given at least 1 U of insulin for every 10 grams of glucose infused. Eighteen consecutive patients, not stratified in any way, were judged eligible in the last 24 months, with a mean age of 71 years (range 54-85 yrs). All patients were evaluated after 2, 3 and 5 days of treatment; only 1 patient has not been evaluated to 5 days. Mean glycemic values on days 2, 3, 5 were in range between 145 and 180 mg/dL. Any adjustments in NPL dose were carried out by the team of nutrition and there was no hypoglycemia that required medical intervention in emergency. Our impression is that also lispro protamine insulin (NPL) in double subcutaneous administration may contribute to improving the glycemic values in patients receiving parenteral nutrition with hyperglycemia.

Validity and Reliability of a Glucometer Against Industry Reference Standards.

As an appealing alternative to reference glucose analyzers, portable glucometers are recommended for self-monitoring at home, in the field, and in research settings. The purpose was to characterize the accuracy and precision, and bias of glucometers in biomedical research. Fifteen young (20-36 years; mean = 24.5), moderately to highly active men (n = 10) and women (n = 5), defined by exercising 2 to 3 times a week for the past 6 months, were given an oral glucose tolerance test (OGTT) after an overnight fast. Participants ingested 50, 75, or 150 grams of glucose over a 5-minute period. The glucometer was compared to a reference instrument. The glucometer had 39% of values within 15% of measurements made using the reference instrument ranging from 45.05 to 169.37 mg/dl. There was both a proportional (-0.45 to -0.39) and small fixed (5.06 and 0.90 mg/dl) bias. Results of the present study suggest that the glucometer provided poor validity and reliability results compared to the results provided by the reference laboratory analyzer. The portable glucometers should be used for patient management, but not for diagnosis, treatment, or research purposes.

Breath Testing for Small Intestinal Bacterial Overgrowth: Maximizing Test Accuracy

The diagnosis of small intestinal bacterial overgrowth (SIBO) has increased considerably owing to a growing recognition of its association with common bowel symptoms including chronic diarrhea, bloating, abdominal distention, and the irritable bowel syndrome. Ideally, an accurate and objective diagnosis of SIBO should be established before initiating antibiotic treatment. Unfortunately, no perfect test exists for the diagnosis of SIBO. The current gold standard, small-bowel aspiration and quantitative culture, is limited by its high cost, invasive nature, lack of standardization, sampling error, and need for dedicated infrastructure. Although not without shortcomings, hydrogen breath testing provides the simplest noninvasive and widely available diagnostic modality for suspected SIBO. Carbohydrates such as lactulose and glucose are the most widely used substrates in hydrogen breath testing, with glucose arguably providing greater testing accuracy. Lactose, fructose, and sorbitol should not be used as substrates in the assessment of suspected SIBO. The measurement of methane in addition to hydrogen can increase the sensitivity of breath testing for SIBO. Diagnostic accuracy of hydrogen breath testing in SIBO can be maximized by careful patient selection for testing, proper test preparation, and standardization of test performance as well as test interpretation.

Serum Levels of Visfatin and Possible Interaction with Iron Parameters in Gestational Diabetes Mellitus

Background/Aims: Visfatin is a novel adipokine with insulinomimetic properties that increases in diabetes. However, for gestational diabetes mellitus (GDM) there are conflicting reports. Recent studies have reported a positive association of serum ferritin concentrations with insulin resistance. Thus, we assessed serum levels of visfatin in pregnant women with varying degrees of glucose tolerance and investigated the possible interaction of visfatin with parameters of iron metabolism. Methods: Visfatin levels were measured at 24-28 weeks of gestation in 88 women who were divided into three groups according to their response to a 50-gram glucose challenge test and a 100-gram oral glucose tolerance test: control group (n = 28), impaired glucose tolerance (IGT) group (n = 30) and GDM group (n = 30). Results: Visfatin levels were significantly higher in the GDM and IGT group than in control (p < 0.001 for GDM vs. control, and p = 0.004 for IGT vs. control). Serum visfatin was significantly associated with serum ferritin, insulin, age, gravidity, and body mass index. In a linear regression model, the covariates explained only 17% of variability of serum visfatin concentration. Body mass index (p < 0.001) contributed independently to visfatin variance. Conclusion: Serum visfatin concentration is significantly higher in GDM and is correlated with ferritin levels.

The Stress-Induced Cardiovascular Reactivity in the Fasting and Fed States of Healthy Young Indian Males

Low blood glucose levels have been associated with a hostile behaviour. The individuals who show aggressiveness and hostility are more likely to develop hypertension and cardiac diseases. The future hypertension has been linked with a high cardiovascular reactivity to stress. We have investigated the association of the blood glucose levels with the Cardio Vascular Reactivity (CVR) to stress. Fourty six volunteers were subjected to stress (which was induced by the cold pressor task) in the fasting state and again, half an hour after the ingestion of 75 grams of glucose. The CVR in both conditions was compared in terms of an increase in the heart rate and the blood pressure. The resting pulse was lower and the blood pressure was higher in the fasting condition, as compared to the values which were obtained in the ½ hour post-prandial condition. The CVR to stress was significantly higher in the fasting condition. The increased resting heart rate and the decreased resting blood pressure in the ½ hourPost-Prandial (PP) condition was due to the higher levels of histamine in the post-prandial state. Low blood glucose levels are associated with a higher CVR to stress. This suggests that the persons are prone to develop future hypertension, those with frank hypertension, and the chronic pain sufferers should avoid prolonged fasts, in order to lower their CVR to the stress stimuli which are encountered in the daily life.

Maternal Plasma Advanced Glycation End Products Concentrations in Response to Oral 50-gram Glucose Load in Mid-Pregnancy: A Pilot Study

Accumulating evidence documents the initiation of diverse physiologic and biochemical responses subsequent to an oral glucose load. We sought to evaluate the extent to which acute hyperglycemia, resulting from a 50-gram glucose load, contributes to changes in maternal plasma concentrations of advanced glycation end products (AGEs), a heterogeneous group of molecules formed from the non-enzymatic reaction of reducing sugars with free amino groups of proteins, lipids, and nucleic acids. Blood specimens were collected from each participant in mid-pregnancy using standard procedures before and after a 50-gram oral glucose load. Maternal plasma methylglyoxal (MG), pentosidine and N(epsilon)-(carboxymethyl)lysine (CML) (free and bound) were measured by HPLC-MS/MS method. Non-parametric methods were employed for statistical analysis. Median plasma MG increased 1.27 fold as a result of acute hyperglycemia. Median bound CML concentrations were elevated 21% in post-load plasma samples as compared with pre-load samples, while median free pentosidine concentrations were 51% lower (both p-values < 0.05). Future studies of larger populations and longer periods of follow-up are warranted to investigate the consequences of acute and chronic hyperglycemia on placental function and fetal development.

Screening for gestational diabetes in the 21st century: a population-based cohort study in Israel

Objective: Studies indicate that gestational diabetes mellitus (GDM) prevalence is increasing worldwide. We aimed to examine secular trends in GDM prevalence and screening practices over the last decade in Israel, and to identify changes in GDM risk factors. Methods: We collected data on all 367,247 pregnant women who were screened for GDM between 2000 and 2010 in Israel’s second largest healthcare organization. Multivariable logistic regression analysis was used to identify risk factors for GDM. Results: GDM prevalence increased by 12%, from 3.8% in 2000 to 4.3% in 2010 and was accompanied by a 37% rise in the proportion screened directly by 100-gram oral glucose tolerance test without a prior 50-gram glucose challenge test (from 6.5% to 8.9%). During the study period there was an on-going increment in the proportion of pregnant women with one or more GDM risk factor, such as older age, low socioeconomic level, history of polycystic ovary syndrome or in vitro fertilization, which was all significantly (p < 0.05) associated with the risk of GDM. Conclusions: The increasing risk of GDM in Israel can be explained by both rising prevalence of women with established risk factors, as well as shifting screening practices.

50-Gram glucose challenge test: is it indicative of outcomes in women without gestational diabetes mellitus?

Objective. To examine whether the 50-gram glucose challenge test (GCT) is associated with perinatal outcomes in women without gestational diabetes mellitus (GDM).Methods. This is a retrospective cohort study of 13,789 women who received the GCT and did not have a diagnosis of GDM at the University of California, San Francisco UCSF. GCT values were categorized and examined as predictors of perinatal morbidity using chi-square test and multivariable logistic regression analyses adjusting for maternal characteristics.Results. In women with an elevated GCT but without GDM, the odds of preeclampsia, cesarean delivery, and elevated birth weight were increased. The odds of large-for-gestational age status were increased with aOR 2.0 (95% CI 1.38–2.90) in the 160–179 mg/dl group. The odds of shoulder dystocia was increased with aOR 3.35 (CI 1.03–10.88) in the ≥180mg/dl group.Conclusion. In women without GDM, elevated 50-gram GCT values were associated with higher odds of perinatal morbidity. These findings further support evidence that impaired glucose tolerance is a continuum with possible associated adverse outcomes even at mild ranges; additional research is required to investigate appropriate interventions for women with abnormal screens for GDM.

Anormal Bir Saatlik 50 Gram Glukoz Yükleme Testi ve Perinatal Sonuçlar

Anormal Bir Saatlik 50 Gram Glukoz Yükleme Testi ve Perinatal Sonuçlar

No association of vascular endothelial growth factor A gene rs9369425 polymorphism with glucose metabolism in Chinese Han population

To investigate the relationship between the vascular endothelial growth factor A gene (VEGFA) rs9369425 single nucleotide polymorphism (SNP) and type 2 diabetes in Chinese Han population. One thousand eight hundred and ninety two type 2 diabetes patients and 1808 controls with normal glucose were recruited in this study. Phenotypes including body mass index, waist, waist hip ratio, plasma glucose and serum insulin levels of blood obtained both at 0 and 120 minute during standard 75-gram glucose oral glucose tolerance tests, were analyzed. Insulin resistance and beta cell function were assessed by homeostasis model assessment (HOMA-IR and HOMA-B). Genotyping was performed by time-of-light mass spectrum using a Sequenom platform. The frequencies of minor allele G in the diabetic patients and controls were 10.8% and 11.3% respectively. No significant difference of allele distribution was detected between the cases and controls (P=0.5086). No significant difference (P>0.05) was detected on the association between rs9369425 SNP and clinical phenotypes. VEGFA rs9369425 was not associated with type 2 diabetes in Chinese Han population. Whether there is association in any other loci in this gene remained to be investigated.

Three years in reviews

as we ring in 2010, I am delighted to highlight a few of our accomplishments, and I take the opportunity to congratulate our authors, reviewers, and Associate Editors for their continued excellence and collegiality. It is undeniable that AJP - Endocrinology and Metabolism has played a pivotal role

239: Risk factors for abnormal early gestational 50-gram glucose tolerance testing

239: Risk factors for abnormal early gestational 50-gram glucose tolerance testing

279: 50-gram glucose tolerance test: is it indicative of outcomes in women without gestational diabetes mellitus?

279: 50-gram glucose tolerance test: is it indicative of outcomes in women without gestational diabetes mellitus?

Reducing Cardiometabolic Risk in Peritoneal Dialysis Patients: Role of the Dialysis Solution

Peritoneal dialysis (PD) is a well-established form of therapy for stage 5 chronic kidney disease requiring renal replacement therapy. D-Glucose has been used successfully for several decades as the osmotic agent employed in dialysis solutions to achieve adequate fluid removal. The absorption of 100-200 grams of glucose per day has been suggested as potentially increasing cardiometabolic risk, particularly in patients with diabetes. Supporting and undermining evidence for this hypothesis is reviewed, with a focus on the role of glucose absorption in changes in body composition, dyslipidemia, and glycemic control in diabetic PD patients. Clinical strategies to optimize fluid removal while minimizing the metabolic impact of glucose absorption are also discussed.

Glycaemic Index and Glycaemic Load of Pounded yam in Diabetic and Healthy Subjects

Background: We aim to determine the glycaemic index and load of pounded yam with egusi (melon) soup in the diabetic and control subjects. Study design: metabolic study of 10 type-2 diabetic and 6 healthy volunteer subjects were carried out on two non- consecutive days after an overnight fast. Fifty grams of glucose was used as reference food while 50grams of available carbohydrate of pounded yam and egusi melon vegetable soup meal was used as test meal. Incremental area under the blood glucose curve (IAUC) was used to determine the glycaemic index. Glycaemic load was determined using the percentage of available carbohydrate in the meal multiplied by the glycaemic index. Result: The glycaemic index of pounded yam was 61 and 59 in the diabetic type-2 and healthy subjects respectively while the glycaemic load was 30.5 and 29.5 in type-2 diabetics and healthy subjects respectively. Conclusion: The glycaemic index of pounded yam is moderate. KEY WORDS: Glycaemic index, Glycaemic load, Pounded yam, egusi melon soup, Type-2 diabetic, glucose

Postpartum Glucose Tolerance Screening in Women with Gestational Diabetes in the State of North Carolina

To determine how frequently health care providers taking care of women with gestational diabetes mellitus (GDM) are screening for postpartum glucose tolerance and what practice approaches they are using to care for women with GDM. A mailed survey assessed health care providers' knowledge of GDM and practice patterns. Factors influencing practice protocols for measuring glucose tolerance postpartum were identified. Of 1,002 eligible North Carolina health professionals, 399 responded (40%); 327 of these (82%) were providing prenatal and postpartum care and returned the completed surveys. Almost all providers (98%) screen for GDM, and the majority (97%) use the 50-gram one-hour glucose challenge test. Only 27% of respondents always screen for diabetes mellitus (DM) postpartum. The most common method for screening was the 75-gram two-hour glucose tolerance test (54%). The factors most commonly associated with failure to screen were patients lost to follow-up, patient inconvenience, and inconsistent screening guidelines. A majority (59%) stated that increased reimbursement would have little to no impact on their consistency in providing diabetic counseling. The rate of postpartum glucose tolerance testing is low in this study of providers of postpartum care. Several modifiable barriers to screening were identified. There is a need for improved screening practices and early intervention that could help prevent the complications of DM and benefit subsequent pregnancies in this high risk population.

Four grams of glucose.

Four grams of glucose circulates in the blood of a person weighing 70 kg. This glucose is critical for normal function in many cell types. In accordance with the importance of these 4 g of glucose, a sophisticated control system is in place to maintain blood glucose constant. Our focus has been on the mechanisms by which the flux of glucose from liver to blood and from blood to skeletal muscle is regulated. The body has a remarkable capacity to satisfy the nutritional need for glucose, while still maintaining blood glucose homeostasis. The essential role of glucagon and insulin and the importance of distributed control of glucose fluxes are highlighted in this review. With regard to the latter, studies are presented that show how regulation of muscle glucose uptake is regulated by glucose delivery to muscle, glucose transport into muscle, and glucose phosphorylation within muscle.

Automated computation of glycemic index for foodstuffs using continuous glucose monitoring.

The glycemic index (GI) is a measure of the ability of a food to raise glucose levels after it is eaten. Continuous glucose monitoring (CGM) has been shown to give identical values of GI when compared to traditional methods. However, there has been no standardized protocol for measuring GI that takes into account interindividual variability and chronophysiological glycemic response to food. Our aim was (1) to create and describe software based on a Microsoft Excel 2000 spreadsheet to facilitate rapid, automated, accurate, and standardized processing of data obtained using recent CGM methodology to measure GI and its variability and (2) to assess the benefits of this new approach. Twenty healthy subjects consumed 50 grams of glucose or four alternative foodstuffs (chocolate, apple baby food, rice squares, or yogurt) at breakfast and dinner during 1 week, resulting in 300 CGMS glucose profiles; 92% of meal tests were satisfactory for evaluation. Application and functions of the software DegifXL are described. Using the new spreadsheet software DegifXL, time required for data processing for the 15 data sets for each subject was reduced from 2000 to 160 minutes relative to previously used manual methods. We characterized the GI for four foodstuffs with three replicate measurements in each of 20 subjects and evaluated between person, between time period, and between replicate GI variabilities. DegifXL, combined with CGM, was an efficient and effective tool for routine measurement of group- and subject-related GI.

Intermittent Unexplained Abdominal Pain: Is It Porphyria?

Intermittent Unexplained Abdominal Pain: Is It Porphyria?

Effects of Galactose Consumption Prior to Exercise on Blood Glucose Regulation and Exercise Performance

Individuals with diabetes are encouraged to exercise but maintaining optimal blood glucose concentrations before, during and after exercise is challenging. Carbohydrate consumption prior to exercise can reduce the risk for hypoglycemia during exercise but the negative consequence is usually pre-exercise hyperglycemia. Blood glucose and insulin concentrations rise less after consumption of the naturally occurring sugar galactose than with more common dietary sugars, suggesting that it may be useful to maintain stable glycemia and support exercise performance in people with diabetes. PURPOSE: The purpose of this study was to determine the effects of pre-exercise galactose supplementation on blood glucose and insulin concentration in recreationally active individuals without diabetes during moderate intensity exercise so that these data can be used to design a similar study in people with diabetes. METHODS: In randomized double-blind controlled study design, 8 lean, fit men and women drank 500 ml of a beverage containing either 60 grams of glucose (GLU), galactose (GAL) or placebo (PLA) 1 hour before exercise. After cycling for 50 minutes at 60% VO2peak, subjects completed a performance test at ∼90% of maximum workload until volitional exhaustion. Plasma GLU, insulin, free fatty acids, GAL and lactate concentrations were measured every 15 minutes before, during and after exercise. A repeated measures ANOVA with Tukey's post hoc analysis was done to determine pair-wise significance. RESULTS: Plasma glucose concentrations were significantly higher at rest and lower during exercise after GLU compared to GAL or PLA (p<0.05). Plasma insulin concentrations were significantly higher after GLU (p<0.05) than after GAL or PLA at rest but there were no differences among conditions during exercise or recovery. Performance (i.e. exercise duration and rating of perceived exertion) was best in 6/8 subjects after GAL compared with GLU or PLA but there were no statistically significant differences. CONCLUSIONS: Supporting findings from prior studies, these data suggest that galactose induces a lower pre-exercise rise in blood glucose and a blunted insulin response. These characteristics may help individuals with diabetes maintain tighter blood glucose control before, during and after exercise.