Rise In Blood Sugar Research Articles

Formulation, Process Optimization, and Biochemical Characterization of Cereal-Based Sweet Potato and Mulberry Instant Beverage

Most of the beverages have a high glycemic index, which is attributed to a sudden rise in blood sugar. The beneficial role of functional foods combination provided the tool to perform and design our study to develop an instant beverage mix (IBM) that might be revealed as the favorable therapeutic potential for the treatment of hyperglycemia and act as a functional beverage. Therefore, resistant fibre-rich ingredients/raw materials were used to formulate the cereal-based instant beverage (CIB). CIB was formulated using black rice flour (40–70%), germinated lentil flour (10–20%), sweet potato flour (10–20%), and mulberry powder (10–20%). The product formulation was optimized with respect to the following responses such as color and appearance, texture, flavor, taste, and overall acceptability using a D-optimal mixture design. The results revealed that the variation in raw ingredients significantly affected the organoleptic properties of trials. The ratio 40 : 20 : 20 : 20 of black rice: germinated lentil: sweet potato: mulberry was found to be optimum for the development of CIB. Optimized CIB had 9.71 ± 0.10 g/100 g of crude protein, 4.73 ± 0.09 g/100 g of fat, and 4.48 ± 0.06 g/100 g of crude fibre. Moreover, the total mineral content and carbohydrate content were found to be 1.08 ± 0.07 g/100 g and 72.45 ± 0.44 g/100 g, respectively, whereas, the energy value was 371.21 ± 4.23 kcal. In vivo glycemic index was also performed for the optimized CIB. The findings showed a lower glycemic response (37.70) than the diabetic control group, and blood glucose was found to be lowered (279.67 ± 20.06 to 227.17 ± 13.44 mg/dL) via the hypoglycemic mechanism. Thus, the optimized CIB exhibited a therapeutic effect against diabetic conditions and might be a healthy instant beverage for human consumption.

Beneficial Effects of Natural Alkaloids from Berberis glaucocarpa as Antidiabetic Agents: An In Vitro, In Silico, and In Vivo Approach.

Diabetes, also known as diabetes mellitus (DM), is a metabolic disorder characterized by an abnormal rise in blood sugar (glucose) levels brought on by a complete or partial lack of insulin secretion along with corresponding changes in the metabolism of lipids, proteins, and carbohydrates. It has been reported that medicinal plants play a pivotal role in the treatment of various ailments such as diabetes mellitus, dyslipidemia, and hypertension. The current study involved exploring the acute toxicity and in vivo antidiabetic activity of berberine (WA1), palmatine (WA2), and 8-trichloromethyl dihydroberberine (WA3) previously isolated from Berberis glaucocarpa Stapf using a streptozotocin (STZ)-induced diabetic rat model. Body weight and blood glucose level were assessed on a day interval for 4 weeks. Biochemical parameters, antioxidant enzymes, and oxidative stress markers were also determined. In an acute toxicity profile, the WA1, WA2, and WA3 were determined to be nontoxic up to 500 mg/kg (b.w). After the second and third weeks of treatment (14 and 21 days), the blood glucose levels in the WA1-, WA2-, and WA3-treated groups were significantly lower than those in the diabetic control group (476.81 ± 8.65 mg/dL, n = 8, P < 0.001). On the 21st day, there was a decrease in the blood glucose level and the results obtained were 176.33 ± 4.69, 197.21 ± 4.80, and 161.99 ± 4.75 mg/dL (n = 8, P < 0.001) for WA1, WA2, and WA3 at 12 mg/kg, respectively, as opposed to the diabetic control group (482.87 ± 7.11 mg/dL, n = 8, P < 0.001). Upon comparison with the diabetic group at the end of the study (28 days), a substantial drop in the glucose level of WA3 at 12 mg/kg (110.56 ± 4.11 mg/dL, n = 8, P < 0.001) was observed that was almost near the values of the normal control group. The treated groups (WA1, WA2, and WA3) treated with the samples displayed a significant decline in the levels of HbA1c. Treatment of the samples dramatically lowered the lipid level profile. In groups treated with samples, plasma levels of triglycerides, total cholesterol, and LDL were significantly lowered [F (5, 42) = 100.6, n = 8, P < 0.001]; these levels were also significantly decreased [F (5, 42) = 129.6 and 91.17, n = 8, P < 0.001]. In contrast to the diabetes group, all treated groups had significantly higher HDL levels [F (5, 42) = 15.46, n = 8, P < 0.001]. As a result, hypolipidemic activity was anticipated in the samples. In addition to that, the activity of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) was considerably elevated in the groups treated with the sample compared to the diabetic control group (n = 8, P < 0.001).

Assessment of IL-6, MDA, GSH and Serum Electrolytes in Diabetic Patients

Background: The public health community has been paying a lot of attention to metabolic syndrome, sometimes known as diabetes mellitus (DM). In many cases for the patients with type 2 diabetes mellitus characterized by an uncontrolled rise in blood sugar (hyperglycemia) brought on by an inability of the body's cells (such as muscles) to detect and utilize the circulating insulin, a condition known as insulin sensitivity or insulin resistance, or by an insulin deficiency. (caused by pancreatic beta cell damage or decreased insulin release). These cases are accompanied by systematic inflammation in the long term, and as a result of the immune effect, there will be an increase in the levels of lipids peroxidation and thus a decrease in the levels of antioxidants. Objective: The study includes an evaluation of inflammatory levels and oxidative stress through an assay of IL-6, malondialdehyde, glutathione, and serum electrolyte levels in the patients with uncontrolled type 2 diabetes mellitus compared with the control. Methods: The case-control study, where ablood sample collections from patients with uncontrolled type 2 diabetes mellitus and control apparently healthy. The samples were analyzed by ELISA, spectrophotometers, and electro-analyzer apparatus. Results: It was found that patients with uncontrolled type 2 diabetes have lower-grade inflammation, which is the reason for the significant increase in interleukin-6 (215±13 Pg/mL) compared with healthy (50±10 Pg/mL). Also, the high levels of free radicals and peroxides can be expressed by the increase in malondialdehyde, as well as a significant reduction in the levels of glutathione value. Patients with uncontrolled type 2 diabetes suffer from electrolyte disturbances due to excessive urine caused by high osmolality and metabolic acidosis due to high ketone bodies and consequently high potassium levels (hyperkalemia) (6.7±0.59 mmol/L). Conclusion: Uncontrolled high diabetes in type 2 patients leads to high inflammatory levels in the body, and this is the reason for increase interleukin 6 levels. Inflammations caused by the immune effect resulting from diabetes lead to the synthesis of higher levels of free radicals, leading to the oxidation of lipids and a decrease of glutathione concentration.

콩비지추출물과 저칼로리 감미제 첨가가 아침간편식의 품질특성 및 당지수에 미치는 영향

This study developed a nutrition bar and granola, which are low in calories and inhibit the absorption of sugars, and measured changes in product characteristics such as glycemic index and consumer acceptability. This study conducted an inhibition test of carbohydrate digestive enzymes activity and a postprandial glycemic measurement test to verify the glycemic improvement effect of the soy-pulp extract. According to the results of the carbohydrate digestive enzyme inhibition test, the inhibitory activity was higher in the order of soy-pulp &gt; momordica charantia, red bean &gt; ecklonia cava, and black bean. DPPH and ABTS tests also confirmed the antioxidant effect of the soy-pulp extract. In the postprandial glycemic control test conducted on 18 adults aged 20-60 years, nutrition bars containing low-calorie sweeteners and soy-pulp extract showed significantly lower glycemic values at 30, 45, and 120 minutes after consumption compared to sugar-containing products. In case of granola, products containing low-calorie sweeteners and soy-pulp extract (experimental group) showed a significant decrease in glycemic values at 15 minutes after consumption compared to sugar-containing products (control group). In the sensory evaluation to measure the change in consumer preference, the experimental group showed a better preference for sweetness and savory taste than the control group (p &lt; 0.05), and there was no significant difference in color and overall taste. Consequently, if low-glycemic sweeteners and soy-pulp extracts are used instead of sugar in the production of breakfast snacks such as nutrition bars and granola, it is possible to expect not only the effect of suppressing postprandial blood sugar rise but also the improvement of taste, such as sweetness and savory taste.

The Potential Health Benefits of Resistant Starch on Human Metabolism- A Narrative Review

Resistant starch, also known as water-soluble dietary fiber, has the advantages of both water-soluble and insoluble fibers. The characteristic of resistant starch is that resistant starch is difficult to be absorbed by the small intestine, so it will not increase blood sugar and has the effect of controlling blood sugar. Like dietary fiber, it is decomposed after entering the large bowel and becomes food for beneficial bacteria in the intestine, which contributes to intestinal health. Its functions include: delaying gastric emptying, preventing a sharp rise in blood sugar, lowering blood cholesterol, and the functions of insoluble dietary fiber include: increasing stool volume, promoting intestinal peristalsis, preventing constipation and hemorrhoids, preventing colorectal diverticulitis and colorectal cancer. The term resistant starch appeared in 1982, also known as difficult-to-digest starch or the third type of dietary fiber. Resistant starch cannot be decomposed by human digestive enzymes until the colon end. The heat generated by the fermentation and utilization of intestinal bacteria is much lower than that of ordinary starch, and the maximum heat generated per gram is no more than 2.8 kcal (ordinary starch is 4 kcal).

The effect of ball milling on the structure, physicochemical and functional properties of insoluble dietary fiber from three grain bran

The effects of ball milling processing on the structure, physicochemical, and functional properties of insoluble dietary fiber (IDF) in bran from prosomillet, wheat and rice were investigated. Meanwhile, the effect of IDF on glucose tolerance and blood lipid levels in mice was evaluated as well. With findings, for all three grains, the particle sizes of IDF were significantly reduced after ball milling treatment (p < 0.05). Scanning electron microscopy revealed fragmented fiber with numerous pores and cracks. The reactive groups of three IDF samples were found to be similar by fourier transform infrared spectroscopy. And consistent with X-ray diffraction and thermal analysis, for all three grains, ball milling reduced the crystallinity of IDF and helped to increase the release of free phenol by 23.4 %, 8.9 %, and 12.2 %, respectively. Furthermore, the water holding capacity, glucose delay capacity, glucose, sodium cholate, and cholesterol adsorption capacity, and in vitro digestibility of starch and fat were all improved to varying degrees. Animal experiments showed that ball milling treatment effectively slowed the postprandial rise in blood sugar (especially IDF of rice bran) and blood lipids (especially IDF of prosomillet bran). As a result, ball milling treatment is a potential method for dietary fiber modification in the food industry.

PROFILE OF LEPROSY IN CHILDREN FROM 2014-2018 IN DR. SOETOMO GENERAL HOSPITAL SURABAYA

Type 2 Diabetes Melitus is a metabolic disorder that is marked by the rise in blood sugar due to a decrease in insulin secretation by pancreatic beta cells and insulin function ordisorders (insulin resistance). Risk factors of diabetes mellitus type 2, namely age, gender, obesity, hypertension, genetics, diet, smoking, alcohol, lack of activity. Patients with Diabetes Melitus are required to implement a complex management disease such as nutritional therapy, physical exercise, glucose controlling, and pharmalogical therapy. Diabetes melitus can cause complications and symptoms that interferes activities, the implications of Diabetes Melitus be a stressor that cause stress, stressor can be controlled by coping mechanism. Mechanism coping is an active process in which the use of resources from the private and develop new behavior that aims to grow the strength of an individual, even an emergency reduce the impact of stress in life, disability incurred. Coping mechanism is adaptive and maladaptive. This aims study to explore coping strategies of patients with type 2 diabetes melitus in internal medice polyclinic Cipto Mangunkusumo Hospital, Jakarta. This study used quantitative description. Research result shows that patient who use adaptive coping 38 people (73%), whereas the use coping maladaptive 14 people (27%), then it can be concluded that diabetes mellitus patients more coping mechanisme malaadaptive.

Abstract No.: ABS3115: Effect of sevoflurane vs desflurane on blood glucose level in patients undergoing intracranial neurosurgery: A randomised control study

Background & Aims:Patients undergoing neurosurgery are prone to neurological damage due to the anaerobic metabolism of blood glucose. In this study we aimed to to compare the effect of sevoflurane and desflurane on blood glucose levels in patients undergoing intracranial surgery.Methods:All consenting patients of either gender 18-65 years belonging to American Society of Anesthesiologists (ASA) physical status I & II scheduled for intracranial surgery under sevoflurane or desflurane maintenance anaesthesia were included. Patients suffering from diabetes, thyroid dysfunction, renal or hepatic disease, on steroids, beta-adrenergic blocking agents, insulin or oral hypoglycaemic agents, pregnant or lactating patients, chronic alcoholic patients, and non-consenting patients were excluded from the study. The enrolled patients were randomised in the sevoflurane and desflurane groups. The periodic glucose level was measured hourly after induction until completion of surgery using the glucose oxidase peroxidase method.Results:A total of 70 patients was included in the study. Both sevoflurane and desflurane when used as maintenance anaesthetics cause changes in blood sugar levels. Sevoflurane causes a gradual increase in blood sugar intraoperatively whereas desflurane causes an initial rise in blood sugar followed by a decline in blood sugar level in euglycemic patients. There was a significant difference in the trend of blood sugar (mg/dL) over time between the two groups (p =<0.001).Conclusion:The changes in blood sugar level by both agents were statistically significant but clinically insignificant as the values remained within clinically normal range and there were no episodes of hypo or hyperglycaemia.

Sustained-Release Glibenclamide-Loaded Solid Lipid Microparticles from Micellar Solutions of Homolipids

Fat from Capra hircus (goat fat) has been widely used for drug delivery. In this work, 1:1, 1:2, and 2:1 of goat fat and Softisan® 142 were melted together, cooled at room temperature, and the resultant matrix further modified with Phospholipon 90G (4:1) to obtain solidified reverse micellar solutions (SRMS). SRMS were used to prepare solid lipid microparticles (SLMs) loaded with or without glibenclamide, a poorly water soluble antidiabetic drug by hot melt homogenization. Particle size, morphology, thermal behavior, drug encapsulation efficiency, in vitro release study, and in vivo fate in diabetogenic rats were investigated. We report here an improved drug holding capacity (70.35%) of the lipid matrix of SRMS 2:1 due to imperfection of the lipid mixtures showing lower transition temperatures (117.0 °C) and enthalpies (−12.5 mW/mg). In vitro drug diffusion showed 66.98% drug release from SLM 2:1 exhibiting non-Fickian diffusion model (anomalous behavior) and almost zero-order kinetic. SLM 2:1 also gradually released 56.98% of glibenclamide under 16 h and maintained a steady state till 24 h; generally lowering blood glucose from 600 to 120 mg/dL unlike SLM 1:2 which showed burst glibenclamide release of 22.66% within 30 min with consequent rise in blood sugar. The 2:1 micellar solution (SRMS) of homolipids could deliver glibenclamide in a sustained form better than the conventional tablet form.

Influence of Beverage Consumption Made from Baobab Pulp (&amp;lt;i&amp;gt;Adansonia digitata L.&amp;lt;/i&amp;gt;) on Postprandial Glycemia in C&amp;#244;te d’Ivoire

The study’s aim was to assess the consumption influence of beverages from baobab pulp on postprandial blood sugar in C?te d’Ivoire. Thus, a consumer survey of baobab juice was carried out in the city of Abidjan. Beverages from baobab pulp collected in four localities of C?te d’Ivoire (Man, Boundiali, Bouake and Abidjan) were prepared. These beverages were consumed by 15 subjects over a period of 9 days to determine their glycemic index (GI), glycemic load (GL) and postprandial blood sugar. During the survey, baobab juice’s consumers’ respondents were composed more of females (53.3%) than males (46.7%). Baobab juice is generally consumed in the afternoon by 35% of respondents twice a week (34.5%). Among the preferred juices sold in Abidjan markets, baobab juice is ranked second by children (21.4%) and fourth by adults (13.4%). The results of the glycemic index (GI) and glycemic load (GL) showed that beverages made from baobab pulp with sugar from Abidjan had high glycemic index and glycemic load. On the other hand, beverages made from baobab pulp with sugar from three other localities showed medium values of GI and GL. However, the GI and GL of the baobab pulps without sugar of four localities are low. The consumption at the will of these beverages without added sugar may be useful for the prevention and control of diabetes. However, beverages made from pulp with added sugar should be consumed in moderation in order to avoid a rise in blood sugar in prediabetics as well as in healthy subjects.

Family's Ability to Take Care The Patient of Type 2 Diabetes Mellitus in Tasikmalaya

Diabetes Mellitus is a metabolic disorder disease characterized by a rise of blood sugar due to a decrease of insulin by the pancreas. The role of the family in caring for the patient with type 2 diabetes mellitus is crucial in treatment. this study was aimed to know the ability of family in caring. a purposive sampling method was applied in this research. a total of 31 respondents were selected. the results showed that the majority of family's ability to recognize as a problem was good with 16 people ( 51,6 % ), in taking decisions for treatment was positive as much as 19 people (61.3%), in treatment of type 2 Diabetes Mellitus patients were positive 25 people (80,6%), in modifying the environment for Treatment was negative 18 people (58.1%). therefore, Health education for the family related to modifying the environment for treatment was required to recover the patient.

Chewing Questionnaire Survey Results and Chewing Ability Test Results of 118 People who Participated in the University Festival

Chewing well and eat slowly are good habits for maintaining good health. A slow rise in blood sugar after eating can keep people away from overeating, obesity, and diabetes. In this study, we conducted a subjective self-administered questionnaire survey on chewing and a chewing ability test using chewing ability chewing gum for 34 high school students, 55 university students, and 23 middle-aged people who participated in the university festival. The chewing ability test, a chewing gum manufactured by LOTTE used. As a result, most of the participants knew xylitol and some word, the 8020 campaign (holding 20 teeth at the age of 80). Also, although many participants could bite apples with skin, a few were confident in their teeth. Many participants replied they were chewing their meals well, but a few participants bite 30 times one bite of food. Participants chewed the chew-ability gum 60 times, and the inspector judged the gum color.

Beneficial Effects of Apple Vinegar on Hyperglycemia and Hyperlipidemia in Hypercaloric-Fed Rats.

The main objective of this study is to determine the effects of apple vinegar on the metabolic changes caused by hypercaloric diet in Wistar rats. Apple vinegar was first analyzed to find out the total acidity, the polyphenolic and flavonoid contents, the total antioxidant capacity, and the free radical scavenging activity. In vivo study on adult male and female Wistar rats was conducted by administering a drink containing either 10% D-glucose or water (control) for five weeks. Apple vinegar is administered daily by gavage (2 mL/kg) to rats fed D-glucose for 5 weeks. The results showed that the polyphenolic content in apple vinegar was 148.02 ± 10.16 mg GAE/100 mL, flavonoid content was 22.93 ± 0.73 QE/100 mL, and total antioxidant capacity was 13.4 ± 0.47 mg AAE/100 mL. Free radical IC50 apple vinegar scavenging activity (DPPH) was 0.74 ± 0.154 μL/mL. The total acidity was (3.24 ± 0.02 mg AAE/100 mL). The treatment during five weeks with D-glucose leads to increased plasma glucose, lipid profile, hepatic enzyme levels, urea, and creatinine. Simultaneous treatment with apple vinegar improves the parameters studied. These results clearly show that the daily consumption of vinegar can reduce the rise in blood sugar and lipid profile induced by hypercaloric diet in rats. Therefore, the use of apple vinegar would have a very beneficial effect in the prevention of metabolic disorders caused by high-caloric food.

Antihyperlipidemic and hepatoprotective properties of alkali- and enzyme-extractable polysaccharides by Dictyophora indusiata

Hyperlipidemia, a very common disease throughout the world, usually gives rise to severe liver damages. The current experiment was to investigate the antihyperlipidemic and hepatoprotective properties of alkali- and enzyme-extractable Dictyophora indusiata polysaccharides (Al-DPS and En-DPS) on the hyperlipidemic mice. The results of animal experiment in vivo showed that treatment with Al-DPS or En-DPS could improve the excessive level of lipid profiles in serum and liver, as well as strengthen antioxidant status. In addition, the histopathological observations of liver testified that polysaccharides were capable of attenuating hepatic cell injury. The primary structural features of Al-DPS and En-DPS were demonstrated by HPGPC, HPLC, FT-IR and NMR. Glucose tolerance test manifested that polysaccharides were able to restrain the rise of blood sugar. The results indicated that Al-DPS and En-DPS may be considered as novel compounds to treat hyperlipidemia and also act as hepatoprotective agents.

Comparative Effects of Garlic, Yogurt, Beniseed Liquor and Fresh Orange Juice on Induced Type-1 Diabetes Mellitus in Rabbits using Streptozotocin

Streptozotocin (STZ) was used to induce type-1 diabetes mellitus in animal models (twenty-one rabbits) at 60 mg/kg birth weight with two weekly booster doses to cause chronic diabetes in New Zealand White rabbits. They were given single intravenous dose of STZ in 1mL citrate buffer having a pH 4.6 and the booster dose given after 7 days and 14 days respectively. The blood glucose level was monitored along with the clinical signs including changes in behavior and weight loss. Treatment commenced immediately after the third booster when the rise in blood sugar was observed (4 hours later). They were treated with glucovance (a drug), fresh garlic extract, yogurt, beniseed liquor and orange juice for a period of 12 weeks (3 months) with the effect of the treatments checked on the glucose level of their blood, full blood count analysis using Mindray BC3300 auto-hematology analyzer and histopathology analysis of their pancreas. The results showed that the glucose level of the rabbits was within 70.02 ± 1.0 mg/dl at p ≤ 0.05 before they were induced. The level rose to 187.33 ± 0.9 mg/dl after the 3rd booster dose of streptozotocin was given to the rabbits. Gross morphology of selected organs showed that the inducement caused discoloration of the kidneys, oedema of the pancreas and significant increase in weight of the heart at p ≤ 0.05. There were no significant differences at p ≤ 0.05 between Packed Cell Volume (PCV) of the control group and the group induced and treated with diabetes drug; while there were significant differences in the fibrinogen values for the experimental groups. The induced type 1 diabetes mellitus caused an increase in the basophils, monocytes, and neutrophils while it caused significant decrease in the percentage of lymphocytes. Histopathologically, the inducement caused poor formation of the islet of Langerhans cells and dot necrotized cells. There is profuse hemorrhage from highly vascularized pancreatic acini surrounded by parenchyma fat cells. The group induced and treated with garlic extract showed some good features that not only depict a good and fast recovery from diabetes but showed some other health benefits of garlic. They are presence of well-formed pancreatic acini and cell infiltrations with well-spaced interstitial cells of the pancreas that shows active cell division of the pancreatic ducts and acini. There is splay and intrafaradization of the cracked pancreatic ducts. The presence of artifacts is seen at the anterior portion of the plate with well-formed interlobular and intralobular ducts. The effect of garlic extract as a good antidiabetic agent has been well established in this research. The curative strength of other foods such as yogurt and fruit extract has been proven in the findings of this research. Therefore, garlic has the most outstanding positive effect on diabetes and is recommended for people who are diabetic to feed on it or use it as food supplement.

Inhibitory Effect ofHeracleum persicumandZiziphus jujubaon Activity of Alpha-Amylase

Postprandial hyperglycemia plays an important role in the development of type 2 diabetes. Inhibition of alpha-amylase was led to a delay in breaks down of starch and glycogen and prevented a rapid rise in blood sugar. Alpha-amylase was isolated by gel filtration chromatography Sephadex G-75 from bovine pancreas. Then, total methanolic extracts of plants were prepared and IC50values of extracts on alpha-amylase were obtained and compared with acarbose IC50. The polyphenolic content of extracts and antioxidant capacity were determined by Folin-Ciocalteu test and DPPH test, respectively. The specific activity of alpha-amylase was 48.2 U/mg. For inhibition of alpha-amylase, IC50values ofH. persicum,Z. jujuba, and acarbose were 307, 827, and 113 μg/ml, respectively. For inhibition of DPPH radical, IC50values of extracts were 235 and 701 μg/ml. Total phenolic contents of methanol extracts were73.8±3.2and44.2±1.8 μg tannic acid equivalent/mg extract. Acarbose causes gastrointestinal symptoms and liver toxicity, butH. persicumandZ. jujubadecrease these side effects and prevent gastrointestinal disorders. Due to the high polyphenolic content and antioxidant capacity of these plants and significant inhibitory effect of the plants on alpha-amylase, these plants can be proposed for treatment of diabetic patients.

Novel bioactive compounds from endophytic fungi of Aborininal medicinla plants

Natural products exhibit interesting anti-microbial, anti-viral, and anti-inflammatory activities. These bioactivities make them an important source for the discovery of new pharmaceuticals. Currently, more than 60% of the drugs available on the market are of natural product origin. One of the aspects of drug discovery process is the identification of small molecules with enzyme-inhibiting activities. Enzymes are essential to human life, mediating biochemical processes including metabolism, cellular signal transduction, cell cycling, and development. Malfunction in these biochemical systems often leads to disease that can be caused either by the dysfunction, overexpression, or hyper-activation of the enzymes involved. An understanding of diseases at the molecular level has provided several enzyme inhibitors in clinics. For instance, galanthamine, a potent acetylcholinesterase (AChE) inhibitor, is used to treat early symptoms of Alzheimer's disease. α-Glucosidase (EC 3.2.1.20) is a membrane bound enzyme and lies at intestinal cells. This enzyme catalyzes the final step of carbohydrates digestion by hydrolyzing the glycosidic bonds in carbohydrates to liberate free glucose. The resulting glucose is a source of an exaggerated rise in blood sugar causing postprandial hyperglycemia. This causes type 2 diabetes mellitus and affects approximately 2.1 billion people worldwide. The potent α-glucosidase inhibitors prevent the breakdown of carbohydrates in small intestine and prolong the absorption of glucose or carbohydrates in blood. These compounds may be used as chemotherapeutic agents in clinics for the treatment of diabetes and obesity. Due to the catalytic role of α-glucosidase in carbohydrate digestion, these inhibitors may also be used as therapeutic target for other carbohydrate mediated diseases including viral infections, cancer, HIV and hepatitis. Our recent chemical investigation of endophytes of Aboriginal medicinal plants of Canada resulted in the identification of natural products exhibiting potent bioactivities including anti-microbial, anti-α-glucosidase and anti-AChE activities. In this presentation, isolation, structure elucidation of new bioactive natural products and their structure-activity relationships will be discussed.

Diazoxide-unresponsive congenital hyperinsulinism associated with ABCC8 nonsense mutation

Case presentation A baby boy with birth weight of 2.4kg at 35 weeks was born via Caesarian section. The boy was allowed feeding on demands, however he had the first onset of hypoglycemia at 2 hours of life. His blood sugar ranged from low reading to 2.5 mmol/L. The patient was treated with boluses of intravenous dextrose D10% followed by maintenance dextrose with its increasing strength in order to treat the refractory hypoglycemia. In addition to that intravenous hydrocortisone and glucagon infusion were started. The patient’s blood sugar could only be maintained > 3.0mmol/L after a glucose load of 30mg/kg/min and a glucagon infusion of 50mcg/kg/hour. During hypoglycemia, the insulin level was 19.6 pmol/L (17.8-173.0) and blood ketone was negative. Oral diazoxide was started at 5.0mg/kg/day in divided doses combined with chlorothiazide 7.0 mg/kg/day. Diazoxide was titrated up to 20.0mg/kg/day as he had a poor response even after 1 week of the treatment. Apart from that oral nifidipine 2.5 mg/kg/day in divided doses was also started after a few days with the combination therapy. Only after starting octreotide infusion a good rise of blood sugar was seen within 1 hour and the glucose load could be brought down and the other drugs were off. The boy was discharged with subcutaneous octreotide infusion at 2mcg/ hour via portable insulin pump. Results The boy is heterozygous for an ABCC8 nonsense mutation, p.R934*. A second ABCC8 mutation has not been found and sequencing of the KCNJ11 gene failed to detect a change from the normal sequence. He has inherited the mutation from his father; a focal lesion is therefore possible. 18F-DOPA PET-CT scanning is recommended and if a focal lesion is identified and surgically resected, microsatellite analysis of the DNA can be undertaken to confirm loss of heterozygosity.

Somogyi Effect in a Patient of Type 2 Diabetes Mellitus

Morning hyperglycemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycemic control. The dawn phenomenon is a normal rise in blood sugar as a person’s body prepares to wake up. In the early morning hours, hormones (growth hormone, cortisol and catecholamines) cause the liver to release large amounts of sugar into the bloodstream. For most people, the body produces insulin to control the rise in blood sugar. If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. If the body doesn’t produce enough insulin, blood sugar levels can rise. This may cause high blood sugar in the morning (before eating). Somogyi effect occurs in a person who takes insulin doesn’t eat a regular bedtime snack, and the person’s blood sugar level drops during the night. The person’s body responds to the low blood sugar by releasing hormones that raise the blood sugar level. This may cause a high blood sugar level in the early morning. The dawn phenomenon is more common than the Somogyi effect. To diagnose these phenomena, it is useful to measure plasma glucose levels for several nights between 2 a.m. and 5 a.m. or use a continuous glucose monitoring system.

Peri operative diabetic management using subcutaneous regular insulin as sliding scale and alberti regimen of glucose insulin potassium infusion - comparative study

Background The management of diabetic patient during the peri-operative period can be a problem to the anaesthesiologist. Many of worker have used short acting regular insulin using sliding scale which starts before operation and continue in post operatively. Alberti and Thomas proposed a simple regimen using a cotinuous intravenous infusion of an glucose insulin potassium (GIK) solution which is administered during the prei-operative period. Objectives The aim of the study is to observe the rise of blood sugar in diabetic patients per and post operatively and to detrermine the more acceptable method of controlling blood sugar amongst two predetermined methods. Methods A total of 80 patients of ASA II &amp; III were randomly selected. They were divided into the following groups. Group A. forty patients were randomly allocated to the treatment of thrice daily subcutaneous injections of short acting regular insulin by sliding scale. Group B. Forty patients were randomly allocated to continuous glucose insulin potassium treatment (GIK). Pre-operative blood glucose was controlled with thrice daily subcutaneous injection of short acting regular insulin. Result The two groups were comparable in demographic data. The blood glucose of group A was raised at mid operation, after 8 hours, 16 hours and 24 hours of operation more than the group B and it were statistically significant. Serum potassium level of the two group did not show any significant difference. The study showed that group B can produce satisfactory blood sugar and serum potassium control than group A. It is safe, simple and less expensive and can be apply in any situation. Conclusion Due to the large number of diabetic patients undergoing surgery and probable complications associated with diabetes, careful perioperave evaluations and management are required in these patients. To select an appropriate interventional strategy depends on the patient, the associated diabetic complications and type of surgery. Chronic diabetic complications can influence surgery and anesthetic conditions. Hence, appropriate risk stratification, optimal blood glucose and suitable interventional strategy are necessary. Glucose insulin potassium infusion can minimize metabolic disturbances during surgery. DOI: http://dx.doi.org/10.3329/jbsa.v26i1.19816 Journal of Bangladesh Society of Anaesthesiologists 2013; 26(1): 45-51