Intravenous Glucose Infusion Research Articles

The association of intravenous insulin and glucose infusion with intensive care unit and hospital mortality: a retrospective study

BackgroundWe assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality.MethodsFor this retrospective association study, we used data from all patients admitted to a medical-surgical ICU between January 2012 and September 2017. We excluded patients admitted < 24 h, patients with a diabetic ketoacidosis, patients with a therapy restriction upon ICU admission and readmissions. Using multivariate logistic regression, we examined the relation between intravenous insulin and glucose infusion and ICU and hospital mortality for all patients. Additionally, we used the same model to analyze the outcomes for patients admitted > 72 h.ResultsOf 9507 eligible patients, 3966 were included. After correction for potential confounders, intravenous insulin was associated with ICU and hospital mortality in patients admitted > 24 h (n = 3966) (odds ratio (OR) 1.09 [95% CI 1.05–1.13] and 1.09 [95% CI 1.06–1.13] per 0.1 IU/kg added, respectively). Likewise, intravenous glucose was associated with ICU mortality (OR 1.01 [95% CI 1.00–1.01]) but not with hospital mortality and (OR 1.00 [95% CI 1.00–1.01]) per g/day added, respectively. In patients admitted > 72 h (n = 1550), insulin dose was associated with both ICU and hospital mortality (p = 0.002 and p < 0.001, respectively), but glucose infusion was not (p = 0.08 and p = 0.2, respectively).ConclusionsIntravenous insulin administration is associated with an increased risk of ICU and hospital mortality, after correction for potential confounders. Parenteral glucose administration was limited in amount but was still associated with ICU mortality. However, based on these results, it is unknown whether this association is an epiphenomenon, or represents a true harm of insulin and glucose administration.

Intravenous infusion of glucose 5% despite sodium mixed, is main contributor of acquired hyponatremia in adult polyvalent medicine service: Case control study

BackgroundAcquired hyponatremia is a life threatening event. Intravenous infusion of a mixture of 5% glucose and sodium solute is mainly used, but its contribution in the occurrence of acquired hyponatremia in adult, is under-investigated outside intensive care unit. ObjectiveTo evaluate the place of intravenous infusion of a mixture of 5% glucose and sodium in predicting acquired hyponatremia in adult polyvalent medicine service. Patients and methodsA case-control study have been conducted. The main exposure was intravenous infusion of a mixture of 5% glucose and sodium solute (4 grams NaCl/liter of 5% glucose). OutcomeAcquired hyponatremia during hospitalization. By logistic regression, the global multifactorial model predicting acquired hyponatremia, and its sub-models were established; as well as following parameters: area under the Receiving Operator Characteristic curve (AUC), maximal Youden's index with its couple of coordinates (sensibility-specificity), Nagelkerke's R-squared adjusted. ResultsAdjusted odds ratio (cases/controls; main exposure; outcome) ORa=2.73 (95% CI 1.40–5.32; P=0.003). Prediction of acquired hyponatremia: global multifactorial model: AUC=0.78 (95% CI 0.72–0.85; P<0.0001), Youden's index=0.34 (95% CI 0.24–0.41); sub-model (global multifactorial model without main exposure): AUC=0.72 (95% CI 0.66–0.78; P<0.0001), Youden's index=0.18 (95% CI 0.07–0.22). ConclusionIntravenous infusion of a mixture of 5% glucose and sodium mainly used, highly contribute to predict acquired hyponatremia in adult polyvalent medicine service, and should be the first cause to consider for managing this acquired hyponatremia.

Pseudohyperkalemia: in vitro phenomenon or misdiagnosis. A case report

&lt;b&gt;Introduction:&lt;/b&gt; Hyperkalemia is a common electrolyte disturbance that occurs within many patients. The more often prevalence of cardiovascular or renal diseases is, the more frequent medical issue hyperkalemia will be. An increasing quantity of entities requires taking medications that affect electrolyte hemostasis. Therefore, reasons for hyperkalemia should be deeply reflected. One of them is pseudohyperkalemia. &lt;b&gt;Purpose:&lt;/b&gt; In this study diagnostics and treatment of hypokalemia were presented based on the case report of a 56-year-old man. &lt;b&gt;Case presentation:&lt;/b&gt; A 56-year-old man was admitted to the Department of Invasive Cardiology of Medical Hospital of Białystok for complaints of strong chest pain associated with palpitations, cold sweats, feelings of general weakness and anxiety. The patient had no medical history of chronic diseases and neglected to take any medications at length. The laboratory tests performed at admission showed an increased serum concentration of potassium. Through the whole hospitalization, many medications were implicated to overcome hyperkalemia (diuretics, calcium resonium, inhalation with beta2-adrenergic agonists, intravenous infusion of glucose with insulin) with no effect. Hormone test was performed, the results excluded Addison’s or pituitary disease. Differential diagnosis with arterial blood draw showed normal potassium serum concentration. &lt;b&gt;Conclusions:&lt;/b&gt; Hyperkalemia is encountered in a broad spectrum of patients. The severely elevated level of potassium could lead to life-threating conditions. Therefore, proper diagnosis making process is a matter of great importance. As clinicians, we need to base not only on laboratory but also examine the whole picture of the patient. Misdiagnosing pseudohyperkalemia might result in unnecessary medical management.

Infusion of glucose and fructose in healthy horses

The aim of this study was to evaluate the metabolic response of five healthy non-pregnant Arabian mares to intravenous glucose or fructose infusions with commercial energy-boosting electrolyte supplements. The animals were kept on a dry lot and had free access to Tifton 85 hay, mineral salt and water. A full factorial experiment was carried out with five horses and five treatments, as follows: corn (control), fructose 25 g (Fru-25); fructose 50 g (Fru-50); glucose 25g (Glu-25); and glucose 50 g (Glu-50). The fructose and glucose solutions were infused into the jugular vein within 10 minutes, regardless of their volume, in doses ranging from 0.13 g/Kg (Fru-50 and Glu-50) to 0.07g/Kg (Fru-25 and Glu-25). Blood samples were drawn from the jugular vein at seven moments: 0 or pre-test (fasting), and 30, 60, 90, 120, 180, and 240 minutes after beginning the intravenous supplementation or food ingestion (corn). The following blood biomarkers were analyzed: glucose, insulin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), phosphorus, total plasma protein (TPP) and insulin levels. The results were subjected to ANOVA and to Tukey’s test, with a p-value of 0.05, using SigmaPlot 13.0 software. The results indicated that glucose, insulin, ALT and AST levels differed significantly between treatments and blood sampling times. Only glucose showed high interaction between treatments and periods (p 0.05). In conclusion, this research demonstrated that glucose or fructose infused into the bloodstream of healthy mares produced different glycemic and insulin curves when equivalent doses of commercial energy-boosting supplements were used.

Effect of sensor location on continuous intraperitoneal glucose sensing in an animal model.

BackgroundIn diabetes research, the development of the artificial pancreas has been a major topic since continuous glucose monitoring became available in the early 2000’s. A prerequisite for an artificial pancreas is fast and reliable glucose sensing. However, subcutaneous continuous glucose monitoring carries the disadvantage of slow dynamics. As an alternative, we explored continuous glucose sensing in the peritoneal space, and investigated potential spatial differences in glucose dynamics within the peritoneal cavity. As a secondary outcome, we compared the glucose dynamics in the peritoneal space to the subcutaneous tissue.Material and methodsEight-hour experiments were conducted on 12 anesthetised non-diabetic pigs. Four commercially available amperometric glucose sensors (FreeStyle Libre, Abbott Diabetes Care Ltd., Witney, UK) were inserted in four different locations of the peritoneal cavity and two sensors were inserted in the subcutaneous tissue. Meals were simulated by intravenous infusions of glucose, and frequent arterial blood and intraperitoneal fluid samples were collected for glucose reference.ResultsNo significant differences were discovered in glucose dynamics between the four quadrants of the peritoneal cavity. The intraperitoneal sensors responded faster to the glucose excursions than the subcutaneous sensors, and the time delay was significantly smaller for the intraperitoneal sensors, but we did not find significant results when comparing the other dynamic parameters.

IGF-Mediated Hypoglycemia as the First Manifestation of Huge Hepatocellular Carcinoma (HCC) in a Chronic Hepatitis B Infected Patient

Paraneoplastic hypoglycemia is a rare presentation of HCC1. Treatment for such episode has not been standardized2. Most patients do not respond to intravenous glucose infusion.A 54-year-old male presented with alteration of consciousness. He had anorexia and 20-kilograms weight lost within 4 months, recurrent dizziness and palpitations which improved with food intake for 2 weeks. Physical examination revealed enlarged liver. No sign of chronic liver stigmata was noted. Others were unremarkable. Hypoglycemia was diagnosed by plasma glucose of 21 mg/dL. Serum insulin and C-peptide level was <2 μIU/mL (8.9-28.4) and 0.3 ng/mL (0.9-7.1), respectively, suggestive of insulin-like growth factor (IGF)-mediated hypoglycemia. CT scan showed 16 cm-arterial enhancing and delayed wash-out mass with central necrosis, occupying almost entire right lobe on non-cirrhotic liver (pic 1). The mass abutted right portal vein, no metastatic foci was seen. Alpha-fetoprotein was 52,300 IU/mL. Diagnosis of HCC was made. The etiology of HCC was chronic hepatitis B infection. HBV DNA was 319 IU/mL. Initially, continuous intravenous glucose infusion of 8 gm/h was given, but hypoglycemia persisted. Continuous glucose infusion of 10 gm/hr with frequent meals was required to maintain blood glucose level above 80 mg/dL. On admission day 3, TACE was done to reduce tumor burden. The need for glucose infusion was rapidly decreased and can be stopped within 3 days after TACE procedure (pic 2). Hepatectomy was successfully performed 1 month after diagnosis. Pathologic examination showed bizarre multinucleated giant tumor cell compatible with moderately differentiated HCC grade III-IV (pic 3).2449_A Figure 1. Picture1.CT abdomen revealed 16 cm hypo-density mass occupying right hepatic lobe with arterial enhancing, delayed wash-out rim and central necrosis.2449_B Figure 2. Level of capillary glucose and amount of glucose infusion during hospitalization2449_C Figure 3. Picture 3. Bizarre multinucleated giant tumor cell compatible with moderately differentiated hepatocellular carcinoma grade III-IVHypoglycemia presenting as the first manifestation of HCC, particularly in non-cirrhotic patients is very rare1. It is caused by production of HCC peptides with insulin-like structure and bioactivity, e.g. IGF-II. IGF-II binds to the IGF-I, IGF-II, and insulin receptors, resulting in dramatic increasing glucose uptake.2 The mainstay of HCC treatment is to reduce tumor burden. Our patient had dramatic response to TACE, followed by surgical resection. After resection for 4 months, the patient was doing well without signs of HCC recurrence.

The effect of exogenous glucose infusion on early embryonic development in lactating dairy cows

The objective of this study was to examine the effect of intravenous infusion of glucose on early embryonic development in lactating dairy cows. Nonpregnant, lactating dairy cows (n = 12) were enrolled in the study (276 ± 17 d in milk). On d 7 after a synchronized estrus, cows were randomly assigned to receive an intravenous infusion of either 750 g/d of exogenous glucose (GLUC; 78 mL/h of 40% glucose wt/vol) or saline (CTRL; 78 mL/h of 0.9% saline solution). The infusion period lasted 7 d and cows were confined to metabolism stalls for the duration of the study. Coincident with the commencement of the infusion on d 7 after estrus, 15 in vitro-produced grade 1 blastocysts were transferred into the uterine horn ipsilateral to the corpus luteum. All animals were slaughtered on d 14 to recover conceptuses, uterine fluid, and endometrial tissue. Glucose infusion increased circulating glucose concentrations (4.70 ± 0.12 vs. 4.15 ± 0.12 mmol/L) but did not affect milk production or dry matter intake. Circulating β-hydroxybutyrate concentrations were decreased (0.51 ± 0.01 vs. 0.70 ± 0.01 mmol/L for GLUC vs. CTRL, respectively) but plasma fatty acids, progesterone, and insulin concentrations were unaffected by treatment. Treatment did not affect either uterine lumen fluid glucose concentration or the mRNA abundance of specific glucose transporters in the endometrium. Mean conceptus length, width, and area on d 14 were reduced in the GLUC treatment compared with the CTRL treatment. A greater proportion of embryos in the CTRL group had elongated to all length cut-off measurements between 11 and 20 mm (measured in 1-mm increments) compared with the GLUC treatment. In conclusion, infusion of glucose into lactating dairy cows from d 7 to d 14 post-estrus during the critical period of conceptus elongation had an adverse impact on early embryonic development.

The effect of hypoglycaemia on neurocognitive outcome in children and adolescents with transient or persistent congenital hyperinsulinism.

To examine the hypoglycaemic effect on neurodevelopmental outcome in patients with transient and persistent congenital hyperinsulinism (CHI) born in the 21st century. A cohort of 117 patients (66 males, 51 females) with CHI aged 5 to 16years (mean age 8y 11mo, SD 2y 7mo) were selected from a Finnish nationwide registry to examine all the patients with similar methods. Neurodevelopment was first evaluated retrospectively. The 83 patients with no risk factors for neurological impairment other than hypoglycaemia were recruited and 44 participated (24 males, 20 females; mean age 9y 7mo, SD 3y 1mo) in neuropsychological assessment with the Wechsler Intelligence Scale for Children, Fourth Edition and the Finnish version of the Developmental Neuropsychological Assessment, Second Edition domains of attention, language, memory, sensorimotor, and visual functioning. In retrospective analysis, transient and persistent CHI groups had similar prevalences of mild (22% and 18% respectively) or severe (5% and 7% respectively) neurodevelopmental difficulties. In clinical assessment, the neurocognitive profile was within the average range in both groups, but children with persistent CHI showed significant but restricted deficits in attention, memory, visual, and sensorimotor functions compared with the general population. The transient CHI group did not differ from the standardization samples. Besides the more apparent broader neurological deficits, children with persistent CHI have an increased risk for milder specific neurocognitive problems, which should be considered in the follow-up. Children with persistent congenital hyperinsulinism showed deficits in attention, memory, visual, and sensorimotor functions. The deficits were potentially of hypoglycaemic origin. Children with transient hyperinsulinism did not differ from the general population.

Glucose Tolerance Tests and Osteocalcin Responses in Healthy People.

Aim: Osteocalcin and undercarboxylated osteocalcin are suggested to be endocrine messengers from the bones and have been shown to stimulate insulin secretion from pancreatic β-cells. Insulin is hypothesized to increase the osteoblastic production of osteocalcin. The aim of the study was to investigate whether the route of glucose administration influence the circulating levels of osteocalcin and undercarboxylated osteocalcin.Methods: Twelve healthy males were enrolled in an acute cross-over study where they underwent an oral glucose tolerance test (OGTT), an isoglycemic intravenous glucose infusion (IIGI) and a fasting period (control). Blood samples were collected throughout 180 min and analyzed for osteocalcin and undercarboxylated osteocalcin and compared to insulin, glucose, and gastro-intestinal hormone responses.Results: Neither osteocalcin levels nor undercarboxylated osteocalcin levels over time differed between the OGTT, IIGI, and fasting. Baseline insulin levels and glucose levels were not associated with osteocalcin or undercarboxylated osteocalcin levels. Increases in insulin and glucose levels were neither associated with altered osteocalcin nor undercarboxylated osteocalcin levels.Conclusion: The route of glucose administration does not influence the circulating levels of osteocalcin and undercarboxylated osteocalcin despite the differential insulin and incretin responses. In the acute setting this suggests that insulin does not increase osteoblastic production of osteocalcin in healthy human males.

The TCF7L2 Variant rs7903146 Affects the Risk of Youth-Onset Type 2 Diabetes by Reducing the Incretin Effect on Insulin Secretion

Background: Common variants of the transcription factor-7-like-2 gene (TCF7L2) have been implicated in the progression of prediabetes to T2D. We explored the effect of the rs7903146 variant on the incretin effect in youths with dysglycemia. Methods: 5 carriers with the risk-genotype of TCF7L2 (TT at the rs7903146, 14.4±2.3y, BMI 34.7±6.4kg/m2) and 5 with the wild type genotype CC (16.2±1.9y, BMI 36.8±6.0kg/m2) underwent a 3-hour OGTT followed, a week later, by an isoglycemic intravenous glucose infusion (IVGTT), designed to match the plasma glucose concentrations during the OGTT. The incretin effect was measured as 100*(SROGTT-SRIVGTT)/SROGTT where SR was the secretion rate of c-peptide. Results: As shown in the Figure, the plasma glucose profile in the OGTT and IVGTT were well matched in both groups. The increase in SR during the OGTT compared to IVGTT was significantly lower in the carriers of the TT compared to CC genotype (ΔiAUCc-peptide 1281±688.6 vs. 5632±1604 pmol/L*min, p &amp;lt; 0.025). Thus, relative to the control group, carriers of the TT-risk genotype had a significant reduction of the incretin effect (TT 0% [-11.74, 16.84], CC: +35% [12.05, 55.71]; p &amp;lt;0.018). Conclusion: The TCF7L2 variant rs7903146 impairs the incretin effect in obese youths carrying the risk-genotype (TT), suggesting a causative mechanism for the association of this variant with progression to T2D. Disclosure A. Galderisi: None. B. Pierpont: None. D. D'Alessio: Consultant; Self; Intarcia Therapeutics, Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk A/S. N. Santoro: None. S. Caprio: None.

Mono- and Co-Activation of the GIP and GLP-1 Receptors Inhibits Bone Resorption

We investigated the effect of mono- and co-administration of the incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) on bone resorption and formation. Seventeen overweight/obese men without diabetes were included in a randomized, double-blinded, placebo-controlled, cross-over study and subjected to a 50g oral glucose tolerance test (OGTT) and four isoglycemic intravenous glucose infusions (IIGI), mimicking the glucose excursions from the OGTT, with concomitant infusions of GIP (4 pmol/kg/min), GLP-1 (1 pmol/kg/min), GIP+GLP-1 (4 and 1 pmol/kg/min, respectively) or placebo. Bone resorption and formation were assessed by measurements of carboxy-terminal type 1 collagen crosslinks (CTX), and procollagen type 1 N-terminal propeptide (P1NP), respectively. Suppression of CTX is shown in Fig. 1. During OGTT the baseline subtracted area under the curve (bsAUC) was significantly lower than during IIGI+saline infusion (-9,117±566 (mean±SEM) vs. -4,333±583 %×min, P&amp;lt;0.0001). Infusion of GLP-1 and GIP significantly potentiated CTX suppression to -10,751±799 %×min and 13,714±440 %×min, respectively. Co-administration of GIP+GLP-1 suppressed CTX to -15,466±268 %×min. P1NP levels were unaffected. Our data suggest that GLP-1, like GIP, may be involved in bone homeostasis and that co-administration of GIP+GLP-1 inhibits bone resorption more than each hormone alone. Disclosure N.C. Bergmann: Employee; Self; Zealand Pharma A/S. A.B. Lund: Other Relationship; Self; Novo Nordisk A/S. S.M. Heimbürger: Research Support; Self; Novo Nordisk A/S. L. Jessen: Employee; Self; Zealand Pharma A/S. Stock/Shareholder; Self; Zealand Pharma A/S, Novo Nordisk A/S. M.B. Christensen: None. T. Vilsbøll: Advisory Panel; Self; Amgen Inc., Boehringer Ingelheim GmbH, Eli Lilly and Company, AstraZeneca, MSD K.K., Sanofi, Novo Nordisk A/S. Consultant; Self; Amgen Inc., Boehringer Ingelheim GmbH, Eli Lilly and Company, AstraZeneca, MSD K.K., Sanofi, Novo Nordisk A/S. Speaker's Bureau; Self; Amgen Inc., Boehringer Ingelheim GmbH, Eli Lilly and Company, AstraZeneca, MSD K.K., Sanofi, Novo Nordisk A/S. Research Support; Self; Eli Lilly and Company, Novo Nordisk A/S. F.K. Knop: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Amgen Inc.. Speaker's Bureau; Self; Merck Sharp &amp; Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Consultant; Self; Amgen Inc.. Advisory Panel; Self; MedImmune, Sanofi. Consultant; Self; Sanofi. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi.

Sex Difference In the Effect of Fetal Exposure to Maternal Diabetes on Insulin Secretion.

We previously showed that fetal exposure to maternal type 1 diabetes (T1D) is associated with altered glucose-stimulated insulin secretion in adult offspring. Here, we investigated whether this β-cell defect displays a sex dimorphism. Twenty-nine adult nondiabetic offspring of T1D mothers (ODMs) were compared with 29 nondiabetic offspring of T1D fathers. We measured early insulin secretion in response to oral glucose and insulin secretion rate in response to intravenous glucose ramping. Insulin sensitivity and body composition were assessed by a euglycemic, hyperinsulinemic clamp and dual-energy X-ray absorptiometry, respectively. In response to oral glucose, male and female ODMs displayed a reduced insulin secretion. In contrast, in response to graded intravenous glucose infusion, only female ODMs (not males) exhibited decreased insulin secretion. There was no defect in response to combined intravenous arginine and glucose, suggesting that male and female ODMs exhibit a functional β-cell defect rather than a reduced β-cell mass. In conclusion, fetal exposure to maternal diabetes predisposes to β-cell dysfunction in adult male and female offspring. This β-cell defect is characterized by a sexual dimorphism following intravenous glucose stimulation.

A Case Report on Suicidal Liraglutide Overdose in a Non Diabetic Female Presented with Hypoglycemia

A 27 years old non diabetic woman with suicidal liraglutide overdose presented in emergency with nausea, vomiting and burning pain abdomen. Case Presentation: We reported her blood glucose of 54 mg/dl in emergency, have given her 25% dextrose intravenous bolus and started her on 10% dextrose intravenous infusion, with other supportive medications. Her symptoms improved with intravenous glucose infusion and blood glucose level maintained normal in next 24 hours. Her liver function test and serum amylase remained within normal range. Conclusion: In our case one episode of hypoglycaemia was reported in emergency (blood glucose 54mg/dl and drowsiness), though hypoglycaemia was never reported in any previous case report of liraglutide overdose. So, hypoglycaemia, though rare, can still be a possible complication of liraglutide overdose.

Persistent and severe hypoglycemia associated with trimethoprim-sulfamethoxazole in a frail diabetic man on polypharmacy: A case report and literature review

Trimethoprim-sulfamethoxazole (co-trimoxazole) is a commonly used broad-spectrum antibiotic, but it can be associated with potentially serious adverse effects, often not recognized by clinicians. This is a relevant problem in elderly patients, who are particularly susceptible to adverse drug reactions. Moreover, multiple medications taken by older people increase the risk for adverse drug reactions and drug-drug interactions. We report the case of an 85-year-old man with diabetes mellitus who attended the emergency room with severe hypoglycemia that persisted despite multiple intravenous bolus doses and continuous infusion of glucose. He needed hospital admission to stabilize glycemia. The patient, a nursing home resident, was being treated with co-trimoxazole for an uncomplicated urinary tract infection, but was also taking multiple additional drugs for his co-morbidities. After co-trimoxazole was discontinued, plasma glucose levels slowly stabilized within the normal range. A diagnosis of prolonged and refractory hypoglycemia induced mainly by the antimicrobial agent was made, with additional contribution from multiple other drugs. No further episodes of hypoglycemia occurred during the next 6months of follow-up. This case study illustrates once more the critical importance of prescription appropriateness in elderly patients with multiple morbidities in terms of type and dosage of drugs, in order to avoid serious adverse reactions. .

Zinc Supplementation Does Not Affect Glucagon Response to Intravenous Glucose and Insulin Infusion in Patients with Well-Controlled Type 2 Diabetes.

Glucagon dysregulation is an essential component in the pathophysiology of type 2 diabetes. Studies in vitro and in animal models have shown that zinc co-secreted with insulin suppresses glucagon secretion. Zinc supplementation improves blood glucose control in patients with type 2 diabetes, although there is little information about how zinc supplementation may affect glucagon secretion. The objective of this study was to evaluate the effect of 1-year zinc supplementation on fasting plasma glucagon concentration and in response to intravenous glucose and insulin infusion in patients with type 2 diabetes. A cross-sectional study was performed after 1-year of intervention with 30mg/day zinc supplementation or a placebo on 28 patients with type 2 diabetes. Demographic, anthropometric, and biochemical parameters were determined. Fasting plasma glucagon and in response to intravenous glucose and insulin infusion were evaluated. Patients of both placebo and supplemented groups presented a well control of diabetes, with mean values of fasting blood glucose and glycated hemoglobin within the therapeutic goals established by ADA. No significant differences were observed in plasma glucagon concentration, glucagon/glucose ratio or glucagon/insulin ratio fasting, after glucose or after insulin infusions between placebo and supplemented groups. No significant effects of glucose or insulin infusions were observed on plasma glucagon concentration. One-year zinc supplementation did not affect fasting plasma glucagon nor response to intravenous glucose or insulin infusion in well-controlled type 2 diabetes patients with an adequate zinc status.

Effect of Intravenous Infusion of Hypertonic Glucose on the Treatment of Cows with Postpartum Anestrus

Effect of Intravenous Infusion of Hypertonic Glucose on the Treatment of Cows with Postpartum Anestrus

Computer Simulation Model to Train Medical Personnel on Glucose Clamp Procedures.

A glucose clamp procedure is the most reliable way to quantify insulin pharmacokinetics and pharmacodynamics, but skilled and trained research personnel are required to frequently adjust the glucose infusion rate. A computer environment that simulates glucose clamp experiments can be used for efficient personnel training and development and testing of algorithms for automated glucose clamps. We built 17 virtual healthy subjects (mean age, 25±6 years; mean body mass index, 22.2±3 kg/m2), each comprising a mathematical model of glucose regulation and a unique set of parameters. Each virtual subject simulates plasma glucose and insulin concentrations in response to intravenous insulin and glucose infusions. Each virtual subject provides a unique response, and its parameters were estimated from combined intravenous glucose tolerance test-hyperinsulinemic-euglycemic clamp data using the Bayesian approach. The virtual subjects were validated by comparing their simulated predictions against data from 12 healthy individuals who underwent a hyperglycemic glucose clamp procedure. Plasma glucose and insulin concentrations were predicted by the virtual subjects in response to glucose infusions determined by a trained research staff performing a simulated hyperglycemic clamp experiment. The total amount of glucose infusion was indifferent between the simulated and the real subjects (85±18 g vs. 83±23 g; p=NS) as well as plasma insulin levels (63±20 mU/L vs. 58±16 mU/L; p=NS). The virtual subjects can reliably predict glucose needs and plasma insulin profiles during hyperglycemic glucose clamp conditions. These virtual subjects can be used to train personnel to make glucose infusion adjustments during clamp experiments.

Dilemma of diagnosing sulphonylurea overdose in children: deliberations and considerations before reaching a diagnosis

A 15-year-old non-diabetic Caucasian girl presented with sudden onset of seizures, unrecordable blood glucose readings and acute renal failure. She denied any medication ingestion and no other precipitating factors were...

Impact of hyperglycemia on cystathionine-\u03b3-lyase expression during resuscitated murine septic shock

BackgroundCystathionine-γ-lyase (CSE) was shown to have a regulatory role in glucose metabolism. Circulatory shock can induce metabolic stress, thereby leading to hyperglycemia and mitochondrial dysfunction. In vitro data suggest an effect of high glucose on CSE expression. Therefore, the aim of this study was to investigate the effects of hyperglycemia on CSE expression in resuscitated murine septic shock.MethodsNormo- (80–150 mg/dl) and hyperglycemic (>200 mg/dl) male C57/BL6J mice (n = 5-6 per group) underwent cecal ligation and puncture (CLP)-induced polymicrobial sepsis or sham procedure (n = 6 per group) and, 15 h afterwards, were anesthetized again, surgically instrumented and received intensive care treatment, including antibiotics, lung protective mechanical ventilation, circulatory support, and intravenous (i.v.) glucose infusion (50% as stable-isotope labeled 1,2,3,4,5,6–13C6 glucose). Blood and breath gas were sampled hourly to quantify parameters of glucose metabolism. 5 h later, mice were sacrificed and organs were harvested. The liver mitochondrial respiratory activity was determined via high resolution respirometry; CSE, peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α), and adipocyte differentiation-related protein (ADRP) expression was immunohistochemically investigated.ResultsIn sepsis combined with hyperglycemia the least CSE and PGC1α expression could be detected, along with reduced mitochondrial respiratory activity, and enhanced ADRP expression, a marker of lipid droplet formation, in the liver. A novel in vivo finding is the CSE translocation from the cytosol to the nucleus triggered by metabolic stress.ConclusionsA relationship between CSE and glucose metabolism was established, which, when dysregulated, may contribute to fatty liver disease and hepatic steatosis.

Treatment with long-acting lanreotide autogel in early infancy in patients with severe neonatal hyperinsulinism

BackgroundTreatment of severe diffuse congenital hyperinsulinism (CHI) without sufficient response to diazoxide is complicated by the lack of approved drugs. Therefore, patients are often hospitalized long-term or have to undergo pancreatic surgery if episodes of severe hypoglycaemia cannot be prevented. A long-acting somatostatin analogue, octreotide, has been reported to be an effective treatment option that prevents severe hypoglycaemia in children with CHI, and its off-label use is common in CHI. However, octreotide requires continuous i.v. or s.c. infusion or multiple daily injections. Here, we report our experiences with the use of a monthly application of a long-acting somatostatin analogue, lanreotide autogel® (LAN-ATG), in early infancy.ResultsThe mean blood glucose concentration within 7 days before the first LAN-ATG administration were compared to 7 days after the first LAN-ATG administration and increased by 0.75 mmol/L (range 0.39–1.19 mmol/L). In the following weeks intravenous glucose infusions, octreotide, and glucagon treatment could be successfully stopped in all patients 3–20 days after the first LAN-ATG injection without substantial worsening of the hypoglycaemia rate. Increased carbohydrate requirements could be normalized with an average reduction in the carbohydrate-intake of 7 g/kg body weight/d (range 1.75–12.8 g/kg body weight/d). Over a total of 52 treatment months, no serious adverse effects occurred.ConclusionLong-term LAN-ATG treatment improved blood glucose concentrations, lowered the frequency of hypoglycaemia or allowed for normalization of oral carbohydrate intake in infants with CHI younger than 6 months of age. No severe side effects were observed. LAN-ATG might be an alternative treatment option in infants with severe CHI who lack risk factors for necrotizing enterocolitis and are not responding to current treatment regimens as an alternative to surgery after careful individual evaluation.