Initial Blood Glucose Research Articles

12599 Early Remission Of Chromosome 6 Q 24-related Neonatal Diabetes Mellitus

Abstract Disclosure: R. Pratibha: None. K. Dummula: None. Introduction: Chromosome 6q24 imprinting abnormalities represent the predominant cause of transient neonatal diabetes mellitus (TNDM), accounting for over two-thirds of cases with an estimated prevalence of 1 in 400,000. While remission typically manifests by 3 months of age, herein we detail a case of Chromosome 6q24-related TNDM exhibiting remission by 1.5 months of age. We share our clinical experience in managing this case without hypoglycemia and using C-Peptide levels as a monitoring tool to track the resolution. Case: A female infant, born at 36 weeks via elective C-section due to fetal growth restriction and oligohydramnios, was closely monitored in the nursery for potential hypoglycemia. Contrary to the expectation, she displayed escalating hyperglycemia, necessitating insulin infusion within 25 hours of birth. Apgar scores were 7 and 9, and the birth weight was 2095 g (6th percentile). Maternal history included impaired glucose tolerance in a previous pregnancy with borderline glucose tolerance during this gestation. The newborn physical exam was unremarkable except for mild macroglossia. Despite initial blood glucose (BG) of 52 mg/dl, it rose to 257 mg/dL by 16 hours. Insulin drip was started at 24 hours due to BG of 304 mg/dL. The monogenic diabetes panel obtained on day of life (DOL) #2 was negative; no acidosis was observed. The C- Peptide was low at 0.2 ng/ml. Insulin infusion was continued until DOL # 20. A trial of glyburide commenced on DOL #9 while on Insulin drip, yielded minimal response, prompting a transition to short-acting insulin for correction of hyperglycemia (>250 mg/dL). C-peptide level during sulfonylurea (SU) trial remained low (0.5 ng/mL). The infant required 2 to 3 corrections per day with 0.05 units of Lispro Insulin, with the last dose administered at 44 days. She did not receive any long-acting Insulin. As of her last follow-up at the endocrine clinic at 57 days of age, the infant is thriving well and has normal blood glucose levels. The 6q24 Methylation-MLPA study showed duplication of 6q24 on the paternally inherited chromosome 6. Significantly, she never encountered hypoglycemia during her hospital stay. The C-peptide increased to 0.8 ng/ml at DOL#37 and had normalized to 1.3 ng/mL by DOL#57 indicating remission of TNDM. Conclusion: 6q24-related TNDM may often be characterized by features such as small for gestational age (SGA), macroglossia, umbilical hernia, cardiac and renal abnormalities. Early presentation of hyperglycemia with this phenotype must prompt its diagnostic evaluation. Early resolution by 1.5 months as seen in our case is uncommon. Uniquely, we used C-peptide as a tracking tool to guide resolution and manage insulin therapy. Presentation: 6/3/2024

6978 Traumatic Presentation Of A Pancreatic Neuroendocrine Tumor

Abstract Disclosure: C.J. Kahn: None. J. Mai: None. A.E. Cabrera: None. A.D. Anderson: None. D.H. Huynh: None. Background: Insulinomas are a subset of functional pancreatic neuroendocrine tumors associated with neuroglycopenic symptoms, fasting hypoglycemia, and rapid resolution of symptoms with glucose administration. Despite this classic presentation, patients often spend years undiagnosed before formal diagnosis and definitive management. Clinical Case: We report the case of a 37-year-old post-partum female with a history of gestational diabetes who presented to our trauma center after losing consciousness while driving and colliding with a utility pole. Emergency Medical Services reported seizure-like activity on the scene with altered sensorium. Her initial blood glucose level of 32 mg/dL improved to 100 mg/dL after 100 ml of 10% dextrose. Initial biochemical analysis obtained from the trauma bay demonstrated a negative serum ethanol level, negative urine toxicology and sulfonylurea level, and elevated C-peptide of 6.71 ng/mL. After stabilization, she underwent a 72-hour fasting test. At the 12-hour mark, she developed hypoglycemia (blood glucose 36 mg/dL) correlated with elevated insulin (28.8 mU/L), proinsulin (173.1 pmol/L), and C-peptide (7.86 ng/mL). Although an initial CT scan of the abdomen and pelvis did not demonstrate any pancreatic abnormalities, an abdominal MRI demonstrated a 13 mm lesion in the tail of the pancreas consistent with a pancreatic neuroendocrine tumor. She subsequently underwent a laparoscopic distal pancreatectomy during the same hospital admission and recovered expeditiously. Final pathology demonstrated a 10 by 15 mm, grade two, well-differentiated neuroendocrine tumor with negative margins. The specimen stained strongly positive for synaptophysin and chromogranin, consistent with the clinical diagnosis of insulinoma. During the patient's postoperative recovery, she had no further episodes of hypoglycemia and did not require insulin for post-pancreatectomy hyperglycemia. She was discharged home with a glucometer and a follow-up scheduled with endocrinology and general surgery. Conclusion: The presentation of patients with insulinomas can vary from vague, nonspecific symptoms to altered levels of consciousness placing patients in potentially lethal situations. Moreover, the insulin resistance experienced by pregnant patients may mask clinical manifestations of hypoglycemia during the peripartum period, making diagnosis more elusive for this population. A high index of suspicion along with prompt diagnosis, in this case, led to definitive surgical management, effectively preventing future traumatic incidents secondary to hypoglycemia. Reference: 1. Dobrindt EM, Mogl M, Goretzki PE, Pratschke J, Dukaczewska AK. Insulinoma in pregnancy (a case presentation and systematic review of the literature). Rare Tumors. 2021;13. doi:10.1177/2036361320986647 Presentation: 6/3/2024

Exploring the influencing factors of non-insulin drug prescriptions in discharged patients with type 1 diabetes.

The aim of this study was to evaluate the admission indicators and characteristics of individuals diagnosed with type 1 diabetes (T1D) to ascertain potential impact on the choice of glucose control therapy after discharge. A total of 398 eligible T1D patients were selected. We conducted multivariable logistic regression analysis to determine the independent influence of predictors on the selection of glucose control therapy after discharge. To explore the influencing factors of different subgroups, we additionally performed subgroup analyses based on gender and age. Our study revealed that body mass index (BMI) was noteworthy influence factor for prescription of insulin and non-insulin antidiabetic drug (NIAD prescription) in T1D patients of general population [OR = 1.109 (1.033-1.195), p = 0.006], male [OR = 1.166 (1.040-1.318), p = 0.011] and individuals below the age of 30 years [OR = 1.146 (1.020-1.301), p = 0.028]. Diastolic blood pressure (DBP) was a protective factor for NIAD prescription in the general population [OR = 0.971 (0.949-0.992), p = 0.008] and women [OR = 0.955 (0.923-0.988), p = 0.008]. The other risk factor of NIAD prescription in men was dyslipidemia [OR = 4.824 (1.442-22.246), p = 0.020]. Pulse pressure [OR = 1.036 (1.007-1.068), p = 0.016] constituted an additional risk factor of NIAD prescription among individuals below the age of 30 years. The risk factors of NIAD prescription for people aged 30 to 50 years were length of stay [OR = 1.097 (1.014-1.196), p = 0.026] and initial blood glucose [OR = 1.078 (1.007-1.168), p= 0.047]. In the case of individuals aged above 50 years, physicians exhibited a higher tendency to prescribe supplementary non-insulin medications to men [OR = 9.385 (1.501-87.789), p = 0.029]. We identified notable factors that influence discharge prescriptions in patients with T1D. In order to enhance the treatment outcome for the patient, clinicians ought to have a special focus on these indicators or factors.

Stress hyperglycemia ratio and its influence on mortality in elderly patients with severe community-acquired pneumonia: a retrospective study

BackgroundCommunity-acquired pneumonia (CAP) is a significant health issue among the elderly, with severe cases (SCAP) having high mortality rates. This study assesses the predictive significance of the stress hyperglycemia ratio (SHR) in elderly SCAP patients and its impact on outcomes in both diabetic and non-diabetic patients.Methods and materialsThis retrospective study included 406 SCAP patients aged 65 or older from the Second People’s Hospital of Lianyungang (January 2020 to December 2023). Data collected included demographics, medical history, vital signs, and lab results. SHR was calculated from initial blood glucose and estimated average glucose (HbA1c). Statistical analyses, including Cox regression and Kaplan-Meier analysis, evaluated SHR’s impact on mortality. Mediation models explored the effects of neutrophil-lymphocyte ratio (NLR) and SHR.ResultsThe 28-day mortality rate was 21.67%. Deceased patients had higher age, Charlson Comorbidity Index, procalcitonin, NLR, glucose, and SHR levels compared to survivors (P < 0.05). Both SHR and NLR significantly increased mortality risk, particularly in non-diabetic patients. Combining NLR and SHR improved ROC AUC to 0.898, with 89.80% sensitivity and 81.10% specificity. Kaplan-Meier analysis showed higher cumulative survival for SHR < 1.14, regardless of diabetes status (P < 0.05). NLR mediated 13.02% of the SHR-survival relationship, while SHR mediated 14.06% of the NLR-survival relationship.ConclusionElevated SHR is a significant mortality risk factor in elderly SCAP patients, independent of diabetes status. Stringent glucose control and careful monitoring of SHR may improve outcomes in elderly patients with acute respiratory conditions.

Admission Blood Glucose Associated with In-Hospital Mortality in Critically III Non-Diabetic Patients with Heart Failure: A Retrospective Study.

Heart failure (HF) is a primary public health issue associated with a high mortality rate. However, effective treatments still need to be developed. The optimal level of glycemic control in non-diabetic critically ill patients suffering from HF is uncertain. Therefore, this study examined the relationship between initial glucose levels and in-hospital mortality in critically ill non-diabetic patients with HF. A total of 1159 critically ill patients with HF were selected from the Medical Information Mart for Intensive Care-III (MIMIC-III) data resource and included in this study. The association between initial glucose levels and hospital mortality in seriously ill non-diabetic patients with HF was analyzed using smooth curve fittings and multivariable Cox regression. Stratified analyses were performed for age, gender, hypertension, atrial fibrillation, CHD with no MI (coronary heart disease with no myocardial infarction), renal failure, chronic obstructive pulmonary disease (COPD), estimated glomerular filtration rate (eGFR), and blood glucose concentrations. The hospital mortality was identified as 14.9%. A multivariate Cox regression model, along with smooth curve fitting data, showed that the initial blood glucose demonstrated a U-shape relationship with hospitalized deaths in non-diabetic critically ill patients with HF. The turning point on the left side of the inflection point was HR 0.69, 95% CI 0.47-1.02, p = 0.068, and on the right side, HR 1.24, 95% CI 1.07-1.43, p = 0.003. Significant interactions existed for blood glucose concentrations (7-11 mmol/L) (p-value for interaction: 0.009). No other significant interactions were detected. This study demonstrated a U-shape correlation between initial blood glucose and hospital mortality in critically ill non-diabetic patients with HF. The optimal level of initial blood glucose for non-diabetic critically ill patients with HF was around 7 mmol/L.

The Effect of Healthy Boba Pearl Drink on Post-Prandial Glucose

This study was a randomized controlled trial using a repeated experimental design with a pre-test and a post-test control group. The study subjects were women of childbearing age, aged 20‒30 years, with no diagnosed chronic diseases and with baseline fasting blood glucose levels less than 125 mg/dL. Participants were randomly assigned to treatment and control groups. The treatment group received 350 mL of healthy boba drink, while the control group received 350 mL of commercial boba drink. The healthy boba drink was made by mixing 67 mL of fresh milk, 133 mL of soy milk, 1 g of stevia sweetener, 100 g of red dragon fruit, and 40 g of healthy boba pearls. It contained 215 kcal of energy, 8.82 g of protein, 8.90 g of fat, 30.78 g of carbohydrate, and 1,808 g of fiber. Each group had an initial fasting blood glucose levels measurement before the intervention, and postprandial glucose levels were measured at the end of the intervention (one time of intervention). The collected data were analyzed univariately to analyze the effect of treatment on postprandial glucose using the independent t-test. The result indicated that the subjects in the treatment group and 96.2% of the subjects in the control group had fasting glucose levels less than 126 mg/dL. Both participants in the control and treatment groups had postprandial glucose levels less than 200 mg/dL. The mean glucose level was 89.49 mg/dL in the treatment group and 92.57 mg/dL in the control group. The study results showed that the treatment group that consumed the healthy boba drink had a lower average postprandial glucose level than the control group. The statistical test results showed that there was a significant effect of healthy boba drink consumption on postprandial glucose levels in the treatment group (p&lt;0.000). It is concluded that the healthy boba drink intervention had a significant effect (p&lt;0.000) on lowering blood glucose by 5.82 mg/dL after the initial treatment. The results of this study are a major first step for future work to develop a healthier boba drink.

Persistent hypoglycemia in patients with liver cancer.

Hypoglycemia is one of the paraneoplastic syndrome manifestations that arise from primary and secondary liver cancer. Hypoglycemia usually presents in the late stage of the disease and indicates a poor prognosis. This case series displays the characteristics profile of patients with primary and secondary liver cancer who are presented with hypoglycemia in a tertiary referral hospital in Indonesia. The study included 41 liver cancer patients who were presented with hypoglycemia. Hepatocellular carcinoma was diagnosed in 51.2% of patients, metastatic liver disease in 14.6% of patients, and undiagnosed liver cancer in 34.1% of patients. The mean age was 47.7 years with male predominance (65.9%). Jaundice was found in 58.5% and hepatomegaly in 70.7% of patients. The mean (± S.D.) initial blood glucose was 42.15 ± 17.11 mg/dL and the Child-Pugh score was 9.93 ± 2.11. Based on imaging, tumor diameter was 12.6 ± 6.9 cm, multiple (61%), and involving both lobes (61%). Treatments for hypoglycemia included oral/enteral feeding, intravenous dextrose, and steroids. No treatment was given for the cancer because all patients were in an advanced stage. The treatment resulted in 41.5% blood glucose being controlled, 56.1% refractory, and 2.4% persistent. Mortality was 70.7% and in average occurred 5.76 ± 4.99 days after hypoglycemia. The mainstay of treatment in these cases is treating the tumor with cytoreduction. However, it was difficult to do cytoreduction because the tumor was already in an advanced stage. Beneficial supportive treatments for maintaining normal blood glucose are frequent meals, dextrose infusion, steroids, and glucagon. Hypoglycemia in liver cancer occurs due to the failure of the liver to fulfill body glucose demand because the liver parenchyma has been largely replaced by the tumor, in addition to the high production of insulin growth factor (IGF). Hypoglycemia is often caused by islet cell and non-islet cell tumors, with a higher occurrence in non-islet cell tumors due to paraneoplastic syndrome and the high metabolic requirements of the tumor. The mainstay of NICTH treatment is treating the tumor with cytoreduction. However, in an advanced stage, cytoreduction therapy is often challenging to conduct. Beneficial supportive treatments for controlling blood glucose are frequent meals, dextrose infusion, and the injection of steroids and glucagon. Steroids play a beneficial role in the treatment of persistent hypoglycemia in hepatocellular carcinoma by stimulating gluconeogenesis and increasing lipolysis. Steroids also have roles in the inhibition of peripheral glucose intake, suppression of big IGF-2 production, and modulation of the GH-IGF axis.

Evaluating insulindysregulation in horses: A two-step insulin-tolerance test using porcine zinc insulin

In insulin dysregulation, hyperinsulinemia (HI) can be accompanied by peripheral insulin resistance (IR) in horses, which can be diagnosed with an insulin-tolerance test (ITT). The administration of 0.1 IU/kg body weight of recombinant regular human insulin (RHI) should elicit a 50 % reduction of the initial blood glucose concentration at 30 min after insulin administration in insulin sensitive horses. Compared to RHI, porcine zinc insulin (PZI) is veterinary-approved and therefore easier accessible for many practitioners. The aim of this study was to compare the insulin and glucose dynamics during a standard ITT with RHI to an ITT performed with PZI. Twelve Icelandic horses were subjected to an ITT with RHI (ITT-RHI) and with PZI (ITT-PZI) at same dosages in a randomised crossover design. The insulin and glucose dynamics that resulted from these tests were compared, and the consistency of classification into insulin-sensitive and IR categories was evaluated. No complications were observed with the use of either RHI or PZI in ITT. A good correlation of the test results was observed (r = 0.88; P < 0.001). The blood glucose concentrations and the percentage reduction in glucose concentration did not differ significantly between the two tests (P = 0.053), but four out of twelve horses were classified as IR in the ITT-RHI whereas with the ITT-PZI seven out of twelve horses were classified as IR with the 50 % glucose reduction from baseline. Based on the Youden index, when using the ITT-PZI, an adjusted cut-off value for blood glucose reduction of 40 % at 30 min resulted in better test performance. With consideration for the seemingly weaker effect of PZI and the adjusted cut-off value, PZI can be an appropriate substitute to RHI in an ITT.

#2209 Hypoglycemia induced by hemodialysis in diabetic and non-diabetic patients, how to prevent it? A prospective study

Abstract Background and Aims Hemodialysis-induced hypoglycemia, a documented complication associated with adverse clinical outcomes, including mortality, is linked to factors such as impaired gluconeogenesis, inadequate nutritional status, reduced insulin clearance, glucose loss to the dialysate, and autonomic neuropathy. Glycemic variability is recognized as an independent risk factor for morbidity and mortality. This study aims to investigate the incidence of hypoglycemia during hemodialysis (HD) by exploring protocol-related factors and their impact, such as in-nutrition during HD. Additionally, the study seeks to examine the relationship between nutritional and inflammatory statuses and variations in intradialytic glycemia in both diabetic and non-diabetic patients. Method This prospective study, conducted between September and December 2023, examined the glycemic profiles of HD patients at a hospital HD program. All patients undergo hemodialysis with a dialysate containing 100 mg/dL of glucose. Plasma glucose levels were assessed at the start, 2:30 hours post-initiation, and the end of sessions. Following the 2:30-hour mark, patients received a meal (523 Kcal). Glycose variability was computed by averaging blood glucose differences across all sessions. Data collected included demographics, hemodialysis specifics, and lab results. Inflammatory and nutritional statuses were evaluated using lab tests at the study's beginning and conclusion [ferritin, protein C reactive (PCR), interleukin 6 (IL-6) and albuminemia, urea, creatinemia, cholesterol, respectively]. Anthropometric measurements and bioimpedance assessments were performed, with values averaged for better representation. Categorical variables are shown with frequencies/percentages, and continuous variables with means/standard deviations or medians/interquartile ranges for skewed distributions. The study used repeated measures ANOVA for glycemic profiles, correlation analyses for outcome influences on glycemia, and parametric/non-parametric tests for relations in diabetic and non-diabetic groups. Significance was set at p&amp;lt;0.05, analyzed with SPSS version 29 for Mac OS 13. Results 63 patients, 67.2% (n=43) were males, the medium age was 72.0±11.8 and 50.8% (n=32) had diabetes. Among 9072 measurements, hypoglycemia was observed in 0.07% (n=6) of diabetic patients and 0.01% (n=1) in non-diabetic individual. The initial blood glucose measurement was 139.5±260.0 mg/dL, the second was 117.05±35 mg/dL, and the third was 132.8±21.3 mg/dL. Significant differences were observed in all measurements [F (1.17, 73.58)=23.62; p&amp;lt;0.001]. The mean glycemic variation between the first and second measurements was 23.8±46.0 mg/dL, and for the third measurement was 5.5±71.5 mg/dL. There was no significant correlation found between glycemic and nutritional parameters neither between inflammatory parameters. In the subgroup analysis comparing diabetic and non-diabetic patients, the diabetic group demonstrated lower serum creatinine levels (6.8±2.7 mg/dL) and total cholesterol (137.4±35.6 mg/dL), coupled with a higher Charlson Index (8.2±1.7). These differences were statistically significant (p=0.055, p=0.035, p&amp;lt;0.001). In the subsequent analysis, no other statistically significant associations were observed. Conclusion Contrary to what is described in the literature, the studied population exhibited a very low incidence of hypoglycemic events. This underscores the importance of nutrition during HD, along with the use of a glucose-containing dialysate, as an effective preventive measure against intradialytic hypoglycemia. Careful consideration of these factors is warranted to prevent adverse health consequences for our patients. It is plausible that diabetic patients may face an elevated risk of malnutrition, necessitating heightened concern and a more proactive preventive approach.

Evaluation of Nurse-Driven Management of Hypoglycemia In Critically Ill Patients.

Intensive care unit (ICU) patients experience hypoglycemia at nearly 4 times the rate seen in non-ICU counterparts. Although inpatient hypoglycemia management relies on nurse-driven protocols, protocol adherence varies between institutions and units. To compare hypoglycemia management between ICU and non-ICU patients in an institution with high adherence to a hypoglycemia protocol. This secondary analysis used retrospective medical record data. Cases were ICU patients aged 18 years or older with at least 1 hypoglycemic event (blood glucose level < 70 mg/dL); non-ICU controls were matched by age within 10 years, sex, and comorbidities. Time from initial hypoglycemic blood glucose level to subsequent blood glucose recheck, number of interventions, time to normoglycemia, and number of spontaneous hypoglycemic events were compared between groups. The sample included 140 ICU patients and 280 non-ICU controls. Median time to blood glucose recheck did not differ significantly between groups (19 minutes for both groups). Difference in mean number of interventions before normoglycemia was statistically but not clinically significant (ICU, 1.12; non-ICU, 1.35; P < .001). Eighty-four percent of ICU patients and 86% of non-ICU patients returned to normoglycemia within 1 hour. Median time to normoglycemia was lower in ICU patients than non-ICU patients (21.5 vs 26 minutes; P = .01). About 25% of patients in both groups experienced a spontaneous hypoglycemic event. Adherence to nurse-driven hypoglycemia protocols can be equally effective in ICU and non-ICU patients. Further research is needed to determine protocol adherence barriers and patient characteristics that influence response to hypoglycemia interventions.

The effect of argatroban on early neurological deterioration and outcomes in minor ischemic stroke: preliminary findings.

Minor ischemic stroke (MIS) is associated with early neurological deterioration (END) and poor prognosis. Here, we investigated whether argatroban administration can mitigate MIS-associated END and improve functional outcomes by monitoring activated partial thrombin time (APTT). Data were collected for patients with MIS admitted to our hospital from January 2019 to December 2022. Patients were divided into a dual antiplatelet therapy (DAPT) group (aspirin + clopidogrel) and an argatroban group (aspirin + argatroban). Those in the latter group who achieved a target APTT of 1.5-3-fold that of baseline and <100 s at 2 h after argatroban infusion were included in the argatroban subgroup. The primary outcome was the END rate of the DAPT group versus that of the argatroban group or the argatroban subgroup. Secondary outcomes included the proportion of patients with modified Rankin Scale (mRS) 0-2 at 7 and 90 days. In addition, baseline date were compared between patients with and without END in the argatroban group. 363 patients were included in the DAPT group and 270 in the argatroban group. There were no significant differences in any above outcome between them. 207 pairs were included in the DAPT group and the argatroban subgroup after 1:1 propensity score matching (PSM). Significant differences were observed in the proportion of END (OR, 2.337; 95% CI, 1.200-4.550, p = 0.011) and mRS 0-2 at 7 days (OR, 0.624; 95% CI, 0.415-0.939, p = 0.023), but not in mRS 0-2 at 90 days or the hemorrhagic events between the two groups. In the argatroban group, univariate analysis showed that the rate of diabetes (OR, 2.316; 95% CI, 1.107-4.482, p = 0.023), initial random blood glucose (OR, 1.235; 95% CI, 1.070-1.425, p = 0.004), drinking history (OR, 0.445; 95% CI, 0.210-0.940, p = 0.031) or those reaching the target APTT (OR, 0.418; 95% CI, 0.184-0.949, p = 0.033) was significantly different among patients with and without END. However, there were no statistical differences in these parameters between them following multivariate analysis. In patients with MIS, argatroban administration and reaching the target APTT can reduce the incidence of END and improve short-term functional prognosis.

Longitudinal trajectories of blood glucose and 30-day mortality in patients with diabetes mellitus combined with acute myocardial infarction: A retrospective cohort analysis of the MIMIC database.

Although blood glucose changes have been suggested to be a potential better target for clinical control than baseline blood glucose levels, the association of blood glucose changes with the prognosis in acute myocardial infarction (AMI) patients with diabetes mellitus (DM) is unclear. Herein, this study aimed to investigate association of short-term longitudinal trajectory of blood glucose with 30-day mortality in this population. Data of AMI patients with DM were extracted from the Medical Information Mart for Intensive Care (MIMIC) database in 2003-2019 in this retrospective cohort study. The latent growth mixture modeling (LGMM) model was utilized to classify the 24-hour longitudinal trajectory of blood glucose of the patients. Kaplan-Meier (KM) curve was drawn to show 30-day mortality risk in patients with different trajectory classes. Univariate and multivariate Cox regression analyses were employed to explore the association of longitudinal trajectory of blood glucose within 24 hours after the ICU admission with 30-day mortality. Also, subgroups analysis of age, gender, and AMI types was performed. The evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs). Among 1,523 eligible patients, 227 (14.9%) died within 30 days. We identified 4 longitudinal trajectories of blood glucose, including class 1 (a low initial average blood glucose level with steady trend within 24 hours), class 2 (a high initial average blood glucose with gently decreased trend), class 3 (the highest initial average blood glucose with rapidly decreased trend) and class 4 (a high initial average blood glucose level with the trend that increased at first and then decreased). After adjusting for covariates, an average blood glucose level of ≥200 mg/dL was linked to higher risk of 30-day mortality, comparing to that of <140 mg/dL (HR = 1.80, 95%CI: 1.23-2.63). Comparing to patients whose longitudinal trajectory of blood glucose conformed to class 1, those with class 2 (HR = 2.52, 95%CI: 1.79-3.53) or class 4 (HR = 3.53, 95%CI: 2.07-6.03) seemed to have higher risk of 30-day mortality. Additionally, these associations were also significant in aged ≥60 years old, female, male, NSTEMI, and STEMI subgroups (all P<0.05). A low level of average blood glucose at the ICU admission or reducing blood glucose to a normal level quickly with adequate measures in 24 hours after ICU admission may be beneficial for AMI patients with DM to reduce the risk of 30-day mortality. These findings may provide some information for further exploration on appropriate range of blood glucose changes in clinical practice.

Effectiveness of Pumpkin Pudding and Pineapple Pudding on Blood Glucose Levels in Diabetic Patients

Hyperglycemia, often known as high blood sugar, is a disease that causes diabetes. Free radicals are produced as a result of hyperglycemia. Due to elevated blood sugar levels, the antioxidant content in pumpkin and pineapple can prevent the formation of free radicals. Reducing blood glucose levels as a result. The purpose of the study is to determine whether giving diabetics pumpkin and pineapple pudding lowers their random blood glucose levels.This type of research is a quasi-experimental design with a pretest and posttest with control group. The sampling technique used was purposive sampling with a sample of 30 diabetic patients, consisting of 2 groups (which were given pumpkin and pineapple pudding): each consisted of 15 patients. Provision for 7 days in a row as much as 250 gr. Random blood glucose levels were measured one day before and after the intervention using the Blood Glucose test. Data analysis using Wilcoxon and Mann Whitney test. The results of this study showed a significant difference in decreasing random blood glucose levels in patients who were given pumpkin pudding (P1) and patients who were given pineapple pudding (P2) between initial and final random blood glucose levels. This research also shows the effectiveness of pumpkin and pineapple pudding in lowering random blood glucose levels.

Risk of endothelial dysfunction in streptozotocin-induced diabetic Sprague-Dawley rats: Nitric oxide in focus

Endothelial dysfunction in diabetes manifests in part as reduction of nitric oxide (NO) bioavailability, which leads to inadequate relaxation of the vascular smooth muscle and a disparity between the vasoconstrictive and vasorelaxant intracellular pathways which favours a rise in vasoconstriction. In this current work, we evaluated serum Nitric oxide (NO) concentration and the activity of Nitric oxide synthase (NOS) in streptozotocin-induced diabetic male and female rats' serum. Our results showed initial and final fasting blood glucose concentration 5.30±0.16mmol/l and 5.24±.015mmol/l versus 5.68±0.18mmol/l and 5.43±0.15mmol/l in male and female controls. Among the diabetic rats, the initial and final fasting blood glucose concentration was 17.50±1.91mmol/l and 15.68±2.84mmol/l versus 20.50±4.76mmol/l and 19.40±4.13mmol/l in male and female rats respectively. NO concentration was 106.12±7.23μmol/l and 131.81±12.54 μmol/l in male and female control rats compared to 52.38±3.01μmol/l and 65.29±16.19 μmol/l in male and female diabetic rats respectively. Serum activity of NOS were 133.72±10.92μIU/l and 156.06±18.22 μIU/l in control male and female rats compared to 98.01±1.48 μIU/l, 78.89±8.39μIU/l in diabetic male and female rats respectively. The difference in both NO concentration and NOS activity was significant between diabetics and non-diabetic rats as well as between male and female diabetics rats (p&lt; 0.05). The endothelial dysfunction in diabetic animals regardless of gender may be an initial pointer to upcoming pathogenesis and we recommend routine evaluation of NO concentration and NOS activities among diabetics.

SAT160 Alcoholic Ketoacidosis : An Endocrine Emergency

Abstract Disclosure: L.E. Tiu: None. T.D. Crisostomo: None. Background: Alcoholic Ketoacidosis is a complex metabolic condition frequently confused with Diabetic Ketoacidosis. Currently, there remains an undefined consensus guideline in the diagnosis and management of this disorder that leads to unreported cases. Clinical Case: A 47-year-old male presented with 2-day history of poor dietary intake due to abdominal pain and vomiting after an alcoholic binge drinking. He is a chronic alcoholic beverage drinker (2 liters of beer per day for 10 years). He has family history of Type 2 Diabetes Mellitus but has no known co-morbidities. Upon admission, vital signs were normal, but he was drowsy and incoherent with signs of dehydration and epigastric tenderness. Initial capillary blood glucose was 52 mg/dL. D50W 50ml intravenously was given with repeat CBG of 222 mg/dL. Arterial blood gas (ABG) showed high anion gap metabolic acidosis (pH 7.0 and anion gap of 42) with undetectable bicarbonate and elevated lactate at 17mmol/L. Serum ketones were elevated at 6mmol/L but Hba1c was normal at 4.6 %. Thus, Alcoholic Ketoacidosis was highly considered. Intravenous hydration with saline solution was instituted then shifted to D10W 125mL/hour to allow insulin infusion therapy at initial rate of 2units/hour. Sodium bicarbonate 100 mEqs was given intravenously with recovery of sensorium thereafter. Oral Vitamin B supplement was started, and two doses of Thiamine 100 mg/IV were given. Other tests showed hyperkalemia (5.28meq/L), hypochloridemia (89.7meq/L), hyperuricemia (12.74mg/dL), and hyperphosphatemia (5.8mg/dL). Serial monitoring and correction of electrolytes were done. Moreover, management integrated simultaneous referrals to other subspecialties to rule out other causes of encephalopathy, to evaluate and manage Hypertriglyceridemic Pancreatitis and Alcoholic Liver Disease, and to facilitate nutritional, psychosocial support and rehabilitation. On 2nd hour, repeat ABG showed improvement of pH to 7.3 and HCO3 to 9.80mmol/L. Lactate decreased to 12.70mmol/L. On the 17th hour, ABG showed metabolic alkalosis with resolution of ketosis hence insulin was discontinued. CBG levels for the next 24-48 hours were within normal limits. Oral feeding was supplemented with parenteral nutrition due to decreased appetite. On 48th hour, he displayed combative behavior with visual hallucinations, but there was no consent for psychiatric referral. On 72nd hour, there was spontaneous marked improvement in his behavior. He was discharged clinically stable. Conclusion: Early recognition of Alcoholic Ketoacidosis is imperative. This is an unrecognized endocrine emergency that portends good outcome with timely diagnosis and management. Treatment includes 1. adequate fluid resuscitation 2. thiamine 3. judicious use of insulin and bicarbonate 4. correction of electrolytes 5. multidisciplinary team management. Presentation: Saturday, June 17, 2023

FRI647 Hemiballismus - A Rare Presentation Of Uncontrolled Diabetes Mellitus Type 2

Abstract Disclosure: C.L. Macrohon: None. M.L. Kanapi: None. Background: Diabetic Striatopathy is a rare disease with a prevalence of 1 in 100,000 and is more commonly seen in elderly women with poor glycemic control. It is an acute movement disorder characterized by sudden, non-purposeful jerking movements secondary to non-ketotic hyperglycemia. This is associated with high-intensity signals on T1-weighted magnetic resonance imaging of the brain noted at the basal ganglia. Case: We have a case of an 80-year old female who came in due to a four-day history of persistent involuntary, non-purposeful jerking of her right upper extremity accompanied by episodes of agitation and visual hallucinations. She has Diabetes Mellitus Type 2 for the past 20 years on Glibenclamide and Metformin. However, self-monitoring of blood glucose revealed fasting glucose levels as high as 300mg/dl. She was asymptomatic hence did not have regular follow-up with her primary care physician. She had no history of previous cerebrovascular disease. Family history was unremarkable. Upon examination, she was disoriented to place but answers appropriately to questions and did not have any speech abnormalities. On inspection it was noted that she had high amplitude involuntary flailing of the right upper extremity accompanied by non-purposeful jerking of her right lower extremity. Initial blood glucose level was 354mg/dl with an Hba1c of 13.7%. Serum ketones was within normal limits with a value of 0.1mmol/L. A plain Magnetic Resonance Imaging of the brain was done which showed a region of T1 weighted hyperintensity with no corresponding abnormal restricted diffusion nor increased susceptibility signals involving the left lentiform nucleus with no evidence of acute infarction nor intracranial hemorrhage noted. At this time, patient was co-managed by Endocrinology and Neurology service with an impression of a Diabetic Striatopathy. For the hemiballism and other neurologic manifestations such as agitation, visual hallucinations and disorientation patient was given risperidone and clonazepam. Blood glucose was then managed through cautious insulin therapy as well as hydration. On the third hospital day, there was noted resolution of right-sided hemiballismus and at this time glycemic control was improved. Conclusion: Proper identification and diagnosis is essential in managing Diabetic striatopathy. Although this may be a rare presentation of uncontrolled diabetes mellitus, clinicians should be aware of the possibility of an acute movement disorder as an unveiling symptom. This shows the importance of prompt blood glucose measurement in these acute cases. Once identified, adequate glycemic control through insulin therapy remains to be the center and most effective therapeutic management for the resolution of these hyperkinetic symptoms. Presentation: Friday, June 16, 2023

Machine learning-based prediction of risk factors for abnormal glycemic control in diabetic cancer patients receiving nutrition support: a case-control study.

To date, risk factors affecting abnormal glycemic control have not been investigated. This study aimed to analyze risk factors for hypoglycemia or hyperglycemia in diabetic cancer patients receiving nutritional support by using machine learning methods. This retrospective two-center study was performed using medical records. Odds ratios and adjusted odds ratios were estimated from univariate and multivariate analyses, respectively. Machine learning algorithms, including five-fold cross-validated multivariate logistic regression, elastic net, and random forest, were developed to predict risk factors for hypoglycemia and hyperglycemia. Data from 127 patients were analyzed. The use of sulfonylurea (SU) and blood urea nitrogen (BUN) level > 20mg/dL increased hypoglycemia by 6.3-fold (95% CI 1.30-30.47) and 5.0-fold (95% CI 1.06-23.46), respectively. In contrast, patients who received an actual energy intake/total energy expenditure (TEE) ≥ 120% and used dipeptidyl peptidase-4 (DPP-4) inhibitors had a higher risk of hyperglycemia by 19.3- (95% CI 1.46-254.78) and 3.3-fold (95% CI 1.23-8.61), respectively. An initial blood glucose level ≥ 182.5mg/dL also increased the risk of hyperglycemia by 15.3-fold. AUROC values for all machine learning methods indicated acceptable and excellent performance for hypoglycemia and hyperglycemia. The use of SU and BUN level > 20mg/dL increased the risk of hypoglycemia, whereas an initial blood glucose level ≥ 182.5mg/dL, a supplied actual energy intake/ TEE ≥ 120%, and the use of DPP-4 inhibitors increased the risk of hyperglycemia.

Student Competition (Knowledge Generation) ID 1984525

Background Drug-induced myelopathy has been reported widely for heroin use, but less frequently for amphetamines or fentanyl. Hyperglycemia-induced acute myelopathy has not previously been described. Methods We present a case of toxic/metabolic myelopathy secondary to the aforementioned results in a patient presenting for tertiary inpatient rehabilitation. Results A 28-year-old man with Type 1 Diabetes without complications and polysubstance use (fentanyl and crystal methamphetamine) presented to hospital with quadriparesis and anesthesia. Patient reported he fell down a flight of stairs while using substances and remained on the ground for hours-days as he was acutely paralyzed when he awoke. Initial examination demonstrated a C5 motor level. Pan-CT demonstrated no intracranial or spinous abnormalities. MRI with gadolinium showed cord edema from C1-T4 and patchy enhancement from C4-C7 without cord compression. Diffusion restriction and hemorrhagic transformation were later seen in C4-C7. Initial blood glucose was 66 with no serum ketones. Serum toxicology was negative and urine toxicology was positive for amphetamines and fentanyl. Autoimmune and infectious workups were negative. He received 5 days of pulse steroids and 7 sessions of plasmapheresis with minimal functional or neurological improvement. He was admitted to rehabilitation as a C5 AIS-B and did not exhibit further improvement in motor or sensory function over 3 months of active inpatient rehab. Conclusions Given the pattern of cord enhancement with hemorrhagic transformation, this injury most likely represents acute myelitis induced by hyperglycemia and amphetamines/fentanyl. To our knowledge, this is the first case report where hyperglycemia may have contributed to acute myelopathy.

Euglycemic diabetic ketoacidosis: The paradox of delayed correction of acidosis

ObjectiveThe effectiveness of standard treatment for diabetic ketoacidosis (DKA) in “euglycemic DKA” (EuDKA, blood glucose (BG) ≤ 250 mg/dL) was evaluated with respect to the time to correction of BG ≤ 200 mg/dL, anion gap (AG)≤12 mmol/L, and serum bicarbonate [HCO3] ≥18 mmol/L. MethodsData were retrieved from an electronic health record (EPIC) for “diabetic ketoacidosis.” Patients were categorized by initial BG as EuDKA, middle range DKA (MrDKA, >250 < 600 mg/dL) and hyperosmolar DKA (HyperDKA ≥600 mg/dL). ResultsThere were 56 patients (27men, 29women; age 45.8 ± 15.6 (SD) years. The initial 8-h insulin infusion rate (0.05 ± 0.02, 0.09 ± 0.03, 0.14 ± 0.05units/kg/h, p < 0.001) and the time to correction of BG (3.4 ± 1.9, 6.1 ± 2.9 and 9.6 ± 3.9 h, p < 0.001), differed for EuDKA, MrDKA and HyperDKA. There were no differences in the time to correction of AG or [HCO3]. The earlier time to correction of BG in EuDKA resulted in paradoxical longer lag times for correction of [HCO3] (p = 0.003) and AG (p = 0.048). Changes in BG, AG and [HCO3] correlated with insulin infusion rates of 0.08–0.1units/kg/h whereas in EuDKA the insulin infusion rate was 0.05 ± 0.02 units/kg/h. ConclusionIn EuDKA, correlation analyses suggest that higher glucose and insulin infusion rates than what would be projected for the level of blood glucose are required to reverse ketoacidosis. Prospective trials are required to optimize the levels of glucose and insulin infusions in EuDKA.

Development and validation of a risk prediction nomogram for serious arrhythmias in acute digoxin toxicity among pediatrics: A multicenter study

Digoxin is a cardiac glycoside obtained from the leaves of the foxglove plant, Digitalis lanata. Several studies have described the safety of digoxin including various life-threatening events, notably cardiac arrhythmias. Early identification of high-risk patients and subsequent initiation of the utmost medical care are associated with a better prognosis. The assessment of serum digoxin levels, which is not always convenient, is the only tool used to evaluate the severity of digoxin exposure. However, the feasibility of this tool, particularly in resource-restricted countries, remains unclear. Therefore, the current study aimed to establish and validate a feasible alternative tool, a bedside nomogram, to identify pediatric patients diagnosed with acute digoxin intoxication who are at risk of developing serious arrhythmias. This was a two-phase, multicenter, retrospective study. The prevalence of serious arrhythmias was approximately 17%. Patients diagnosed with serious arrhythmias showed significantly higher serum digoxin, random blood glucose, and potassium levels but lower sodium, magnesium, and hemoglobin levels. Serious arrhythmias were associated with significantly lower P-R intervals, shorter QTc intervals, and more frequent digoxin effects (p < 0.05). The proposed nomogram showed that combining age and initial random blood glucose, sodium, and potassium levels could predict the future incidence of serious arrhythmia with an accuracy of 96.2% (sensitivity = 94.4%, specificity = 96.5%), an area under the curve (AUC) of 0.977, and p < 0.001. Validation of the proposed nomogram yielded an AUC for the nomogram probability of approximately 81%, and the AUC for the predicted probability using the developed model was 98.3%, indicating that both the validated model and the developed nomogram were significant predictors of serious arrhythmia. The utility of using the four-factor nomogram to determine the risk of serious arrhythmia in children exposed to an overdose of digoxin is comparable, if not superior, to the serum digoxin level.