Maximum Blood Glucose Levels Research Articles

Maximum blood glucose levels during hospitalisation to predict mortality in patients with acute coronary syndrome: a retrospective cohort study

ObjectiveThe aim in this study was to stratify maximum blood glucose levels to identify the the best cut-off value of glucose levels to predict mortality in acute coronary syndrome (ACS)...

Association Between Intercostal Nerve Block and Postoperative Glycemic Control in Patients With Diabetes Undergoing Video-Assisted Thoracoscopic Pulmonary Resection: A Retrospective Study

The present study was performed to investigate the possible association between intercostal nerve block (INB) and postoperative glycemic control in patients with diabetes undergoing video-assisted thoracoscopic pulmonary resection. A retrospective study. Single-center tertiary academic hospital. Patients with diabetes, ages 18 to 79 years, who had undergone elective video-assisted thoracoscopic pulmonary resection (segmentectomy or lobectomy) from January 1, 2015, to December 31, 2018. Postoperative blood glucose levels and insulin dosage were extracted from the record. Patients with diabetes who received INB before closure of surgical incisions were compared with those who did not receive INB. The primary outcome was the daily blood glucose (BG) level. Univariate analyses and multivariate regression analysis were performed to explore risk factors of hyperglycemia within 48 hours after the surgery. Baseline characteristics were comparable between the two groups. Patients who received INB had a lower maximum BG level and amplitude of glycemic excursion from zero-to-24 hours after surgery (p = 0.007 and p = 0.041, respectively) and lower maximum and minimum BG levels from 24-to-48 hours after surgery (p = 0.023 and p = 0.006, respectively). Meanwhile, the daily insulin dose increment during zero-to-24 hours and 24-to-48 hours after surgery decreased (p = 0.010 and p = 0.003, respectively), the white blood cell counts within 48 hours after surgery were lower (p = 0.021), and the length of postoperative stay decreased in the INB group (p = 0.044). Multivariate regression analysis further confirmed that INB was an independent protective factor of postoperative hyperglycemia (Nagelkerke R2 value 0.229; odds ratio 0.298; 95% confidence interval 0.099-0.901; p = 0.032). INB, performed before closure of surgical incisions, was associated with improved glycemic control in patients with diabetes within 48 hours after video-assisted thoracoscopic pulmonary resection.

Utility of bedside artificial pancreas for postoperative glycemic control in cardiac surgery.

In the present single-center retrospective study, we analyzed arterial blood glucose levels for 15h after surgery in 69 patients treated using the bedside artificial pancreas and in 160 patients treated with continuous intravenous insulin infusion using a scale that adjusts for current blood glucose level, glycemic fluctuation, and insulin dose. Hypoglycemia (arterial blood glucose level < 70mg/dL) was not observed in any case. Patients in the group treated using the bedside artificial pancreas showed lower mean, maximum, and minimum blood glucose levels and glycemic variability and shorter treatment duration in the intensive care unit than patients treated with continuous intravenous insulin infusion. Notably, these results were not affected by diabetes status or differences in operative procedures. Analysis of patients undergoing isolated coronary artery bypass grafting surgery revealed that the incidence of surgical site complications composite with infection and dehiscence was lower. In cardiac surgery, postoperative treatment using bedside artificial pancreas is a novel therapy that improves hyperglycemia and glycemic variability, without hypoglycemia, and is, therefore, an attractive strategy for future surgeries.

Dependence of heart rate variability on indicators of type 1 diabetes mellitus control.

The aim of our study was to evaluate the influence of the main indicators of type 1 diabetes mellitus (T1DM) control on heart rate variability (HRV). We examined 62 patients at the age of 18-45 years with an average T1DM duration of 11.0 (5.0; 18.0) years. HRV in the time and frequency range was evaluated by analyzing a 24-hour Holter electrocardiogram (ECG). The following laboratory parameters were used as markers of course and compensation of T1DM: C-peptide, HbA1c, blood creatinine, albuminuria (AU), estimated glomerular filtration rate (eGFR) by CKD-EPI formula. In addition, the maximum and minimum blood glucose levels and the blood glucose range (maximum minus minimum blood glucose values) were conducted by continuous glucose monitoring system iPro2 (Medtronic MiniMed, USA). The daily monitoring of electrocardiogram (ECG) was made in parallel with long term monitoring of blood glucose. Echocardiography in all patients was performed to exclude organic heart disease and the possibility of its influence on HRV. Poor control of T1DM negatively influences HRV through decrease in both frequency and time characteristics. The blood glucose range can be an additional negative factor for cardiovascular system in T1DM patients, regardless of HbA1c, whereas it positively correlates with HRV- relative hypersympathicotonia markers: LF/HF 24-h, ρ=0.43 (p&lt;0.05), LF/HF day ρ=0.37 (p&lt;0.05), ρ=0.38 LF/HF night. Diabetic nephropathy is another factor of cardiovascular disease progression in T1DM, since its criteria have reliably negative (for eGFR) and positive (for AU) correlations of mean force with all HRV characteristics. Selected markers of T1DM control cause 45, 73% of variance in HRV, mainly affecting TP 24-h, TP daytime, VLF 24-h, VLF daytime. Reduction of these frequency HRV characteristics may indicate autonomic neuropathy in patients with poor control of T1DM.

Increasing Individual Target Glucose Levels to Prevent Hypoglycemia in Patients with Diabetes.

Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients’ contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians’ factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%–7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%–8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%–9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.

UJI EFEKTIVITAS INFUSA DAUN INSULIN (Thitonia diversifolia (Hemsl.) A. Gray) TERHADAP PENURUNAN KADAR GLUKOSA DARAH PADA MENCIT (MUS MUSCULUS) PUTIH JANTAN

Latar Belakang: Daun insulin merupakan salah satu tumbuhan yang memiliki kegunaan dari daunnya. Daun insulin memiliki kandungan flavonoid yang diduga bisa menurunkan kadar glukosa darah. Penelitian ini bertujuan untuk mengetahui efektivitas infusa daun insulin terhadap penurunan kadar glukosa darah pada mencit putih jantan yang diinduksi glukosa.. &#x0D; Metode: Penelitian ini merupakan penelitian eksperimen dengan rancangan Pretest-Postest with Control Group. Hewan uji yang digunakan adalah 25 ekor mencit putih jantan yang dibagi dalam 5 kelompok, yaitu kelompok kontrol negatif (Na-CMC), kelompok kontrol positif (Glibenklamid), kelompok infusa daun insulin 420 mg, 840 mg, dan 1260 mg. Dilakukan pengamatan dan pengecekkan kadar glukosa darah mencit pada menit ke-30, 60, 90, dan 120.&#x0D; Hasil: Hasil uji statistik One-Way ANOVA menunjukkan hasil signifikan pada menit ke-90 dan 120. Dilanjutkan dengan uji Post Hoc Duncan yang menunjukan dosis terbaik, yaitu dosis 420 mg yang memiliki efek sebanding dengan Glibenklamid 5 mg, kemudian diikuti dengan dosis 1260 mg dan 840 mg yang sudah memiliki efek antihiperglikemia tetapi belum terlihat perbedaan.&#x0D; Kesimpulan: Dosis infusa yang dapat menurunkan kadar glukosa darah adalah dosis 420 mg dengan penurunan kadar glukosa darah maksimal pada menit ke-90 dan menit ke120.

Usefulness of Glycemic Control Using an Artificial Pancreas Apparatus for Cardiovascular Surgery

Blood glucose management is important for cardiovascular surgery using cardiopulmonary bypass. The usefulness of an artificial pancreas apparatus (STG-55) to control blood glucose in patients undergoing cardiopulmonary bypass was investigated. Subjects comprised 44 patients using the artificial pancreas during cardiopulmonary bypass between June 2016 and March 2017; 55 were initially enrolled, but 11 were excluded because of blood removal failure. Patients were divided into a monitoring group in which blood glucose levels were only monitored using the artificial pancreas (11 patients: six people with diabetes and 5 people without diabetes) and a management group with glycemic control by automatic insulin administration using the artificial pancreas (33 patients: people with diabetes and 21 people without diabetes). Mean maximum blood glucose levels and variation ranges significantly differed between the monitoring and management groups (p = 0.02). The variation range significantly differed between people with and without diabetes in the monitoring group (p = 0.008), but not in the management group. The artificial pancreas apparatus continuously and accurately reflected glycemic variations, facilitating strict and favorable control.

POTENTIALS TO PREDICT THE DEVELOPMENT OF DIABETES 1 TYPE COMPLICATIONS BY GLUCOSE CONTROL INDICATORS

Diabetes mellitus is recognized as a new non-infectious «epidemic of the XXI century» due to its steady increase in morbidity and a number of medical and social problems. These problems are associated with disability and mortality of patients resulted from the development of chronic complications of the disease. Hyperglycemia plays a major role in the development of diabetic complications. Diabetic microangiopathies predetermine the course and prognosis of the disease. HbA1c level and glucose variability are the complementary characteristics of glucose control. The aim of the study was to develop a mathematical model for predicting the development of diabetic microangiopathy in patients with diabetes type 1 by using continuous glucose monitoring system (CGMS). 62 patients (aged 18–45 years) with type 1 diabetes mellitus were examined. Clinical laboratory examination included: assessment of the of HbA1c level, C-peptide level, levels of blood creatinine and albuminuria. Patients were divided into groups: group 1 had HbA1c≤7.0% (n = 18), group 2 had HbA1c&gt; 7.0% (n = 44). Long-term monitoring of blood glucose levels was conducted with using the CGMS system during 6 days. Maximum blood glucose level, minimum blood glucose level and the difference of maximum and minimum blood glucose levels were accounted. The mathematical equation was obtained by using the simple linear regression analysis. This mathematical equation shows relationship between the level of albuminuria and the difference between maximum and minimum blood glucose levels. It can be used to predict the progression of diabetic nephropathy in patients with type 1 diabetes. We suggested the method for prognosticating the development and progression of diabetic microangiopathy (on an example of diabetic nephropathy) in patients with diabetes mellitus type 1 that does not require special software. This calculation may be performed using self-monitoring of blood glucose in clinical practice.

Hypoglycemia in blood glucose level in type 2 diabetic Japanese patients by continuous glucose monitoring

BackgroundHypoglycemia is associated with cardiovascular diseases, increased risk of death. Therefore, it is important to avoid hypoglycemia. The aim of this study was to characterize hypoglycemia according to glycated hemoglobin (HbA1c) level and determine the contributing factors in type 2 diabetes mellitus (T2DM), using continuous glucose monitoring (CGM).MethodsT2DM patients (n = 293) receiving inpatient care were divided into five groups according to HbA1c level on admission (Group 1: ≥ 6 to < 7%, Group 2: ≥ 7 to < 8%, Group 3: ≥ 8 to < 9%, Group 4: ≥ 9 to < 10%, and Group 5: ≥ 10%). The frequency of hypoglycemia and factors associated with hypoglycemia were analyzed.ResultsHypoglycemia occurred in 15 patients (5.1%), including 4 (8%), 4 (6%), and 7 (10%) patients of Groups 1, 2, and 3, respectively, but in none of groups 4 and 5. Patients with hypoglycemia of Groups 1 had low insulin secretion and were high among insulin users, those of Groups 2 had low homeostasis model assessment of insulin resistance (HOMA-IR). Those of Group 2 and 3 had significantly lower mean blood glucose levels, those of Group 3 only had significantly lower maximum blood glucose level and percentage of AUC > 180 mg/dL. In any of the HbA1c groups, variations in blood glucose level were significantly larger in patients with hypoglycemia than without.ConclusionsHypoglycemia occurred in patients with a wide range of HbA1c on admission (range 6–9%), suggesting that prediction of hypoglycemia based on HbA1c alone is inappropriate. Among patients with low HbA1c, strict control sometimes induce hypoglycemia. Among patients with high HbA1c, the possibility of hypoglycemia should be considered if there is a marked discrepancy between HbA1c and randomly measured blood glucose level. Larger variations in blood glucose level induce hypoglycemia in any of the HbA1c groups. The treatment to reduce variations in blood glucose level is important to prevent hypoglycemia.

Risk Factors of Intraoperative Dysglycemia in Elderly Surgical Patients.

BACKGROUNDː Dysglycemia is associated with adverse outcome including increased morbidity and mortality in surgical patients. Acute insulin resistance due to the surgical stress response is seen as a major cause of so-called stress hyperglycemia. However, understanding of factors determining blood glucose (BG) during surgery is limited. Therefore, we investigated risk factors contributing to intraoperative dysglycemia.METHODSː In this subgroup investigation of the BIOCOG study, we analyzed 87 patients of ≥ 65 years with tight intraoperative BG measurement every 20 min during elective surgery. Dysglycemia was defined as at least one intraoperative BG measurement outside the recommended target range of 80-150 mg/dL. Additionally, all postoperative BG measurements in the ICU were obtained. Multivariable logistic regression analysis adjusted for age, sex, American Society of Anesthesiologists (ASA) status, diabetes, type and duration of surgery, minimum Hemoglobin (Hb) and mean intraoperative norepinephrine use was performed to identify risk factors of intraoperative dysglycemia.RESULTSː 46 (52.9%) out of 87 patients developed intraoperative dysglycemia. 31.8% of all intraoperative BG measurements were detected outside the target range. Diabetes [OR 9.263 (95% CI 2.492, 34.433); p=0.001] and duration of surgery [OR 1.005 (1.000, 1.010); p=0.036] were independently associated with the development of intraoperative dysglycemia. Patients who experienced intraoperative dysglycemia had significantly elevated postoperative mean (p<0.001) and maximum BG levels (p=0.001). Length of ICU (p=0.007) as well as hospital stay (p=0.012) were longer in patients with dysglycemia.CONCLUSIONSː Diabetes and duration of surgery were confirmed as independent risk factors for intraoperative dysglycemia, which was associated with adverse outcome. These patients, therefore, might require intensified glycemic control. Increased awareness and management of intraoperative dysglycemia is warranted.

Control Limitations in Models of T1DM and the Robustness of Optimal Insulin Delivery.

In insulin therapy, the blood glucose level is constrained from below by the hypoglycemic threshold, that is, the blood glucose level must remain above this threshold. It has been shown that this constraint fundamentally limits the ability to lower the maxima of the blood glucose level predicted by many mathematical models of glucose metabolism. However, it is desirable to minimize hyperglycemia as well. Hence, a desirable insulin input is one that minimizes the maximum glucose concentration while causing it to remain above the hypoglycemic, or higher, threshold. It has been shown that this input, which we call optimal, is characterized by glucose profiles for which either each maximum of the glucose concentration is followed by a minimum or each minimum is followed by a maximum. We discuss the implication of this inherent control limitation for clinical practice and test, through simulation, the robustness of the optimal input to a number of different model and parameter uncertainties. We further develop guidelines on how to design an optimal insulin input that is robust to such uncertainties. The optimal input is in general not robust to uncertainties. However, a number of strategies may be used to ensure the blood glucose level remains above the hypoglycemic threshold and the maximum blood glucose level achieved is less than that achieved by standard therapy. An understanding of the limitations on the controllability of the blood glucose level is important for future treatment improvements and the development of artificial pancreas systems.

Hiperglucemia inducida por estrés en pacientes ancianos hospitalizados no críticos

AimsHospital complications and hyperglycemia are common in elderly patients during hospitalization. Our aim was to analyze the relationship between hyperglycemia and hospital complications in an ageing population. MethodsWe conducted an observational study to evaluate the association between maximum blood glucose (MBG) levels and hospital complications. Patients were stratified according to the quartiles of MBG levels. Diabetes mellitus (DM) was determined by patient history and/or admission glycated hemoglobin (HbA1c) level ≥6.5%. Hyperglycemia in patients without DM was defined as stress-induced hyperglycemia (SH). The composite primary end-point included frequent complications and/or all-cause hospital mortality. ResultsAmong 461 patients, mean age 80±7.5years, 238 (51.6%) patients had DM, 20 had undiagnosed DM, and 162 (35.1%) developed hospital complications. Patients with complications had higher mean daily BG levels (215±84 vs 195±85mg/dl, P<.01). The incidence of complications was directly associated with severity of hyperglycemia according to the quartiles of MBG levels in patients without DM, namely SH (<140 mg/dl, 22.2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; P=.002), but not in patients with DM (<140mg/dl, 26.3%; 140-185mg/dl, 40.4%; 186-250mg/dl, 35.6%; >250mg/dl, 37.4%; P=.748). In the multivariate analyses, SH was independently associated with complications: OR 2.60 (CI95%: 1.2-5.6), 2.82 (CI95%: 1.2-6.5), 5.50 (CI95%: 1.4-20.8) for the second, third and fourth quartile respectively (P=.01), as compared to the first quartile. We found no association with readmissions and all-cause mortality. ConclusionsSH in elderly patients is associated with hospital complications, but not with all-cause mortality, compared to patients with diabetes or normoglycemia.

Hiperglucemia inducida por estrés en pacientes ancianos hospitalizados no críticos

AimsHospital complications and hyperglycemia are common in elderly patients during hospitalization. Our aim was to analyze the relationship between hyperglycemia and hospital complications in an ageing population. MethodsWe conducted an observational study to evaluate the association between maximum blood glucose (MBG) levels and hospital complications. Patients were stratified according to the quartiles of MBG levels. Diabetes mellitus (DM) was determined by patient history and/or admission glycated hemoglobin (HbA1c) level ≥6.5%. Hyperglycemia in patients without DM was defined as stress-induced hyperglycemia (SH). The composite primary end-point included frequent complications and/or all-cause hospital mortality. ResultsAmong 461 patients, mean age 80±7.5years, 238 (51.6%) patients had DM, 20 had undiagnosed DM, and 162 (35.1%) developed hospital complications. Patients with complications had higher mean daily BG levels (215±84 vs 195±85mg/dl, P<.01). The incidence of complications was directly associated with severity of hyperglycemia according to the quartiles of MBG levels in patients without DM, namely SH (<140 mg/dl, 22.2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; P=.002), but not in patients with DM (<140mg/dl, 26.3%; 140-185mg/dl, 40.4%; 186-250mg/dl, 35.6%; >250mg/dl, 37.4%; P=.748). In the multivariate analyses, SH was independently associated with complications: OR 2.60 (CI95%: 1.2-5.6), 2.82 (CI95%: 1.2-6.5), 5.50 (CI95%: 1.4-20.8) for the second, third and fourth quartile respectively (P=.01), as compared to the first quartile. We found no association with readmissions and all-cause mortality. ConclusionsSH in elderly patients is associated with hospital complications, but not with all-cause mortality, compared to patients with diabetes or normoglycemia.

Calorie Restriction Effect of Heat-Processed Onion Extract (ONI) Using In Vitro and In Vivo Animal Models.

Onion (Allium cepa L.) is widely consumed as food or medicinal plant due to its well-defined health benefits. The antioxidant and antihyperlipidemic effects of onion and its extracts have been reported well. However, very limited information on anti-hyperglycemic effect is available in processed onion extracts. In our previous study, we reported that Amadori rearrangement compounds (ARCs) produced by heat-processing in Korean ginseng can reduce carbohydrate absorption by inhibiting intestinal carbohydrate hydrolyzing enzymes in both in vitro and in vivo animal models. To prove the enhancement of anti-hyperglycemic effect and ARCs content by heat-processing in onion extract, a correlation between the anti-hyperglycemic activity and the total content of ARCs of heat-processed onion extract (ONI) was investigated. ONI has a high content of ARCs and had high rat small intestinal sucrase inhibitory activity (0.34 ± 0.03 mg/mL, IC50) relevant for the potential management of postprandial hyperglycemia. The effect of ONI on the postprandial blood glucose increase was investigated in Sprague Dawley (SD) rats fed on sucrose or starch meals. The maximum blood glucose levels (Cmax) of heat-processed onion extract were significantly decreased by about 8.7% (from 188.60 ± 5.37 to 172.27 ± 3.96, p < 0.001) and 14.2% (from 204.04 ± 8.73 to 175.13 ± 14.09, p < 0.01) in sucrose and starch loading tests, respectively. These results indicate that ARCs in onion extract produced by heat-processing have anti-diabetic effect by suppressing carbohydrate absorption via inhibition of intestinal sucrase, thereby reducing the postprandial increase of blood glucose. Therefore, enhancement of ARCs in onion by heat-processing might be a good strategy for the development of the new product on the management of hyperglycemia.

Relation Between Hypoglycemia and Glycemic Variability in Type 2 Diabetes Patients with Insulin Therapy: A Study Based on Continuous Glucose Monitoring.

To determine the factors associated with hypoglycemia in patients with type 2 diabetes mellitus (T2DM) on insulin therapy. This retrospective study included 62 inpatients with T2DM on insulin therapy who underwent 5-day continuous glucose monitoring (CGM). We analyzed the relation between hypoglycemia (defined as blood glucose below 70 mg/dL, as determined by the CGM) and time spent in hypoglycemia with fasting blood glucose, mean blood glucose (MBG), standard deviation (SD), coefficient of variation, minimum blood glucose level, maximum blood glucose level, and the percent time spent with blood glucose levels of >180 mg/dL. Twelve patients (19.4%) developed hypoglycemia, and most were maintained on mix insulin therapy alone. In the hypoglycemic group, MBG was lower and SD was higher, than in the non-hypoglycemic group, although HbA1c was not different. Multivariate logistic regression analysis identified MBG and SD as factors related to hypoglycemia. Receiver operating characteristic curve analysis showed that the optimal MBG and SD cutoff values for prediction of hypoglycemia were 150.9 and 41.1 mg/dL, respectively. When subjects were divided into four groups according to these values, time at blood glucose <70 mg/dL was longest, and total insulin dosage highest, in the MBG-low/SD-high group. MBG and SD of glucose levels were identified as significant and independent determinants of hypoglycemia in T2DM on insulin therapy. It is important to use the least insulin dose, with the target of minimizing glycemic variability, to achieve good glycemic control without hypoglycemia.

In vivo study on the slow release of glucose in vacuum fried matrices

In vitro studies have shown that vacuum frying may be an effective process to reduce starch digestibility as it may limit gelatinization; this is significant as overconsumption of starchy foods contributes to obesity and type 2 diabetes. Although in vitro studies are an instrumental tool, in vivo studies allow observation of the overall effect on a living organism. The aim of this research was to assess how in vivo starch digestibility can be reduced when frying under vacuum (9.9 kPa), after feeding Sprague-Dawley rats, while also understanding its relationship to in vitro starch digestibility. Results showed that vacuum-fried dough has a lower degree of gelatinization (∼53.8%) and a maximal blood glucose level at 60 min (slower glycemic response) than atmospheric counterparts (∼98.3% degree of gelatinization and maximal blood glucose level at 30 min). Similarly, in vitro procedures exhibited less rapidly available glucose and higher unavailable glucose fractions in vacuum-fried dough.

Flight is the key to postprandial blood glucose balance in the fruit bats Eonycteris spelaea and Cynopterus sphinx.

Excessive sugar consumption could lead to high blood glucose levels that are harmful to mammalian health and life. Despite consuming large amounts of sugar‐rich food, fruit bats have a longer lifespan, raising the question of how these bats overcome potential hyperglycemia. We investigated the change of blood glucose level in nectar‐feeding bats (Eonycteris spelaea) and fruit‐eating bats (Cynopterus sphinx) via adjusting their sugar intake and time of flight. We found that the maximum blood glucose level of C. sphinx was higher than 24 mmol/L that is considered to be pathological in other mammals. After C. sphinx bats spent approximately 75% of their time to fly, their blood glucose levels dropped markedly, and the blood glucose of E. spelaea fell to the fast levels after they spent 70% time of fly. Thus, the level of blood glucose elevated with the quantity of sugar intake but declined with the time of flight. Our results indicate that high‐intensive flight is a key regulator for blood glucose homeostasis during foraging. High‐intensive flight may confer benefits to the fruit bats in foraging success and behavioral interactions and increases the efficiency of pollen and seed disposal mediated by bats.

Re-evaluation of glycated hemoglobin and glycated albumin with continuous glucose monitoring system as markers of glycemia in patients with liver cirrhosis.

[This retracts the article DOI: 10.3892/br.2016.808.].

Nurse-Directed Blood Glucose Management in a Medical Intensive Care Unit.

Insulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy. To evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload. A nurse-directed protocol for blood glucose management was developed by an interprofessional team, and the protocol's performance was investigated in 175 patients compared with 384 historical controls. With the nurse-directed protocol, hypoglycemia incidents declined significantly (31% vs 12%, P < .001), and minimum blood glucose levels increased significantly (80 mg/dL vs 93 mg/dL, P < .001). Mean and maximum blood glucose levels, the proportion of glucose readings within the target range (31% vs 26%, P = .06), and the number of blood glucose checks (59 vs 58, P = .85) remained unchanged with use of the protocol. Implementation of the nurse-directed protocol for blood glucose management did not increase nursing workload but reduced hypoglycemia incidents significantly while maintaining adequate glycemic control.

Higher-Than-Conventional Subcutaneous Regular Insulin Doses Following Diabetic Ketoacidosis in Children and Adolescents

Objective:To evaluate the effect of initial insulin dosage on glycemic control in the first 48 hours of subcutaneous regular insulin therapy after resolution of diabetic ketoacidosis (DKA).Methods:Records of patients with DKA hospitalized in the past 3 years [n=76, median age=10.0 (6.0-12.0) years, Male/Female: 44/32] were reviewed. The patients were designated into two groups according to distribution of starting doses of subcutaneous insulin. Group 1 (n=28) received a median dose of 1.45 U/kg/day (1.41-1.5) and group 2 (n=48) a median dose of 0.96 U/kg/day (0.89-1). Clinical and laboratory data were analyzed.Results:Median, minimum, and maximum blood glucose levels of Group 1 in the first 48 hours of treatment were significantly lower than that of Group 2 [213 (171-242) vs. 255 (222-316), p=<0.001; 102 (85-151) vs. 129 (105-199), p=0.004; and 335 (290-365) vs. 375 (341-438), p=0.001, respectively]. The number of patients who experienced hypoglycemia (<70 mg/dL) were similar [Group 1, 5 (17.9%) vs. Group 2, 4 (8.3%), p=0.276] and none had severe hypoglycemia. In Group 1, the ratio of blood glucose levels within the target range (100-200 mg/dL) were higher (37.5% vs. 12.5%) and the number of results >200 mg/dL were lower (50% vs. 81.3%) compared to Group 2 (p=0.001 and p<0.001, respectively).Conclusion:After resolution of DKA, a higher initial dose of 1.4-1.5 U/kg/day regular insulin is associated with better glycemic control in children and adolescents without an increase in risk of hypoglycemia.