Mean Plasma Glucose Concentration Research Articles

Stability of serum total cholesterol, triglycerides, and plasma glucose of healthy individuals at different storage conditions

Evaluation of the stability of serum and plasma analytes under different temperatures and time points is vital since it significantly affects the pre-analytical errors. The aim of the study was to determine the stability of serum total cholesterol and triglyceride and plasma glucose of healthy individuals under different storage conditions (25-30°C and 2-8°C) and at different time points (1-hour, 4-hour, 6-hour, and 24-hour). Venous blood samples were collected from healthy individuals aged between 20-50 years after a 12-hour fast. Plasma and serum were separated and stored at different temperatures (25-30°C and 2-8°C) and different time points (1-hour, 4-hour, 6-hour, and 24-hour). Results indicated a significant difference between the mean plasma glucose concentration at room temperature (25-30°C) and refrigerated temperature (2-8°C) at 1-hour (0.072%, p = 0.05). However, there were no significant differences in mean serum total cholesterol concentrations (p = 0.633) and mean serum triglyceride concentrations (p = 0.246) between these temperatures at 1-hour time point. Regarding time points (1-hour, 4-hour, 6-hour, and 24-hour), significant differences in plasma glucose concentrations occurred at 24-hour (10.03%, p = 0.001) at room temperature (25-30°C) and 6-hour (8.79%, p = 0.003) at refrigerated temperature (2-8°C) compared to the 1-hour reference values. Additionally, there were significant differences in serum total cholesterol concentration at 4-hour (12.55%, p = 0.000) and serum triglyceride at 24-hour (29.18%, p = 0.001) compared to the reference values obtained at 1-hour at room temperature (25-30°C). No significant differences were observed among the time points (1-hour, 4-hour, 6-hour, and 24-hour) for serum total cholesterol (p = 0.507) and serum triglyceride values (p = 0.761) at refrigerated temperature (2-8°C). Plasma glucose is unstable at both room temperature (25-30°C) and refrigeration (2-8°C), with recommended testing within 6 hours at room temperature (25-30°C) and stored in a refrigerator (2-8°C) if delayed. It is better to estimate serum total cholesterol within 1-hour of collection at room temperature (25-30°C) while serum triglyceride concentration within 6 hours at the same temperature to obtain accurate and reliable results.

Approach to the Neonate With Hypoglycemia.

After birth, healthy neonates undergo a period of altered glucose metabolism, known as "transitional hypoglycemia." During the first 0 to 4 hours of life, the mean plasma glucose concentration decreases to 57 mg/dL, then by 72 to 96 hours of life increases to 82 mg/dL, well within the normal adult range. Recent data suggest that transitional hypoglycemia is due to persistence of the fetal beta cell's lower threshold for insulin release, resulting in a transient hyperinsulinemic state. While hypoglycemia is an expected part of the transition to postnatal life, it makes the identification of infants with persistent hypoglycemia disorders challenging. Given the risk of neurologic injury from hypoglycemia, identifying these infants is critical. Hyperinsulinism is the most common cause of persistent hypoglycemia in neonates and infants and carries a high risk of neurocognitive dysfunction given the severity of the hypoglycemia and the inability to generate ketones, a critical alternative cerebral fuel. Screening neonates at risk for persistent hypoglycemia disorders and completing evaluations prior to hospital discharge is essential to prevent delayed diagnoses and neurologic damage.

A Multicenter, Open-Label, Single-Arm Trial of the Efficacy and Safety of Empagliflozin Treatment for Refractory Diabetes Mellitus with Insulin Resistance (EMPIRE-01).

Insulin resistance syndrome and lipoatrophic diabetes are characterized by severe insulin resistance and are often refractory to treatment. Trials assessing the efficacy of antidiabetes drugs for these rare conditions have been limited, however. Sodium-glucose cotransporter2 (SGLT2) inhibitors, which lower glycemia independently of insulin action, have shown efficacy for type2 diabetes with insulin resistance. We here investigated the efficacy and safety of the SGLT2 inhibitor empagliflozin for treatment of insulin resistance syndrome and lipoatrophic diabetes. The trial was conducted at five academic centers in Japan and included seven patients with insulin resistance syndrome and one patient with lipoatrophic diabetes. Participants received 10mg of empagliflozin daily. If the hemoglobinA1c (HbA1c) level was ≥ 7.0% (52mmol/mol) after 12weeks, the dose was adjusted to 25mg. The study duration was 24weeks, and the primary outcome was the change in HbA1c level by the end of the treatment period. Safety evaluations were performed for all participants. By the end of the 24-week treatment period, the mean HbA1c level for all eight patients had decreased by 0.99 percentage points (10.8mmol/mol) (95% confidence interval [CI], 0.59 to 1.38 percentage points, 6.6 to 14.9mmol/mol) and the mean fasting plasma glucose concentration had declined by 63.9mg/dL (3.55mmol/L) (95%CI 25.5 to 102.3mg/dL, 1.42 to 5.68mmol/L). Continuous glucose monitoring revealed a reduction in mean glucose levels from 164.3 ± 76.1 to 137.6 ± 46.6mg/dL (9.13 ± 4.23 to 7.65 ± 2.59mmol/L) as well as an increase in the time in range (70-180mg/dL) from 58.9 ± 36.1% to 70.8 ± 18.3%. Seventeen mild adverse events were recorded in five individuals throughout the study period. No severe events were reported. The mean body mass showed a slight decrease and the mean serum ketone body concentration showed a slight increase during treatment. Our results demonstrate that empagliflozin shows a certain level of efficacy and safety for treatment of insulin resistance syndrome and lipoatrophic diabetes. jRCTs2051190029 and NCT04018365.

Measuring capillary blood glucose concentration: Is the first blood drop really the right blood drop?

BackgroundCapillary blood glucose (CBG) is fundamental for diabetes mellitus management. However, it is still unclear whether the first or the subsequent blood drops most accurately reflect patients’ blood glucose levels. Methods128 healthy volunteers were included in this prospective cohort study from November 2021 to December 2021. Capillary blood glucose concentrations of the first four blood drops, measured using glucose meters were compared with venous blood concentrations of the respective donors, measured using an in-lab hexokinase method. ANOVA, the Spearman correlation coefficient and Bland-Altman plots were used to analyze the data. ResultsThe mean plasma glucose concentration was 90.46 mg/dl with an SD of ± 14.416 (5.02 ± 0.8 mmol/l). There were statistically strong correlations among the glucose concentrations of all capillary blood drops (correlation coefficients of r > 0.8). The first capillary blood drops showed the lowest mean difference to plasma blood glucose concentrations (+4.92 mg/dl; +0.27 mmol/l), followed by the third drop (+7.28 mg/dl; +0.4 mmol/l), second drop (+7.30 mg/dl; +0.4 mmol/l) and fourth drop (+8.87 mg/dl; +0.49 mmol/l). ConclusionThere is a strong correlation and good agreement between the different capillary blood drops, making all blood drops equally suitable for blood glucose monitoring. In practice, the given setting (clinical or patient self-monitoring) should be considered upon choosing a specific blood drop.

Short-term physiological responses to moderate heat stress in grazing dairy cows in temperate climate.

Even in temperate climate regions, an increase in ambient temperature and exposure to solar radiation can cause heat stress in lactating dairy cows. We hypothesised that grazing dairy cows exhibit short-term physiological changes due to increasing heat load under moderate climate conditions. Over two consecutive summers, 38 lactating Holstein dairy cows were studied in a full-time grazing system. Data were collected in 10 experimental periods of up to three consecutive days with a moderate comprehensive climate index (CCI). The individual animals' vaginal temperature (VT), heart rate, and locomotor activity data were automatically monitored with sensors. Blood samples and proportional whole milk samples were collected at afternoon milking. The concentrations of beta-hydroxybutyrate, glucose, non-esterified fatty acids, urea nitrogen, plasma thyroxine and triiodothyronine were analysed in blood plasma, and fat, protein, lactose, urea nitrogen, cortisol, Na+, K+, and Cl- concentrations were analysed in milk. The daily distribution of VT recordings greater than 39°C showed a circadian rhythm with a proportion of recordings of 2% and lower during the night and a percentage of 10% or higher in the afternoon. The cows' maximal daily vaginal temperature (VTMAX) between 0830 and 1430h was positively related to the mean daily CCI in the same time period (CCIMEAN; mean and SD 23.6±5.4°C). Cows with greater VTMAX had an increased mean heart rate, plasma glucose and milk cortisol concentrations and decreased concentrations of plasma thyroxine and triiodothyronine. The concentration of Na+ in milk was lower, and the concentration of K+ in milk tended to be higher in cows with increased VTMAX. For beta-hydroxybutyrate, non-esterified fatty acids and urea nitrogen concentrations in plasma and fat and lactose concentrations in milk no relationships were found in terms of increasing VT. For milk urea nitrogen and protein concentrations, the proportion of total variance explained by inter-individual or -period variance was high. In conclusion, changes observed in milk and blood likely reflected short-term physiological responses to moderate heat stress. In particular, milk cortisol and Na+ may be useful traits for timely monitoring of heat stress in individual cows because their inter-individual variances were relatively small and samples can be collected non-invasively.

Pharmacodynamics, pharmacokinetics, safety, and tolerability of a ready-to-use, room temperature, liquid stable glucagon administered via an autoinjector pen to youth with type 1 diabetes.

Prompt and reliable management of hypoglycemia in youth with diabetes is important to prevent serious medical complications. To determine efficacy, pharmacodynamics (PD), pharmacokinetics (PK), safety, and tolerability of a ready-to-use, liquid stable glucagon formulation administered subcutaneously via an autoinjector pen to youth with type 1 diabetes (T1D). After plasma glucose concentration was < 80 mg/dL (< 4.4 mmol/L) after insulin, participants aged 2 to < 12 years with T1D were administered 0.5mg of glucagon; participants aged 12 to < 18 years instead received 1mg of glucagon. Then, adolescents were challenged with 0.5mg after a 7- to 28-day washout period. Primary endpoint was mean plasma glucose concentration at 30min after glucagon. Plasma glucose concentrations significantly (p< 0.001) increased from baseline to 30min after glucagon, with mean change in plasma glucose concentration between baseline and 30min for each age cohort as follows: 2 to < 6 years (n= 7; 81.4mg/dL [4.5 mmol/L]); 6 to < 12 years (13; 84.2mg/dL [4.7 mmol/L]); 12 to < 18 years (11; dose, 1mg; 54.0mg/dL [3.0 mmol/L]); and 12 to < 18 years (11; 0.5mg; 52.4mg/dL [2.9 mmol/L]). Among age cohorts, no clinically relevant differences were observed for PD and PK parameters. Common adverse events were nausea, vomiting, and hypoglycemia. Age-appropriate dosing of this glucagon formulation was effective at 30min in reversing plasma glucose concentrations from < 80 mg/dL in youth with T1D.

Determining insulin sensitivity from glucose tolerance tests in Iberian and landrace pigs.

As insulin sensitivity may help to explain divergences in growth and body composition between native and modern breeds, metabolic responses to glucose infusion were measured using an intra-arterial glucose tolerance test (IAGTT). Iberian (n = 4) and Landrace (n = 5) barrows (47.0 ± 1.2 kg body weight (BW)), fitted with a permanent carotid artery catheter were injected with glucose (500 mg/kg BW) and blood samples collected at -10, 0, 5, 10, 15, 20, 25, 30, 45, 60, 90, 120 and 180 min following glucose infusion. Plasma samples were analysed for insulin, glucose, lactate, triglycerides, cholesterol, creatinine, albumin and urea. Insulin sensitivity indices were calculated and analysed. Mean plasma glucose, creatinine and cholesterol concentrations were lower (P < 0.01) in Iberian (14, 68 and 22%, respectively) than in Landrace pigs during the IAGTT. However, mean plasma insulin, lactate, triglycerides and urea concentrations were greater (P < 0.001) in Iberian (50, 35, 18 and 23%, respectively) than in Landrace pigs. Iberian pigs had larger area under the curve (AUC) of insulin (P < 0.05) or tended to a greater AUC of lactate (P < 0.10), and a smaller (P < 0.05) AUC for glucose 0-60 min compared with Landrace pigs. Indices for estimating insulin sensitivity in fasting conditions indicated improved β-cell function in Iberian compared with Landrace pigs, but no difference (P > 0.10) in calculated insulin sensitivity index was found after IAGTT between breeds. A time response (P < 0.05) was obtained for insulin, glucose and lactate so that maximum concentration was achieved at 10 and 15 min post-infusion for insulin (Iberian and Landrace pigs, respectively), immediately post-infusion for glucose, and 20 min post-infusion for lactate, decreasing thereafter until basal levels. There was no time effect for the rest of metabolites evaluated. In conclusion, growing Iberian pigs challenged with an IAGTT showed changes in biochemical parameters and insulin response that may indicate an early stage of insulin resistance.

Effect of Sample Volume Variation and Delay in Analysis on Plasma Glucose Concentration in Sri Lankan Healthy Adults.

The correct volume of sample and time of storing prior to the analysis are important considerations in the estimation of plasma glucose concentration of patients. The present study was to determine the effect of sample volume variation and time delay in the analysis of plasma glucose results in healthy adults. A total of 30 individuals aged between 20 and 30 years were selected for the study. Blood samples were collected into three fluoride-oxalate collection tubes separately. The results revealed that the sample volume variation from 2.0 mL fluoride-oxalate tube to 1.0 mL and 3.0 mL did not significantly affect the plasma glucose concentration (p > 0.05). However, the plasma glucose concentration in the sample significantly decreased upon delaying the analysis. The mean fasting plasma glucose concentration of analysis after one hour of collection and analysis after three hours of collection was not significantly different (p > 0.05). The mean fasting plasma glucose concentrations between one hour and five hours timepoints after collection (p < 0.001) and between three hours and five hours after collection (p = 0.014) were significantly different. In conclusion, overfilling and underfilling (2.0 ± 1.0 mL) of fluoride-oxalate tubes did not affect the plasma glucose results significantly. If the samples are analyzed within three hours of collection, the time dependent change too is not statistically significant.

47 Quantitative evaluation of hunger in pregnant sows: metabolic and hormonal responses to feeding frequency under limit-fed regime

Abstract The objectives of the study were to determine the pattern of glucose, insulin, active ghrelin, and total PYY responses and indirectly quantify perceived hunger in pregnant sows under-limit fed conditions. Eighteen sows [(Landrace × Yorkshire); BW 211.86 ± 1.29 kg; parity 3.80 ± 0.16; backfat 13.50 ± 0.25 mm)] were sampled from 180 sows. Sows were blocked by parity and BW and randomly assigned to 1 of 3 treatments in a RCBD. Treatments included sows fed once at [0730 h (Control, T1), twice [half ration at 0730 and 1530 h (T2)], or thrice [one-third portion at 0730, 1130, and 1530 h (T3)]. The daily feed quantity was kept at 1.25× maintenance energy intake (100 × (BW)0.75) kcal ME/d. Sows received corn-soybean meal-based diet which provided 6935 kcal ME/d and SID Lys:ME of 1.71 g/Mcal from d 30 to 60 of gestation. Hunger was quantified using total area under the curve (AUC) of the hormonal responses. Data analysis was done using PROC MIXED and GLIMMIX procedure of SAS. Sow was the experimental unit. Adjustment for multiple comparisons was by Tukey’s method. The control sows had greater 23-h mean glucose concentration than sows fed 3× daily (P = 0.002). Active ghrelin concentration for sows fed 3× daily tended to be lower (P = 0.063) compared with control sows but reduced (P = 0.018) relative to sows fed 2× daily. In conclusion, sows fed 3× daily had 9.0% reduction in 23-h glucose total AUC, 42.5% greater 23-h insulin total AUC, 27.4% reduction in active ghrelin total AUC, and 14.2% greater PYY total AUC compared with pregnant sows fed 1× daily. It is suggested that hunger in pregnant sows occurs at active ghrelin/total PYY ratio of 5.06 ± 0.20 and at a mean plasma glucose concentration of 70.37 ± 1.39 mg/dL and below.

Dose-dependent efficacy of the glucose-dependent insulinotropic polypeptide (GIP) receptor antagonist GIP(3-30)NH2 on GIP actions in humans.

The glucose-dependent insulinotropic polypeptide (GIP) fragment GIP(3-30)NH2 is a selective, competitive GIP receptor antagonist, and doses of 800 to 1200 pmol/kg/min inhibit GIP-induced potentiation of glucose-stimulated insulin secretion by >80% in humans. We evaluated the effects of GIP(3-30)NH2 across a wider dose range in eight healthy men undergoing six separate and randomized 10-mmol/L hyperglycaemic clamps (A-F) with concomitant intravenous infusion of GIP (1.5 pmol/kg/min; A-E) or saline (F). Clamps A to E involved double-blinded, infusions of saline (A) and GIP(3-30)NH2 at four rates: 2 (B), 20 (C), 200 (D) and 2000 pmol/kg/min (E), respectively. Mean plasma concentrations of glucose (A-F) and GIP (A-E) were similar. GIP-induced potentiation of glucose-stimulated insulin secretion was reduced by 44 ± 10% and 84 ± 10% during clamps D and E, respectively. Correspondingly, the amounts of glucose required to maintain the clamp during D and E were not different from F. GIP-induced suppression of bone resorption and increase in heart rate were lowered by clamps D and E. In conclusion, GIP(3-30)NH2 provides extensive, dose-dependent inhibition of the GIP receptor in humans, with most pronounced effects of the doses 200 to 2000 pmol/kg/min within the tested range.

Stocking Density Induced Stress on Plasma Cortisol and Whole Blood Glucose Concentration in Nile Tilapia Fish (Oreochromis niloticus) of Lake Victoria, Kenya

Effects of high stocking densities (HSDs) were evaluated for Nile tilapia fish (Oreochromis niloticus) under culture to determine its influence on plasma cortisol and whole blood glucose concentration. Plasma cortisol levels (ng/ml) were assayed byEnzyme-LinkedImmunosorbentAssay (ELISA). Whole blood glucose levels were determined using a hand-held one touch ultraglucose meter (MD-300) and test strips. Plasma cortisol and whole blood glucose level determinations were replicated three times forO. niloticusreared under both low stocking densities (LSD) and HSD. One way Analysis of Variance (ANOVA) was performed on the data collected, and comparison of significant differences in means was carried out between LSD and HSD at 0.01%. Plasma cortisol levels revealed statistically (P≤0.01) significant values of HSD at 6.32 ± 1.06 ng/ml than in LSD at 4.62 ± 1.58 ng/ml for theO. niloticusgroups studied. Whole blood glucose analysis revealed a statistical (P&lt;0.05) difference in the means in HSD and LSDO. niloticusgroups (F(df,1; 8) = 7.946 &gt; Fcrit = 4.414;P=0.01). Mean plasma glucose concentration was statistically (P≤0.01) higher for HSD than LSDO. niloticusgroups at mean ± SD, 96.84 ± 5.28 and 76.82 ± 5.92, respectively. The findings of this study demonstrate that high stocking densities increase both cortisol and whole blood glucose concentration in tilapia fish, indicating a marked increase in stress levels. Elevated plasma cortisol and whole blood glucose concentration can be used as biomarkers for acute stress inO. niloticusproduced under aquaculture systems. The findings of this study can help inform policy on the management of stress caused by overstocking ofO. niloticusand other related Cichlids under industrial aquaculture production.

Muscle Glycogen Utilization during Exercise after Ingestion of Alcohol.

Ingested ethanol (EtOH) is metabolized gastrically and hepatically, which may influence resting and exercise metabolism. Previous exercise studies have provided EtOH intravenously rather than orally, altering the metabolic effects of EtOH. No studies to date have investigated the effects of EtOH ingestion on systemic and peripheral (e.g., skeletal muscle) exercise metabolism. Eight men (mean ± SD; age = 24 ± 5 yr, body mass = 76.7 ± 5.6 kg, height = 1.80 ± 0.04 m, V˙O2peak = 4.1 ± 0.2 L·min) performed two bouts of fasted cycling exercise at 55% V˙O2peak for 2 h, with (EtOH) and without (control) prior ingestion of EtOH 1 h and immediately before exercise (total dose = 0.1 g·kg lean body mass·h; 30.2 ± 1.1 g 40% ABV Vodka; fed in two equal boluses) in a randomized order, separated by 7-10 d. Muscle glycogen use during exercise was not different between conditions (mean [normalized 95% confidence interval]; EtOH, 229 [156-302] mmol·kg dm, vs control, 258 [185-331] mmol·kg dm; P = 0.67). Mean plasma glucose concentrations during exercise were similar (control, 5.26 [5.22-5.30], vs EtOH, 5.34 [5.30-5.38]; P = 0.06). EtOH ingestion resulted in similar plasma nonesterified fatty acid concentrations compared with rest (control, 0.43 [0.31-0.55] mmol·L, vs EtOH, 0.30 [0.21-0.40] mmol·L) and during exercise. Plasma lactate concentration was higher during the first 30 min of rest after EtOH consumption (mean concentration; control, 0.83 [0.77-0.90] mmol·L, vs EtOH, 1.00 [0.93-1.07] mmol·L), but the response during exercise was similar between conditions. Muscle glycogen utilization was similar during exercise with or without prior EtOH ingestion, reflected in similar total whole-body carbohydrate oxidation rates observed.

Effect of Chelated and Inorganic Zinc, Selenium and Chromium on Antioxidant Status, Biochemical and Production Parameters in Broiler

In the present investigation we explore the use of organic and inorganic zinc, selenium and chromium to modulate antioxidant defense system, biochemical status and enhance production response of Broiler. Total 312 day old Cobb broiler chicks were used in the experiment. The results indicate that mean plasma superoxide dismutase, glutathione peroxidise and glucose concentration were non-significantly different in all groups. Significantly (p less than 0.05) higher mean plasma catalase concentration and TBA value was found in T13 and control group respectively. Mean plasma total protein, albumin and globulin were significantly (p less than 0.01) higher in organic Zn, Se and Cr (T13) followed by organic Cr (T10) supplemented group. Mean body weight gain, feed intake, FER and PI were significantly (p less than 0.01) higher in organic Zn, Se and Cr (T13) followed by organic Se (T7) supplemented group. In the present investigation organic Zn, Se and Cr supplementation showed systemic effects with a better biochemical status, which could be translated into better production performance and lower mortality.

Chromium propionate increases insulin sensitivity in horses following oral and intravenous carbohydrate administration.

Forty-eight Quarter Horse geldings (3 to 8 yr of age) were used to determine the effects of dietary chromium (Cr), in the form of Cr propionate (Cr Prop) on insulin sensitivity. Horses were blocked by age, body condition score, and glucose response to concentrate feeding on day 0 and randomly assigned to treatments. Treatments consisted of 0, 2, 4, or 8 mg Cr/d from Cr Prop. Horses were fed daily a concentrate mix at a rate of 0.2 kg/100 kg body weight (BW) and grass hay at 1.75 to 2.0 kg/100 kg BW. All horses were fed the control diet for 7 d prior to the initiation of the study. After an overnight fast, blood samples from the jugular vein were obtained at 0, 2, and 4 h after concentrate feeding on days 0 and 28 for the determination of glucose, nonesterified fatty acids, and insulin. A glucose tolerance test (GTT) was conducted on day 42. Glucose was infused via jugular vein catheters, and blood samples were collected at various times relative to dosing for glucose and insulin determination. Plasma glucose on day 28 was affected (P < 0.05) by treatment, time, and treatment × time. Horses fed 4 mg Cr/d had lesser (P < 0.05) plasma glucose concentrations than those in the other treatments at 0 h. At 2 h post-feeding glucose concentrations were greater (P < 0.05) in horses fed 0 or 8 mg Cr/d than in those given 4 mg Cr. Horses fed 2 mg Cr/d had lesser (P < 0.05) plasma glucose at 4 h post feeding compared with those fed 0 or 8 mg Cr. Plasma glucose did not differ among horses receiving 2 or 4 mg Cr/d at 2 or 4 h. Serum insulin was affected (P < 0.05) by treatment, time, and treatment × time. Insulin concentrations were greater (P < 0.05) in horses fed 0 or 2 mg Cr/d than in those given 4 or 8 mg Cr at 0 h. At 4 h post-feeding insulin concentrations were greater (P < 0.05) in horses given 0 or 8 mg Cr than in those fed 2 or 4 mg Cr/d. Plasma glucose was affected (P < 0.05) by treatment and time, but not by treatment × time following the GTT. Mean plasma glucose (across sampling times) concentrations were greater (P < 0.05) in controls than in horses fed 2 or 4 mg Cr/d. Glucose concentrations following the GTT did not differ among controls and horses given 8 mg Cr/d. Following glucose infusion, serum insulin concentrations were greater (P < 0.05) in horses fed 2 or 4 mg Cr and tended to be greater in those fed 8 mg Cr/d compared with controls. The results of this study indicate that 2 or 4 mg Cr/d from Cr Prop increased insulin sensitivity in adult horses following oral carbohydrate consumption.

Twenty-Four Hour Fasting (Basal Rate) Tests to Achieve Custom-Tailored, Hour-by-Hour Basal Insulin Infusion Rates in Patients With Type 1 Diabetes Using Insulin Pumps (CSII).

Twenty-four hour fasting periods are being used to scrutinize basal insulin infusion rates for pump-treated patients with type 1 diabetes. Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy undergoing a 24-hour fast as a basal rate test were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations within, below, or above arbitrarily defined target ranges were assessed for periods of the day of special interest (eg, 01:00-07:00 am, "dawn" period, 04:00-07:00 pm, and "dusk" period). Statistics: χ2-tests, paired t-tests were used. Basal rates (mean: 0.90 ± 0.02 IU/h) showed circadian variations with peaks corresponding to "dawn" (1.07 ± 0.02 IU/h from 01:00 to 07:00 am) and, less prominently, "dusk" (0.95 ± 0.02 IU/h from 03:00 to 07:00 pm). Individual mean plasma glucose concentrations averaged 6.6 ± 0.1 mmol/L, with 53.1% in the predefined "strict" (4.4-7.2 mmol/L) target range. Interestingly, during the "dawn" period, plasma glucose was significantly higher (by 0.5 ± 0.1 mmol/L [95% confidence interval: 0.3-0.8 mmol/L; P < .0001]) and the odds ratio for hypoglycemia was significantly lower compared to the reference period. Twenty-four hour fasting periods as basal rate tests frequently unravel periods with inappropriate basal insulin infusion rates potentially responsible for fasting hyper- or hypoglycemia. Notably, the higher basal insulin infusion rate found during the "dawn" period seems to be justified and may need to be accentuated.

Experimental non-severe hypoglycaemia substantially impairs cognitive function in type 2 diabetes: a randomised crossover trial.

Previous studies have demonstrated a relationship between cognitive impairment and hypoglycaemia (<3mmol/l). This study hypothesised that non-severe insulin-induced hypoglycaemia reduces cognitive function in individuals with type 2 diabetes. In this randomised crossover study, 25 participants with type 2 diabetes attended two experimental visits with hyperinsulinaemic glucose clamping: one hypoglycaemic clamp (plasma glucose 3.0 ± 0.2mmol/l) and one euglycaemic clamp (plasma glucose 6.0 ± 0.2mmol/l). Participants were eligible if their diabetes was treated with diet or glucose-lowering medications (except sulfonylureas or insulin), age was 35-70years, BMI was 23-35kg/m2 and HbA1c was below 75mmol/mol (9%). Cognitive function was assessed with a neurocognitive test battery measuring verbal memory, executive function, sustained attention and psychomotor speed. From the examined cognitive domains, a global cognition score was constructed estimating global cognition. A measurement for psychomotor speed was selected as the primary outcome. Participants and people assessing the outcomes were blinded to group assignment. Cognitive performance was impaired during hypoglycaemia with a mean score in the primary outcome test, Symbol Digit Modalities Test measuring psychomotor speed, of 48.7 ± 9.8 (hypoglycaemia) vs 56.6 ± 12.0 (euglycaemia); i.e. a change of -7.9 points (95% CI -10.9, -4.9; p < 0.0001). In addition, hypoglycaemia reduced global cognitive score by -0.7 (95% CI -0.9, -0.6; p < 0.0001). A stable glucose plateau was achieved during both experimental visits. For the hypoglycaemic clamp, mean plasma glucose concentration (± SD) during neurocognitive testing was 3.1 (± 0.3) mmol/l. Age, sex, fasting C-peptide, counter-regulatory hormones and the severity of hypoglycaemic symptoms did not influence cognitive function. Acute non-severe hypoglycaemia (mean plasma glucose 3.1mmol/l) has a substantial negative impact on cognitive function in individuals with type 2 diabetes. ClinicalTrials.gov NCT03014011. The study was supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp (MSD-MA-NORD-007-01). The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. Funding was also received from Skibsreder Per Henriksen, R. og hustrus Foundation, The Danish Alzheimer Foundation and Savværksejer Jeppe Juhl og hustrus Foundation.

1840-P: Pioglitazone Increases Metabolic Insulin Clearance (MCRI) in IGT Subjects: The ACT NOW Study

Recent studies have documented that the MCRI plays a major role in determining the plasma insulin response to ingested glucose. We evaluated the long-term effect of pioglitazone (PIO) on MCRI in 441 IGT subjects (ACT NOW study) who were randomized to PIO (45 mg/day) or placebo and followed for an average of 2.4 years. OGTT was performed at baseline and study end. 50 placebo-treated subjects developed type 2 diabetes versus 15 PIO-treated subjects (p&amp;lt;0.005). Insulin secretion rate (ISR) was measured from deconvolution of plasma C-peptide curve. MCRI was measured as ISR/mean insulin conc during OGTT. Data were correlated with changes in liver enzymes and peripheral insulin sensitivity measured with the Matsuda index (MI). Results: PIO improved MI from to 3.9 ±1 to 7.5 ±3 (p&amp;lt;0.0001), glucose tolerance (mean glucose OGTT from 172±2to 148±1mg/dl, p&amp;lt;0.0001) and reduced ALT(from 30±1 to 24±1, p&amp;lt;0.0001). Fasting insulin secretion increased in the placebo group (420 ±14 to 558 ±21 pmol/min, p &amp;lt; 0.0001 vs. baseline) and did not change in the PIO group (411 ±14 to 446 ± 19; p &amp;lt;0.0001, PIO vs. placebo). During the OGTT (0- 120 min) ISR increased in both groups (PIO, 165 ±3 to 189 ± 5 nmol; placebo, 167 ±3 to 202 ±6; p &amp;lt; 0.0001 vs. baseline in both groups; p = NS, PIO vs. placebo).The MCRI increased in both groups but the increase was much greater in PIO (3.5 ± 0.2 to 6.0±0.2 ml/min; placebo, 3.5 ± 0.1 to 4.7±0.2; p &amp;lt; 0.0001 vs. baseline in both groups; p &amp;lt;0.0001, PIO vs. placebo). In the whole dataset the improvement in insulin clearance was associated with improvement in peripheral insulin sensitivity (r=0.62, p&amp;lt;0.0001), the reduction in mean plasma glucose concentration during OGTT (r=-0.31, p&amp;lt;0.0001) and decrease in ALT (r=-0.14, p&amp;lt;0.009). Conclusion: PIO treatment results in an increase in MCRI that is associated with improved hepatic function, glucose metabolism and peripheral insulin sensitivity. Disclosure A. Gastaldelli: Consultant; Self; A. Menarini Diagnostics, Eli Lilly and Company, Genentech, Inc., Gilead Sciences, Inc., Inventiva Pharma. D. Tripathy: None. R.A. DeFronzo: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Elcelyx Therapeutics, Inc., Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc. Speaker's Bureau; Self; AstraZeneca, Novo Nordisk Inc.

Preexercise Carbohydrate Ingestion and Transient Hypoglycemia: Fasting versus Feeding.

ABSTRACTPurposeCarbohydrate (CHO) ingestion 30 to 45 min before exercise results in transient hypoglycemia after starting the exercise in some, but not all, subjects. However, whether transient hypoglycemia is more likely to occur under fed or fasted condition remains unknown. This study aimed to directly compare the effects of fasting versus feeding on plasma glucose responses after preexercise CHO intake and to examine the relationship between insulin responses and onset of transient hypoglycemia.MethodsSixteen subjects performed 60-min cycle ergometer exercises at 75% maximal oxygen uptake (V˙O2max) under overnight fasted and fed (4 h after breakfast) conditions. In both conditions, they consumed 500 mL of beverage (150 g of glucose) 30 min before beginning exercise.ResultsThe mean plasma glucose concentrations 15 min after starting the exercise did not fall below 4.0 mmol·L−1 (criteria for hypoglycemia) in both states; however, individual differences in the occurrence of transient hypoglycemia were noted. In the fasted state, plasma glucose levels transiently dropped below 4.0 mmol·L−1 in five subjects, who had substantially higher serum insulin levels at the start of exercise, compared with those who did not develop hypoglycemia. Although seven subjects developed transient hypoglycemia in the fed state, no relationship was observed between insulin responses and hypoglycemia. Three subjects developed hypoglycemia in both fasted and fed states.ConclusionsThese results suggest that transient hypoglycemia after preexercise CHO ingestion occurs in some, but not all, subjects, under both conditions. Furthermore, subjects with enhanced insulin responses seem to be more prone to transient hypoglycemia in the fasted condition.

Effects of dietary fiber on postprandial glucose in healthy adults

Frequently and persistently raised glucose level causes numerous complications. So it is important to find out a component of diet that can improve glucose homeostasis after ingestion of food without causing any side effect or complication. The aim of this randomized controlled clinical trial study was to verify the effect of dietary fiber on postprandial blood sugar (PPBS). The study was carried out in a sample of fifty healthy adult subjects at the Department Physiology of Rajshahi Medical College during the period from January 2014 to December 2014. Fasting blood sugar of the subjects was estimated before ingestion of identical glucose drink with or without dietary fiber (ispaghula husk) and PPBS was measured at 30, 60 and 120 min after the drink. The mean plasma glucose concentrations after a 50 gm oral glucose load significantly (p &lt; 0.05, p &lt; 0.001) decreased at 30, 60 and 120 min in both condition with dietary fiber and without dietary fiber. The mean plasma postprandial glucose concentration in condition with dietary fiber was significantly (p &lt; 0.001) lower than the corresponding value without dietary fiber. The study suggests that ingestion of water soluble dietary fiber along with glucose drink reduces sharp rise as well as sustained rise of postprandial glucose.&#x0D; Mediscope Vol. 6, No. 1: Jan 2019, Page 25-29

Effects of Nickel Supplementation on Antioxidant Status, Immune Characteristics, and Energy and Lipid Metabolism in Growing Cattle.

Nickel (Ni) has not been elucidated as an essential mineral in dairy animals, though in plants and lower organisms, its role in activation of urease enzyme is well known. This study was conducted to evaluate the effect of Ni supplementation on intake, growth performance, urease activity, antioxidant and immune status, and energy and lipid metabolism in growing cattle. Eighteen growing Hariana heifers were randomly allocated into three groups on body weight (125 ± 3.0kg) and age basis (10 ± 2.0months). Feeding regimen was similar in all the groups except that treatment groups were supplemented with 0.0 (Ni0.0), 1.5 (Ni1.5), and 3.0 (Ni3.0) mg of Ni/kg dry matter (DM) in three respective groups. DM intake (DMI), average daily gain (ADG), feed efficiency, plasma urease activity, biomarkers of antioxidant and immune status, energy and lipid metabolism, and plasma Ni levels were observed during the 90-day experimental period. There was linear increase (p< 0.05) in mean DMI and ADG without affecting feed efficiency was observed in 3.0mg of Ni/kg DM supplemented heifers. Dietary Ni supplementation showed linear increase (p < 0.05) in mean plasma urease activity. No effects of (p > 0.05) of Ni supplementation were observed on superoxide dismutase (SOD) and catalase (CAT) activity and plasma lipid peroxide (LPO) concentration; whereas, mean plasma total antioxidant status (TAS) showed linear decrease (p < 0.001) in Ni-supplemented groups. Adding Ni up to 3.0mg of Ni/kg DM did not exert (p > 0.05) any effect on plasma total immunoglobulin and immunoglobulin G (IgG) concentrations. Mean plasma cortisol level showed negative association with supplemental Ni levels and concentration was found lowest (p < 0.05) in 3.0mg of Ni/kg DM-added group. Dietary Ni supplementation did not affect mean plasma concentrations of glucose, cholesterol, triglyceride, and non-esterified fatty acids (NEFA). There was a linear increase (p< 0.001) in plasma Ni concentrations as the Ni concentrations increased in the diet. The results of present study indicated that dietary supplementation of 3.0mg of Ni/kg DM improved performance of growing cattle by increasing urease activity.