Mean Blood Glucose Values Research Articles

The Effect of Glucose Variability on the Risk of Microvascular Complications in Type 1 Diabetes

It is not known whether glycemic instability may confer a risk of microvascular complications that is in addition to that predicted by the mean blood glucose (MBG) value alone. This study has analyzed data from the Diabetes Control and Complications Trial (DCCT) to assess the effect of glucose variability on the risk of retinopathy and nephropathy in patients with type 1 diabetes. Pre- and postprandial seven-point glucose profiles were collected quarterly during the DCCT in 1,441 individuals. The mean area under the curve glucose and the SD of glucose variability within 24 h and between visits were compared with the risk of retinopathy and nephropathy, having adjusted for age, sex, disease duration, treatment group, prevention cohort, and phase of treatment. Multivariate Cox regression showed that within-day and between-day variability in blood glucose around a patient's mean value has no influence on the development or progression of either retinopathy (P = 0.18 and P = 0.72, respectively) or nephropathy (P = 0.32 and P = 0.57). Neither preprandial (P = 0.18) nor postprandial (P = 0.31) glucose concentrations preferentially contribute to the probability of retinopathy. This study has shown that blood glucose variability does not appear to be an additional factor in the development of microvascular complications. Also, pre- and postprandial glucose values are equally predictive of the small-vessel complications of type 1 diabetes.

Use of continuous subcutaneous insulin infusion by a portable insulin pump during pregnancy in women with type 1 diabetes mellitus

Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated--HbAlc, mean blood glucose value in daily profiles--MBG, daily requirement for insulin--IJ/kg BM), lipid levels, blood preassure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. There was a significant improvement in HbA1c (8.94 +/- 1.62 vs. 6.90 +/- 1.22 %,p < 0.05), MBG (9.23 +/- 2.22 vs. 6.41 +/- 1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66 +/- 0.22 vs. 0.55 +/- 0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbAlc (r = -0.60, p < 0.05), triglyceride levels (r = -0.63, p < 0.01), and the number of pregnancies (r = -0.62, p < 0.01), as well as between APGAR score and MBG (r = -0.52, p < 0.05) and cholesterol levels (r = -0.65, p < 0,01) before a portable insulin pump was applicated. There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.

Resistin polymorphisms are associated with cerebrovascular disease in Finnish Type 2 diabetic patients

Resistin is a hormone secreted by adipocytes and it is also expressed in monocytes. Resistin has been found to increase insulin resistance, a key feature in Type 2 diabetes. The aim of this study was to investigate whether resistin polymorphisms are associated with Type 2 diabetes and its clinical characteristics. We studied the allele and genotype frequencies of the single-nucleotide polymorphisms (SNPs)-420 (C>G), +157 (T>C) and +299 (G>A) in the resistin gene in 258 Finnish Type 2 diabetics and 494 controls. These three markers were in significant linkage disequilibrium with each other. No significant (P<0.05) differences in the allele or genotype frequencies were observed between the study groups. Subjects with Type 2 diabetes showed a significant association between cerebrovascular disease and the SNPs-420 (P=0.004) and +299 (P=0.007), the G-G and A-A genotypes, respectively, had the highest frequencies. SNPs-420 (P=0.000) and +299 (P=0.002) in men and SNP+157 in men (P=0.005) and in women (P=0.019) showed significant association with higher mean blood glucose. The rare allele homozygotes also had the highest mean blood glucose values. We also observed associations between at least one of the SNPs and fasting blood glucose, glycosylated haemoglobin A1 (GHbA1), low-density lipoprotein (LDL) cholesterol and systolic and diastolic blood pressure. After correction for multiple comparisons, the association between the promoter variant SNP-420 and cerebrovascular disease in both genders and the associations between mean blood glucose and SNP-420 and SNP+299 in men remained significant. The results suggest that resistin may play a role in atherogenesis probably through increasing insulin resistance.

Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults

Recent data suggest that current overweight and central adiposity guidelines based on Western populations are not appropriate for Asian populations. The published data among Chinese are insufficient to address this issue. We aimed to identify cutoffs for body mass index (BMI; in kg/m(2)) and waist circumference that confer increased risk of cardiovascular disease in Chinese adults as would be consistent with overweight and central adiposity. A nationally representative, cross-sectional sample of 15 239 Chinese adults aged 35-74 y was studied. Mean blood pressure, total cholesterol, LDL-cholesterol, triacylglycerol, and glucose values were incrementally higher and mean HDL-cholesterol values were incrementally lower with each unit increase in BMI and waist circumference in both men and women. Both the point at which sensitivity equaled specificity and the shortest distance in the receiver operating characteristic curves for hypertension, dyslipidemia, diabetes, or >/=2 of these risk factors suggested a BMI cutoff of 24 and a waist circumference cutoff of 80 cm for both men and women. Lower cutoffs for BMI and waist circumference are needed in the identification of Chinese patients at high risk of cardiovascular disease.

Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women

A paucity of data exists concerning the normal glycemic profile in nondiabetic pregnancies. Using a novel approach that provides continuous measurement of blood glucose, we sought to evaluate the ambulatory daily glycemic profile in the second half of pregnancy in nondiabetic women. Fifty-seven obese and normal weight nondiabetic subjects were evaluated for 72 consecutive hours with continuous glucose monitoring by measurement interstitial glucose levels in subcutaneous tissue every 5 minutes. Subjects were instructed not to modify their lifestyle or to follow any dietary restriction. For each woman, mean and fasting blood glucose values were determined; for each meal during the study period, the first 180 minutes were analyzed. For the study group, the fasting blood glucose level was 75 +/- 12 mg/dL; the mean blood glucose level was 83.7 +/- 18 mg/dL; the postprandial peak glucose value level was 110 +/- 16 mg/dL, and the time interval that was needed to reach peak postprandial glucose level was 70 +/- 13 minutes. A similar postprandial glycemic profile was obtained for breakfast, lunch, and dinner. Obese women were characterized by a significantly higher postprandial glucose peak value, increased 1- and 2-hour postprandial glucose levels, increased time interval for glucose peak, and significantly lower mean blood glucose during the night. No difference was found in fasting and mean blood glucose between obese and nonobese subjects. Glycemic profile characterization in both obese and normal weight nondiabetic subjects provide a measure for the desired level of glycemic control in pregnancy that is complicated with diabetes mellitus.

Contributions of Weekly Mean Blood Glucose Values to Hemoglobin A1c in Insulin-Treated Type 2 Diabetes: The Diabetes Outcomes in Veterans Study (DOVES)

Daily self-monitored blood glucose testing is recommended for patients with insulin-treated type 2 diabetes. However, most patients do not test frequently enough for optimal glycemic control. Less frequent testing may be sufficient for assessing glycemic control among stable patients as well as improving patient compliance. The study objective was to evaluate the weekly contribution of glucose readings to hemoglobin (Hb)A1c during an 8-week period of intensified self-monitored blood glucose testing. The authors randomly selected stable, insulin-treated subjects with type 2 diabetes. Subjects monitored their blood glucose four times daily for 8 weeks; the authors then downloaded glucose meters and measured an HbA1c. Mean blood glucose values were calculated for each of the 8 weeks. Multiple linear regression analyses examined the contribution of these mean values to the HbA1c. A total of 182 subjects completed the monitoring protocol; mean HbA1c was 7.63 +/- 1.42%, mean glucose was 9.78 +/- 2.27 mmol/L, the regression correlation was 0.77, P < 0.001. A fitted multiple linear model using all 8 weekly mean blood glucose values showed large variation in their independent contributions to the HbA1c. Mean blood glucose values from consecutive weeks were highly correlated and did not provide independent information about glycemic control. Stepwise regression showed that the mean blood glucose values from weeks 4, 6, and 8 significantly and equally influenced HbA1c. Glycemic control can be efficiently assessed by reviewing at least 5 weeks' worth of monitoring results, focusing on alternate weeks and giving less weight to more remote readings.

Beneficial effect of glucose‐insulin‐ potassium infusion in noncritically ill patients has to be proven – reply

Dear Sir, We thank Dr van der Hosts and colleagues for their interest to discuss our study and agree with their concerns about the need of more studies to prove the benefits of intensified insulin therapy in this diabetic group. Earlier studies with glucose-insulin-potassium (GIK) infusion have been amongst diabetics with severe illness and probably suffered from severe insulin resistance [1–3]. These patients in this study were both type 1 and type 2 diabetics and the indications for the infusion were all from blood glucose fluctuation in ‘healthy’ insulin sensitive type 1 diabetics to severe insulin resistance amongst infectious diabetics. Hypoglycaemia is common in and probably the biggest limiting factor to improve diabetes control amongst type 1 diabetics [4]. All this mild hypoglycaemia in this study was amongst type 1 diabetic patients and two of the hypoglycaemia episodes were in the same person. The daily insulin demand was between 28 and 122 IU per day. Comparison and mean blood glucose values were calculated from measurements five times per day. The aim with this study was to validate and prove that this infusion was safe enough to handle at a normal internal medicine ward and without increasing the personal staff. Our hope is that this GIK-infusion algorithm could be a useful tool for future studies to prove the benefits of intensified insulin therapy even for this group of diabetics. No conflict of interest was declared.

The effect of walking before and after breakfast on blood glucose levels in patients with type 1 diabetes treated with intensive insulin therapy

Objective: We examined the effect of walking at different timing on carbohydrate metabolism in patients with type 1 diabetes. Subjects and Methods: Subjects included six non-obese patients treated with intensive insulin therapy. The blood glucose profile was determined with and without walking for 30 min before (ExBM) or after (ExAM) breakfast. Results: Mean blood glucose values at 07:00 h in the control, ExBM, and ExAM were 9.0, 8.0, 8.8 mM, respectively. Glucose levels gradually increased after meals up to 13.6, 15.0, and 15.3 mM, respectively, at 09:00 h (0.5 h after meals). At 09:30 h, glucose levels significantly fell to 11.0 mM during walking in the ExAM (P=0.039 vs 09:00 h values). The area under blood glucose response curve was significantly lower only in the ExAM when compared with that in the control (P=0.043) (11.8, 17.8. and 3.8 h mM in the control, ExBM and ExAM, respectively). Conclusion: These results might suggest that walking after meals improves glycemic control in patients with type 1 diabetes being treated with intensive insulin therapy consisting of the basal-bolus (NPH-human regular) insulin regimen.

Description and Evaluation of a Glycemic Management Protocol for Patients with Diabetes Undergoing Heart Surgery

To evaluate a protocol for glycemic management in the treatment of postoperative heart patients with diabetes in the setting of a community hospital. The protocol included a standardized guideline in tabular form for nurse-implemented insulin infusion ("drip") therapy for postoperative glycemic control. At the time of discontinuation of the insulin drip, the glycemic status of patients with diabetes was managed by the endocrine department. Overall, 29 patients were assessed without and 29 patients with use of the protocol in a community hospital. From postoperative days 0 through 4, use of the protocol resulted in a greater number of blood glucose determinations, a trend toward greater utilization of insulin drip therapy without a significant increase in the number of patients treated with insulin drip, and no change in the frequency of hypoglycemic episodes. During the same time interval, the percentages of postoperative days during which at least one blood glucose value equaled or exceeded 250 mg/dL were 27.5% without the protocol and 16.8% with use of the protocol (P = 0.0318). The principal finding of the study was reduction in the percentage of postoperative days during which mean blood glucose values equaled or exceeded 200 mg/dL to less than half the previously observed frequency-from 38.4% without the protocol to 16.8% with the protocol (P = 0.0001). The effectiveness of the insulin drip component of the protocol is suggested by a trend, shown on postoperative days 2 through 4, of 70 patient days with mean blood glucose levels <200 mg/dL (58 of these days without insulin drip therapy) and 15 patient days with mean blood glucose values > or =200 mg/dL (none of these days associated with same-day insulin drip therapy). A standardized approach to insulin drip therapy, in combination with subspecialty consultation for follow-up glycemic management with use of subcutaneous administration of insulin, can improve glycemic control in postoperative heart patients without continuation of insulin drip therapy outside the critical-care unit. The trends observed on postoperative days 2 through 4, that most patients maintained glycemic control without insulin drip therapy and that all failures of glycemic control occurred among patients who no longer received insulin drip therapy, suggest the possibility of developing criteria for selection of patients for continuation of insulin infusion outside the critical-care unit.

Varying clinical presentations at onset of type 1 diabetes mellitus in children--epidemiological evidence for different subtypes of the disease?

On the basis of 2121 case observations between 1987 and 1997, we describe the clinical and laboratory characteristics of diabetes mellitus type 1 at its onset. Our objective is to analyze whether clinical presentation follows a uniform pattern or whether there is evidence for different subtypes. Thirty-one pediatric hospitals and one diabetes center in Baden-Wuerttemberg (BW), Germany, participated in this study. The hospital records of 2121 children below 15 yr of age were examined retrospectively. Statistical analysis was done after logarithmic transformation into a normal distribution. The average duration of symptoms was found to be 15.2 d (95% CI (Confidence Intervals) = 14.3-16.1) ranging between 2.0 and 180 d (95% central range). The most frequent symptoms were polyuria and polydipsia; 7.2% presented with altered level of consciousness. The mean blood glucose value was 407.9 mg/dL (95% CI = 400.0-416.0), corresponding to 23.3 mmol/L (95% CI = 22.8-23.8). The median pH value was 7.35 (95% CI = 7.34-7.36), and the median base excess was -5 mmol/L (95% CI =-5 to -4). The younger patients had a shorter duration of symptoms and suffered most frequently from ketoacidosis. Although the symptoms of diabetes at its onset follow a uniform pattern, the clinical presentation and duration of symptoms indicate that there may be various forms of type 1 diabetes.

Blood viscosity and blood pressure: role of temperature and hyperglycemia

We planned a study to research the relations among blood pressure (BP), viscosity, and temperature in healthy subjects and among BP, viscosity, and glucose in diabetics. With simple random sampling method, 53 healthy and 29 diabetes mellitus (DM) type II subjects were selected. Parameters were determined with capillary viscometer and glucometer at 22°C, 36.5°C, and 39.5°C in healthy subjects, and at 22°C on diabetic patients during OGTT with 75 g of glucose. Statistical evaluations of the data were made with regression analysis, Student t test, Spearman’s correlation, and analysis of variance. When temperature decreased from 36.5°C to 22°C, blood viscosity increased 26.13%. This increase resulted in a 20.72% decrease in blood flow rate. According to the Hagen-Poiseuille equation, the required BP increase for compensation of the resulting tissue ischemia was 20.72%. Also, a 34.73% decrease in erythrocyte deformability and 18.71% increase in plasma viscosity were seen. When temperature increased from 36.5° to 39.5°C, blood viscosity decreased 10.38%. This caused 11.15% decrease in blood flow rate, and 11.15% decrease in BP, according to the equation. Erythrocyte deformability increase of 9.92% and plasma viscosity decrease of 4.99% arose from the temperature rise. There is a correlation between total data for temperatures and viscosities (r = −0.84, P < .001). When the mean value of blood glucose increased from 100 to 400 mg/dL, viscosity increased 25% (r = 0.59, P = .002). In this state, blood flow rate decrease was 20% and BP increase for physiological compensation was 25%. Consequently, temperature, glucose and viscosity levels of blood are important factors for BP.

Besonderheiten der Insulintherapie bei Gestationsdiabetes (GDM) - Special Aspects of Insulin Therapy in Pregnancies Complicated by Gestational Diabetes Mellitus (GDM) -

Fragestellung: Bei Gestationsdiabetes (GDM) entwickeln rund 10 - 20 % der Feten einen Hyperinsulinismus. Da dieser alle frühen und späten kindlichen Komplikationen verursacht, ist eine aggressive Insulintherapie nur bei fetalem Hyperinsulinismus erforderlich. Für die Indikation zur Insulinbehandlung bestehen keine einheitlichen Richtlinien. Sie erfolgt nach internistischen Gesichtspunkten anhand der mütterlichen Glykämie und/oder nach geburtshilflichen Gesichtspunkten als prophylaktische Insulintherapie, oder nach fetalen Parametern wie Makrosomie oder dem Fruchtwasserinsulinspiegel.

Hemoglobin Alc values decrease with advancing gestation despite the same level of glycemic control in diabetic pregnancies

Objective: To test the hypothesis that hemoglobin A1c values are poorly predictive of glycemic controls in pregestational diabetic patients during the latter half of pregnancy.Methods: In an ongoing study, a cohort of 21 pregestational diabetic patients (class B-R) had serial hemoglobin Alc values documented after conception. Mean fasting blood glucose values from the same patients were obtained from the 4–6 weeks preceding each hemoglobin Alc value. All patients were on a multiinjection insulin regimen adjusted weekly. Data points were plotted against gestational age, and best-fitting regression lines were created. Slopes were compared using analysis of variance.Results: The slopes of the hemoglobin Alc and mean fasting blood glucose regression lines were –2.83 and –0.076, respectively. A statistically significant difference between these two calculated values was appreciated with a P value of less than 0.001.Conclusions: For this cohort of pregnant diabetic patients, hemoglobin A1c values fell with advancing gestational age despite relatively unchanged blood glucose levels over the same time period. Hemoglobin Alc values obtained late in pregnancy seem to be a poor indicator of maternal glycemic control and therefore are of little help in diabetic management.

The effect of urapidil and ramipril on hyperglycemia in streptozotocin diabetic rats.

Angiotensin-converting enzyme inhibitors and alpha1-adrenoceptor antagonists improve glucose disposal in diabetes mellitus. We compared the effect of the antihypertensive hybrid drug urapidil [alpha1-adrenoceptor antagonist serotonin 1A (5-hydroxytryptamine 1A, 5-HT1A) receptor agonist] on hyperglycemia in streptozotocin diabetic rats with the angiotensin-converting enzyme inhibitor ramipril. 5-HT1A receptor agonists induce hyperglycemia. This could be an important disadvantage during treatment of diabetes mellitus with urapidil. Diabetes was induced by streptozotocin (70 mg/kg i.p.). Treatment for 7 days (ramipril 10 mg/kg p.o.; urapidil 20 mg/kg p.o.) significantly decreased mean blood glucose values (urapidil: 15.7+/-0.9 mmol/l, P=0.007; ramipril: 15.0+/-0.8 mmol/l, P=0.038 vs. diabetic control group: 18.7+/-1.0 mmol/l). Both drugs reduced significantly blood pressure, urinary glucose, water consumption, and food requirement. Serotonin concentration in the brain (medulla oblongata, pituitary) was not affected. A normalization comparable with healthy control rats was observed only in a diabetic control group with insulin therapy. In conclusion, our results demonstrate that the antihypertensive drug urapidil has no detrimental effect on hyperglycemia compared with the angiotensin-converting enzyme inhibitor ramipril in experimental diabetes mellitus despite its 5-HT1A receptor agonistic properties.

Histologic grading of acute allograft rejection in pancreas needle biopsy: correlation to serum enzymes, glycemia, and response to immunosuppressive treatment.

Allograft rejection continues to be the most common cause of graft failure in technically successful pancreas transplants. Early diagnosis and treatment of rejection is essential for long-term graft survival. Pancreas graft biopsies are now used routinely for the diagnosis of acute allograft rejection. The correlation between clinical evidence of graft dysfunction (increased serum enzymes and glucose), severity of acute rejection on biopsy (rejection grade), and response to treatment has not been previously studied. A total of 151 pancreas transplant needle biopsy specimens from 57 patients were evaluated. Statistical correlation was done between the histologic rejection grade (O-V) and the peak level of enzymes in serum, glycemia, type of antirejection treatment instituted, and response to treatment. Differentiation between grades was also evaluated statistically. Response to antirejection treatment was 25%, 40%, 88%, 78%, 50%, and 17% for grades O-V, respectively. The response for grades II and III was better than for grades 0-I and IV-V (P=0.0003 and 0.0008, respectively). The response to corticosteroids alone was 36%, 86%, 68%, and 0% for grades I, II, III, and IV, respectively. The response to antilymphocyte regimen was 50%, 89%, 85%, 71%, and 17% for grades I, II, III, IV, and V, respectively. Overall correlation between the mean levels of enzymes and rejection grade was seen; the increase of lipase was statistically significant (r=0.24, P=0.012). Amylase and lipase correlated very well with each other (r=0.84, P=0.0001). No correlation was found in the mean values of blood glucose with the serum enzyme increase and with severity of rejection. Hyperglycemia was present in 12 patients; this abnormality in patients with grades II-IV responded promptly to treatment, whereas in patients with grade V, hyperglycemia persisted despite antirejection treatment. Other causes of increased enzymes were found in patients with biopsy specimens showing no rejection (grades 0 and I, 43% and 31%, respectively). Increased serum enzymes, particularly lipase, correlate with the grade of acute rejection, but their lack of specificity precludes their use as sole markers of acute rejection. Glucose levels are not a sensitive marker for acute rejection. Rejection grades II and III are the most responsive to treatment, and a significant proportion of these cases respond to treatment with corticosteroids only. The higher rejection grades (IV and V) require treatment with antilymphocytic regimens, and their overall response to treatment is moderate to poor, respectively.

The α1-adrenoceptor antagonist/5-hydroxy-tryptamine1A agonist urapidil improves glucose disposition in streptozotocin diabetic rats

O-31 Introduction: Urapidil (U) is an established drug in the treatment of hypertension. Serotonin1A-(5-HT1A) agonists impair glucose metabolism [1]. We investigated, possible adverse metabolic effects of U due to its 5-HT1A agonistic properties in streptozotocin diabetic rats. Methods: Male Wistar Kyoto Rats were made diabetic by streptozotocin i.p. and randomized (n = 6) to four treatment groups (U3: U 3 mg kg−1 (2×/day) PO, U10: U 10 mg kg−1 2×/day PO, U30: U30 mg kg−1 2×/day PO, insulin 2 IU kg−1 2×/day s.c.). Results: 7 days' treatment with U 10 mg kg−1 and U 30 mg kg−1 2×/day decreased mean blood glucose values significantly (U10: 281 ± 20 mg dL−1, P = 0.024; U30: 285 ± 15 mg dL−1, P = 0.04) in comparison to diabetic control (376 ± 15 mg dL−1). Insulin treatment normalized blood glucose levels (Fig. 1).FigureConclusion: Urapidil, even in high doses, has no disadvantage on circulating glucose concentration in experimental diabetes mellitus despite its 5-HT1A agonistic properties. Possibly the α1-antagonistic properties counteract the 5-HT1A receptor-mediated negative metabolic effects [2].

Changes in carbohydrate metabolism in the eel anguilla anguilla, during short‐term exposure to diazinon

The present communication deals with the effect of diazinon (0.042 mg/L) on the energy metabolism of the european eel Anguilla anguilla. Analysis of various parameters such as glycogen, lactate and glucose was made on different eel tissues after 6, 24, 48, 72 and 96 hr of diazinon exposure. Liver and muscle glycogen content decreased significantly (p < 0.05) from 6 to 96 hr pesticide exposure. Mean blood glucose values were elevated significantly after exposure to this sublethal diazinon concentration. Liver, blood and muscle lactate levels in fish increased during all exposure time being the highest at 96 hr exposure. Diazinon intoxicated fish showed signs of pesticide poisoning as muscular twitching, gyrating swimming movements and diminished sensory activity but survived the stipulated exposure period. The results are discussed in relation to the stress effect produced by the pesticide and the related responses of the fish.

Pesticide Effects on Eel Metabolism

Previous works on endosulfan eel toxicology in this laboratory demonstrated that 0.041 mg/liter of endosulfan was the 50% lethal concentration of 96 hr exposure. Eels of species Anguilla anguilla were exposed to two sublethal endosulfan concentrations: 8.2 μg/liter (1/5 LC 50) and 4.1 μg/liter (1/10 LC 50), and the experiment was done at different exposure times: 12, 24, 48, 72, and 96 hr. Muscle glycogen content decreased significantly ( P < 0.05) at 24, 48, 72, and 96 hr exposure to 8.2 μg/liter pesticide; levels did not decline at any time when animals were exposed to 4.1 μg/liter. Muscle lactate levels in fish did not change significantly while lactate levels in eel blood increased at 12, 24, 48, 72, and 96 hr exposure to 8.2 μg/liter. Mean blood glucose values were elevated after exposure to both endosulfan concentrations. The results are discussed in relation to the stress effect produced by the pesticide and the related responses of the fish.

Intraperitoneal insulin delivery decreases the levels of chylomicron remnants in patients with IDDM.

To investigate whether intraperitoneal insulin (IPII) decreases the levels of circulating chylomicron remnants in patients with insulin-dependent diabetes mellitus (IDDM). Eight nonobese, normolipidemic IDDM patients were studied twice: before (while on subcutaneous insulin) and 6 months after initiation of IPII by a programmable implanted medication system. Fasting and mean blood glucose, HbA1, and lipid values were determined. Blood samples were also drawn before and every 2 h for 10 h after ingestion of a fat meal (corn oil + Vitamin A). Triglycerides (TGs), apolipoprotein B (apoB), and retinyl esters were determined over time in two TG-rich lipoprotein subfractions (Sf > 100 and Sf20-100) isolated from plasma by density-gradient ultracentrifugation. IPII slightly decreased the mean blood glucose from 7.8 +/- 1.1 to 7.4 +/- 1.1 mmol/l (mean +/- SD, P = 0.027, paired Student's t test) and the HbA1 from 9.4 +/- 1.5 to 8.7 +/- 1.2 (NS). TG and apoB levels in postprandial Sf > 100 and Sf20-100 were not changed by IPII. On IPII, however, retinyl ester levels in Sf > 100 decreased (P = 0.05, analysis of variance [ANOVA]) and tended to be lower in Sf20-100 (P = 0.075). In addition, following IPII, the retinyl ester:apoB ratio was lower in Sf > 100 (P = 0.0002) and marginally lower (P = 0.06) in Sf 20-100. IPII decreased chylomicron remnant levels, which might decrease the atherosclerotic risk in IDDM. Since glycemic control was only slightly improved, the effect was most likely due to the intraperitoneal route of delivery.

Amniotic fluid volume reflects recent glycemic status in gestational diabetes mellitus

Objective: Our purpose was to determine the association between amniotic fluid volume and recent glucose status in gestational diabetes.Study Design: Serial amniotic fluid index values, mean blood glucose levels, and percent hyperglycemia (≥ 120 mg/dl) 1 day and 1 week before the ultrasonographic examinations were prospectively collected in 399 gestational diabetics. Patients demonstrating at least one amniotic fluid index measurement within the normal range (i.e., 5 cm < amniotic fluid index ≤ 20 cm) and at least one elevated measurement (i.e., amniotic fluid index>20 cm) formed the study group. With each patient serving as her own control, glucose index values preceding normal and elevated amniotic fluid index values were compared.Results: Significantly higher mean blood glucose values 1 day (114.7 mg/dl vs 102.8 mg/dl, p < 0.01) and 1 week before (111.0 mg/dl vs. 102.0 mg/dl, p < 0.05) were calculated for examinations resulting in elevated amniotic fluid index values compared with normal amniotic fluid index values, respectively. Similarly, significantly higher percents of hyperglycemia 1 day (32% vs 16.5%, p < 0.05) but not 1 week (30.8% vs 21.7%, p>0.05) before the elevated amniotic fluid index were documented.Conclusion: Amniotic fluid volume reflects recent glycemic status in gestational diabetes mellitus.