Variations In Blood Glucose Levels Research Articles

Comparative Study of Intra Operative Blood Sugar Level in Spinal Anesthesia and General Anesthesia in Patients undergoing Elective Surgery

Introduction: The aim of the study was to carry out the comparative study of variations in blood glucose levels intra operatively in patients undergoing surgical procedures in Spinal Anesthesia and General Anesthesia by capillary blood glucose level.Objective: To compare intra operative blood glucose level in Spinal and General Anesthesia.Methodology: Sixty non diabetic patients (30 in each group) aged between 20 – 60 years belonging to ASA I and ASA II status were enrolled for this prospective comparative study. Capillary blood glucose was measured preoperatively and thereafter at 15 minutes interval after incision in Spinal Anesthesia and after induction of General Anesthesia till one hour of surgery. For statistical analysis paired sample t – test was used for comparing mean of quantitative data. Difference was considered statistically significant if p < 0.05.Results: Blood sugar level was well controlled in patients receiving spinal anesthesia. General anesthesia produced more increase in blood sugar level compared to base line value which was statistically significant (P<0.05). Similarly, Glycaemia was significantly higher in the General anesthesia group (p < 0.05) when compared with Spinal Anesthesia group suggesting poor control of stress response during general anesthesia.Conclusion: Based on capillary blood glucose level, spinal anesthesia proved more effective in suppressing stress response as compared to general anesthesia in elective surgical patients. BJHS 2018;3(2)6: 458-462

Determination of the Effect of a Teneligliptin-Canagliflozin Combination Drug Using Free Style Libre Pro

A combination drug comprising teneligliptin (Ten) and canagliflozin (Can) became commercially available in Japan in September 2017. No studies reported the effect of this combination drug on variations in blood glucose levels through continuous blood glucose monitoring with the Free Style Libre Pro (Libre Pro). This study prospectively examined the effects in patients treated with either Ten or Can. The subjects were 15 outpatients with diabetes with HbA1c levels ranging from 6.5% to 15% who had been treated with Ten 20 mg (10 patients) or Can 100 mg (5 patients). Doses of antidiabetes drugs other than Ten and Can were maintained throughout the study. The subjects used Libre Pro for 2 weeks. During the first week, Ten or Can was administered. During the second week, the teneligliptin-canagliflozin combination drug (TC) was administered. After completing Libre Pro monitoring, TC was administered continuously for 3 weeks, while patients were followed on an outpatient basis (UMIN000029015). Glycoalbumin level of the Ten group and Can group decreased significantly after switching to TC (p = 0.002, p = 0.035). Over 7 days, the Libre Pro-measured mean blood glucose level of the both group ameliorated significantly after switching to TC (p < 0.001, p = 0.006). Regarding blood glucose variation, the median standard deviation (SD) decreased significantly from 39.2 to 30.5 of the Ten group after switching to TC (p = 0.002), and from 32.9 to 24.4 of the Can group (p = 0.024). In the Ten group, The mean amplitude of glycemic excursions (MAGE) at day 7 improved significantly from 75.0 mg/dL to 47.5 mg/dL after switching to TC (p = 0.013); in the Can group, from 88.5 mg/dL to 44.5 mg/dL (p = 0.043). There were no significant changes in fasting blood glucagon levels in either group. These results indicate that patients who switched from Ten to TC experienced significant improvements in blood glucose control, as assessed by Libre Pro. Disclosure T. Tosaki: Other Relationship; Self; Eli Lilly and Company, Takeda Development Center Asia, Pte. Ltd., MSD K.K., Mitsubishi Tanabe Pharma Corporation. H. Kamiya: Other Relationship; Self; MSD K.K., Ono Pharmaceutical Co., Ltd., Sanofi K.K., AstraZeneca, Astellas Pharma KK, Eli Lilly and Company, Novartis Pharma K.K., Dainippon Sumitomo Pharma Co., Ltd, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd.. S. Sato: None. A. Kudara: None. A. Inagaki: None. M. Kondo: None. S. Tsunekawa: None. Y. Kato: Speaker's Bureau; Self; Merck Sharp & Dohme Corp., Sanofi, Takeda Pharmaceutical Company, Eli Lilly Japan. J. Nakamura: Other Relationship; Self; Astellas Pharma US, Inc., AstraZeneca, Ono Pharmaceutical Co., Ltd., MSD K.K., Kyowa Hakko Kirin Co., Ltd., Kowa Pharmaceuticals America, Inc., Sanofi K.K., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Mitsubishi Tanabe Pharma Corporation, Eli Lilly and Company, Novartis Pharma K.K., Pfizer Inc..

Nocturnal reactive hypoglycaemia well treated subjectively and objectively with voglibose

Clinicians sometimes encounter difficulty in diagnosing hypoglycaemia. Here, we present a case report of a 53-year-old woman with recurrent nocturnal hypoglycaemia. A continuous glucose monitoring system (CGMS) revealed postprandial hyperglycaemia...

The albumin-exendin-4 recombinant protein E2HSA improves glycemic control and \u03b2-cell function in spontaneous diabetic KKAy mice

BackgroundE2HSA is a genetic fusion protein that consists of two tandem exendin-4 molecules that are covalently bonded to recombinant human serum albumin via a peptide linker. Previous studies have demonstrated that E2HSA significantly decreased blood glucose levels, improved β-cell function and promoted β-cell proliferation in diabetic db/dB mice. This study aimed to evaluate the benefits of E2HSA on glucose and lipid metabolism in a spontaneous diabetes animal model, KKAy mice.MethodsE2HSA was acutely administered at doses of 1, 3 and 9 mg/kg by subcutaneous injection in diabetic KKAy mice with exendin-4 (2 μg/kg) as a positive reference, and then the non-fasting blood glucose and food intake levels were dynamically monitored. In addition, different doses of E2HSA were injected once daily, as well as with exendin-4 twice daily, for 7 weeks to evaluate the effect on glucose and lipid metabolism, as well as the body weight, food and water intake.ResultsSingle injection of E2HSA decreased non-fasting blood glucose and food intake levels in a dose-dependent manner for 4 days and 2 days, respectively. Repeated injections with E2HSA significantly decreased variations in blood glucose levels with a reduction of HbA1c levels by 1.6% at a 9 mg/kg dose, simultaneously increased fasting blood insulin levels, inhibited fasting blood glucagon levels, improved the impaired oral glucose tolerance and enhanced glucose infusion rate, which is the gold standard for evaluating β-cell function. Moreover, repeated injections with E2HSA also ameliorated the dyslipidemia and reduced body weight, food and water intake in diabetic KKAy mice.ConclusionsE2HSA significantly reduced blood glucose levels over a prolonged duration, enhanced β-cell function, and ameliorated dyslipidemia and obesity in diabetic KKAy mice. Thus, E2HSA may be a new candidate for the treatment of type 2 diabetes.

Twenty-four-hour variations in blood glucose level in Japanese type 2 diabetes patients based on continuous glucose monitoring.

Aims/IntroductionHigh fluctuations in blood glucose are associated with various complications. The correlation between glycated hemoglobin (HbA1c) level and fluctuations in blood glucose level has not been studied in Japanese patients with type 2 diabetes. In the present study, blood glucose profile stratified by HbA1c level was evaluated by continuous glucose monitoring (CGM) in Japanese type 2 diabetes patients.Materials and MethodsOur retrospective study included 294 patients with type 2 diabetes who were divided by HbA1c level into five groups (≥6.0 to <7.0%, ≥7.0 to <8.0%, ≥8.0 to <9.0%, ≥9.0 to <10.0% and ≥10%). The correlation between HbA1c level and CGM data was analyzed. The primary end‐point was the difference in blood glucose fluctuations among the HbA1c groups.ResultsThe mean blood glucose level increased significantly with increasing HbA1c (P trend < 0.01). The standard deviation increased with increases in HbA1c (P trend < 0.01). The mean amplitude of glycemic excursions did not vary significantly with HbA1c. The levels of maximum blood glucose, minimum blood glucose, each preprandial blood glucose, each postprandial maximum blood glucose, range of increase in postprandial glucose from pre‐meal to after breakfast, the area under the blood concentration–time curve >180 mg/dL and percentage of the area under the blood concentration–time curve >180 mg/dL were higher with higher HbA1c. Mean glucose level and pre‐breakfast blood glucose level were significant and independent determinants of HbA1c.ConclusionsIn Japanese patients treated for type 2 diabetes, the mean amplitude of glycemic excursions did not correlate with HbA1c, making it difficult to assess blood glucose fluctuations using HbA1c. Parameters other than HbA1c are required to evaluate fluctuations in blood glucose level in patients receiving treatment for type 2 diabetes.

GSM based Needleless Blood Glucose Monitoring System

Diabetes is one of the leading non communicable diseases affecting public health. Though it is termed as a deficiency rather than a disease, uncontrolled diabetes will lead to complications resulting in renal failure/liver failure/ heart-attack/loss of sight or foot problems leading to amputation if not diagnosed, monitored and treated on time. In order to avoid these complications blood glucose level should be periodically monitored. Conventional methods used for this purpose uses sharp needle which leads to loss of blood and has a risk of infections to the patients. In order to overcome such problems, a non-invasive glucose monitoring system is necessary. In this study, we propose a design, a cost effective and non-invasive glucose monitoring device using near infrared spectroscopy techniques. In addition, GSM module attached to this device will enable wireless data sharing facility. The results can therefore also be transmitted easily to the doctor for examination. The results obtained can also be stored for future records and also to analyse variations in blood glucose level and adjustment of dosage of medicine. The current study shows that our device has accuracy level equivalent to that of conventionally available devices and also provides convenient, hassle free usage to the patients.

Peritoneal dialysis assists residual renal function to maintain glucose tolerance: a prospective observational study

Renal failure can cause the deterioration of glucose metabolism and increase blood glucose fluctuations, which have been reported to be a factor in the progression of vascular disorders. Little information is available on the daily variation in blood glucose levels in patients with end-stage renal disease (ESRD) and peritoneal dialysis (PD). Daily plasma glucose excursion was evaluated by continuous glucose monitoring (CGM) for 24–72 h. Fourteen ESRD patients without type 2 diabetic nephropathy (non-diabetic patients) and six ESRD patients with type 2 diabetic nephropathy (diabetic patients) participated in this study. ESRD patients started PD which were undergone in only the daytime, and not in the night time. As the PD solution, Dianeal®1.5 % PD-2N (1.5 L) was infused intraperitoneally for 3 h three times daily. The patients received standard meals with a total calorie intake of 30 kcal/kg/day and a protein intake of 0.8 g/kg/day before and after initiation of PD. Daily glucose profiles were measured both 2 week before and 1 week after the commencement of PD with CGM system (CGMS). CGMS parameters were compared between before and after the initiation of PD. In non-diabetic patients with ESRD, the maximum glucose concentration (GC) and area under the curve (AUC) of GC >140 mg/dL significantly decreased after PD initiation. In diabetic patients with ESRD, the mean GC, SD, minimum value, AUC of GC >140 mg/dL, and maximum nocturnal GC significantly decreased, while the percentage of nocturnal GC <70 mg/dL markedly increased after PD commencement. In all patients, there was a significant negative correlation between the incidence of hypoglycemia and residual renal function before the initiation of PD and the correlation disappeared after PD initiation. In all patients, the GC range and coefficient of variation were negatively associated with the peritoneal Kt/V value. Residual renal function promotes the maintenance of glucose tolerance in patients with ESRD. Glucose fluctuation improved shortly after initiation of PD, whereas nocturnal hypoglycemia was evident in diabetic patients.

Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

OBJECTIVE:To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine.STUDY DESIGN:This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated.RESULTS:There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters.CONCLUSION:The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease.

The gut microbiota modulates glycaemic control and serum metabolite profiles in non-obese diabetic mice.

Islet autoimmunity in children who later progress to type 1 diabetes is preceded by dysregulated serum metabolite profiles, but the origin of these metabolic changes is unknown. The gut microbiota affects host metabolism and changes in its composition contribute to several immune-mediated diseases; however, it is not known whether the gut microbiota is involved in the early metabolic disturbances in progression to type 1 diabetes. We rederived non-obese diabetic (NOD) mice as germ free to explore the potential role of the gut microbiota in the development of diabetic autoimmunity and to directly investigate whether the metabolic profiles associated with the development of type 1 diabetes can be modulated by the gut microbiota. The absence of a gut microbiota in NOD mice did not affect the overall diabetes incidence but resulted in increased insulitis and levels of interferon gamma and interleukin 12; these changes were counterbalanced by improved peripheral glucose metabolism. Furthermore, we observed a markedly increased variation in blood glucose levels in the absence of a microbiota in NOD mice that did not progress to diabetes. Additionally, germ-free NOD mice had a metabolite profile similar to that of pre-diabetic children. Our data suggest that germ-free NOD mice have reduced glycaemic control and dysregulated immunologic and metabolic responses.

PC.118 Audit of early glycaemic control in infants with hypoxic ischaemic encephalopathy who received therapeutic hypothermia, and neurodevelopmental outcomes

BackgroundGlycaemic control in infants undergoing therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy (HIE) may have a significant impact on long-term outcomes. Limited information is available on the optimal blood glucose...

Variations in blood glucose levels following gastrostomy tube insertion in a paediatric population

Radiologic insertion of a gastrostomy or gastrojejunostomy tube is a common procedure in children. Glucagon is used to create gastric hypotonia, permitting gastric distension and facilitating percutaneous puncture. Glucagon can cause hyperglycaemia and potentially rebound hypoglycaemia. The safety of glucagon and incidence of hypoglycaemia has not been studied following gastrostomy or gastrojejunostomy tube insertion. To determine variations in blood glucose in children post gastrostomy or gastrojejunostomy tube insertion. Secondarily, to determine the frequency of hypoglycaemia and hyperglycaemia in children who did or did not receive glucagon. This is a retrospective observational study of 210 children undergoing percutaneous gastrostomy or gastrojejunostomy tube insertion over a 2-year period. We studied the children's clinical and laboratory parameters. Abnormal blood glucose levels were defined according to age-established norms. We used descriptive statistics and ANOVA. We analysed 210 children with recorded blood glucose levels. More than 50% of the children were less than the third percentile for weight. In the glucagon group (n = 187) hyperglycaemia occurred in 82.3% and hypoglycaemia in 2.7% (n = 5). In the no glucagon group (n = 23), hyperglycaemia occurred in 43.5% and there were no cases of hypoglycaemia. The peak blood glucose occurred within 2h, with normalization by 6h post-procedure. Five children became hypoglycaemic, all received glucagon; 4/5 had weights <3rd percentile. Logistic regression analysis revealed no factors significantly associated with hypoglycaemia. Greatest blood glucose variability occurs between 1h and 3h post-procedure. Hyperglycaemia is common and more severe with glucagon, and hypoglycaemia rarely occurs. These findings have assisted in developing clinical guidelines for post-percutaneous gastrostomy/gastrojejunostomy tube insertion.

The relationship between the levels and variability of blood glucose and the prognosis of massive cerebral infarction

To investigate the relationship between the levels and variability of blood glucose and the prognosis of massive cerebral infarction. A retrospective study involving 72 massive cerebral infarction patients without diabetes mellitus admitted to Taizhou Enze Medical Centre Luqiao Hospital from January 2012 to June 2013 was conducted. The mean blood glucose level (GluAve), standard deviation of blood glucose level (GluSD), and coefficient of variation of blood glucose level (GluCV) during the first 72 hours were monitored. Complications such as cerebrocardiac syndrome, pulmonary infection, stress ulcer bleeding, urinary system infection, decubitus sore, electrolyte disturbances, and epileptic seizures were also recorded. According to the 28-day outcome after admission, patients were divided into survivor group (n=60) and non-survivor group (n=12). The values of GluAve, GluSD and GluCV were compared between the two groups. The patients were again divided into three groups based on the level of GluAve (<7.8, 7.8-11.1, >11.1 mmol/L). Finally, patients were divided into four groups based on the level of GluCV (<15%, 15%-30%, 30%-50%, >50%). Acute physiology and chronic health evaluation II (APACHEII) score, mortality, and complications were compared among groups. The levels of GluAve, GluSD and GluCV in non-survivor group were significantly higher than those in survivor group [GluAve: 17.91 ± 5.33 mmol/L vs. 12.41 ± 3.12 mmol/L, t=3.145, P=0.002; GluSD:2.87 ± 1.96 mmol/L vs. 1.83 ± 1.08 mmol/L, t=2.611, P=0.017; GluCV: (27.56 ± 14.73)% vs. (20.12±10.97)%, t=2.020, P=0.043]. With the gradual increase of GluAve level, the mortality and total complication rate were elevated significantly [28-day mortality: 5.00% (1/20), 13.89% (5/36), 37.50% (6/16), χ²=7.16, P=0.028; total complication rate: 35.00% (7/20), 55.56% (20/36), 93.75% (15/16), χ²=12.85, P=0.002]. But there was no significant difference in APACHEII score (9.80 ± 4.17, 12.11 ± 5.81, 13.69 ± 6.57, F=2.241, P=0.114) and stress ulcer incidence rate [5.00% (1/20), 11.11% (4/36), 31.25% (5/16), χ²=5.59, P=0.061]. With the gradual increase of GluCV level, APACHEII score, 28-day mortality, the incidence of various complications, and total complication rate were all raised significantly [APACHEII score: 7.00 ± 1.56, 10.08 ± 1.88, 13.14 ± 5.76, 16.76 ± 7.17, F=12.486, P=0.000; mortality: 0 (0/15), 8.70% (2/23), 23.81% (5/21), 38.46% (5/13), χ²=9.27, P=0.026; total complication rate: 40.00% (6/15), 47.83% (11/23), 57.14% (12/21), 100.00% (13/13), χ²=12.42, P=0.006]. Both the GluAve level and GluCV level are significantly correlated with the outcome of patients suffering from massive cerebral infarction. The change in GluCV level seems to be more sensitive in predicting the prognosis of massive cerebral infarction than GluAve.

The use of dipeptidyl peptidase-4 inhibitors for the treatment of patients with type 2 diabetes mellitus and chronic renal disease

The rapid increase in the number of patients with type 2 diabetes mellitus and renal pathology necessitates the revision of the presently adopted approaches to renal replacement therapy with a view of relieving the economic and financial burden imposed by the use of expensive therapeutic methods on the health budgets of the developed countries. The importance of achievement and maintenance of the target blood sugar levels for the prevention of the development and progression of renal lesions has been demonstrated in a series of large-scale clinical studies. Compensation of disorders of carbohydrate metabolism at the late stages of chronic renal disease in the patients presenting with diabetes mellitus encounters difficulties arising from the danger of hypoglycemia associated with the impairment of renal gluconeogenesis, cumulation of antiglycemic agents and their metabolites, decreased clinical significance of glycated hemoglobin levels under conditions of developing anemia and marked hyperglycemia. Discontentedness with the currently available means for the control of carbohydrate metabolism that fail to meet the up-to-date-requirements for the effectiveness and safety in a given clinical situation accounts for the ever increasing interest in the possibility of using innovative incretin-based medicines taking into account their pharmacological profile (they are known to change insulin secretion in response to variations in blood glucose levels, improve the function of beta-cells, have beneficial effect on the cardiovascular system, and control body weight).

Determination of the Potency of Extracted, Purified and Formulated Insulin from the Pancreatic Organs of the Sudanese Beef Cattle

The treatment of type 1 diabetes is mainly dependent on insulin therapy and current formulated insulin formulations are used for its control all over the world. The presented study was designed to evaluate the potency of extracted, purified and formulated insulin from the pancreatic organs of the Sudanese beef cattle. Twenty healthy rabbits were used to conduct the study following subcutaneous administration of the sample insulin, to determine the hypoglycemic effect and to analyze the potency of the testing insulin by the hypoglycemic seizure method, blood sugar method and glucose enzymatic colorimetric test (GOD-PAP) respectively. The potency of the injected insulin samples was estimated by comparing the variation in blood glucose levels produced in the treated animals with that produced by a standard insulin preparation under the suitable conditions of the blood sugar method. The results revealed that the potency of the testing beef insulin samples was slightly higher (i.e., 2.2 USP units/ml, 9%) compared to the standard and assumed potency of the prepared insulin preparations (i.e., 1-2 USP units/ml) which indicated that the solvents and diluents used to prepare the assay dilution might be of higher potency and must be diluted to such an extent that the testing insulin potency must be compatible with the standard dilutions. Furthermore, to determine the choice of an assay to analyze the potency of insulin preparations, not only the accuracy of the result but also the purpose for which the test is to be used and the time limit must be taken into consideration.

Blood glucose estimation as an indirect assessment of modulation of neuroendocrine stress response by dexmedetomidine versus fentanyl premedication during laparoscopic cholecystectomy: A clinical study.

Background:Anesthesia and surgery-induced neuroendocrine stress response can be modulated by appropriate premedication. The present study was designed to assess the clinical efficacy of dexmedetomidine versus fentanyl premedication for modulation of neuroendocrine stress response by analyzing the perioperative variation of blood glucose level during laparoscopic cholecystectomy under general anesthesia.Subjects and Methods:In a prospective randomized double-blind study, 60 adult consented patients of either sex with ASA I and II, scheduled for elective laparoscopic cholecystectomy under general anesthesia and meeting the inclusion criteria, were allocated into two groups. Group D patients (n = 30) were given intravenous dexmedetomidine 1μg/kg and Group F patients (n = 30) received fentanyl 2 μg/kg, given over a 10-min period, before induction of anesthesia. Perioperative blood glucose levels were analyzed preoperatively, at 30 min after beginning of surgery, and 2.5 h after surgery. Anesthetic and surgical techniques were standardized. All patients were also assessed for intraoperative hemodynamic changes of heart rate and mean arterial pressure at specific timings.Results:Blood glucose concentration has shown 20% increase after surgery. The differences between groups were not statistically significant as observed by analyzing the variation of serial perioperative blood glucose estimation. Both premedicants had attenuated the hemodynamic and neuroendocrine stress response of pneumoperitoneum and general anesthesia. The dexmedetomidine group showed more stabilization of intraoperative hemodynamics of mean arterial blood pressure and heart rate when compared to fentanyl group.Conclusion:During the laparoscopic cholecystectomy, dexmedetomidine and fentanyl, both premedicants have effectively modulated the neuroendocrine stress response of general anesthesia as assessed by analysis of perioperative blood glucose variation, but dexmedetomidine was better.

Nanobiotechnology advanced antifouling surfaces for the continuous electrochemical monitoring of glucose in whole blood using a lab-on-a-chip

In the current work we have developed a lab-on-a-chip containing embedded amperometric sensors in four microreactors that can be addressed individually and that are coated with crystalline surface protein monolayers to provide a continuous, stable, reliable and accurate detection of blood glucose. It is envisioned that the microfluidic device will be used in a feedback loop mechanism to assess natural variations in blood glucose levels during hemodialysis to allow the individual adjustment of glucose. Reliable and accurate detection of blood glucose is accomplished by simultaneously performing (a) blood glucose measurements, (b) autocalibration routines, (c) mediator-interferences detection, and (d) background subtractions. The electrochemical detection of blood glucose variations in the absence of electrode fouling events is performed by integrating crystalline surface layer proteins (S-layer) that function as an efficient antifouling coating, a highly-oriented immobilization matrix for biomolecules and an effective molecular sieve with pore sizes of 4 to 5 nm. We demonstrate that the S-layer protein SbpA (from Lysinibacillus sphaericus CCM 2177) readily forms monomolecular lattice structures at the various microchip surfaces (e.g. glass, PDMS, platinum and gold) within 60 min, eliminating unspecific adsorption events in the presence of human serum albumin, human plasma and freshly-drawn blood samples. The highly isoporous SbpA-coating allows undisturbed diffusion of the mediator between the electrode surface, thus enabling bioelectrochemical measurements of glucose concentrations between 500 μM to 50 mM (calibration slope δI/δc of 8.7 nA mM(-1)). Final proof-of-concept implementing the four microfluidic microreactor design is demonstrated using freshly drawn blood. Accurate and drift-free assessment of blood glucose concentrations (6. 4 mM) is accomplished over 130 min at 37 °C using immobilized enzyme glucose oxidase by calculating the difference between autocalibration (10 mM glc) and background measurements. The novel combination of biologically-derived nanostructured surfaces with microchip technology constitutes a powerful new tool for multiplexed analysis of complex samples.

Food Insecurity and Hypoglycemia Among Safety Net Patients With Diabetes

In 2008, 1 in every 7 US households was food insecure, or at risk of going hungry because of an inability to afford food.(1) Food insecurity generally occurs cyclically and episodically, with periods of food adequacy followed by food scarcity; the average food insecure household experiences seven episodes of food scarcity annually.(2) We hypothesized that the cyclic nature of food insecurity, and its associated fluctuations in dietary intake, would predispose patients with diabetes to wide variations in blood glucose levels, including clinically significant hypoglycemia.

The Impact of Elevated Blood Glycemic Level of Patients with Type 2 Diabetes Mellitus on the Erythrocyte Membrane: FTIR Study

In developed countries, medical awareness about the disease and how to deal with it is less acknowledged. With diabetes mellitus the situation becomes more serious due to the fact that it affects nearly all parts of the body and may lead to loss of vision. In this study, the variation of blood glucose level of type 2 diabetic patients was considered, and its effect(s) on their blood erythrocyte membranes was studied by Fourier transform infrared spectroscopy. Patients with type 2 diabetes mellitus were classified into two groups with mean fasting blood glucose level of 185 mg/dl (D-185 group) and 285 mg/dl (D-285 group). For comparison, healthy individuals were involved where their mean fasting blood glucose level is 86 mg/dl. Type 2 diabetes mellitus was found to induce change in the lipid and protein components and causing some important structural changes in the protein secondary structure with change in the beta-sheet and beta-turn structures at D-285 mg/dl group. Erythrocyte membrane disorder was increased associated with restriction in the vibrational motion around the phospholipids interface region.

Decreased glucose tolerance but normal blood glucose levels in the field in the caviomorph rodent Ctenomys talarum: The role of stress and physical activity

Hystricomorph rodents have a divergent insulin molecule with only 1–10% of the biological activity in comparison to other mammalian species. In this study, we used the subterranean rodent Ctenomys talarum as a model and performed blood glucose tolerance tests (GTTs) with trained and untrained individuals to evaluate blood glucose regulation and the possible role of physical activity as a compensatory mechanism. Additionally, we evaluated the variations in blood glucose during acute and chronic stress and gathered data in the field to evaluate natural-occurring variations in blood glucose levels. The GTTs showed that C. talarum have a diminished capacity of regulating blood glucose levels in comparison to other mammals and suggest that unexplored differences in the compensatory mechanisms, insulin structure and/or glucose transporters exist within species of hystricomorph rodents. However, blood glucose levels in the field stayed within the normal mammalian range. Physical activity did not prove to be a compensatory mechanism for blood glucose regulation. The individuals did not display important increases in blood glucose after acute stressors and managed to adequately regulate blood glucose during chronic stress. We suggest that the species may not face a selective pressure favoring a more tightly, mammalian like, capacity of regulating blood glucose levels.

A model for diabetic nephropathy: Advantages of the inducible cAMP early repressor transgenic mouse over the streptozotocin‐induced diabetic mouse

We have previously found progressive diabetic nephropathy in inducible cAMP early repressor (ICER Igamma) transgenic (Tg) mice. The ICER Igamma Tg mouse is an interesting model of sustained hyperglycemia due to its low production of insulin and insulin-producing beta cells. Here in a longitudinal study we further analyzed diabetic nephropathy and structural and functional alterations in other organs, comparing our model with streptozotocin (STZ)-diabetic model mice. The high-dose STZ-diabetic model showed marked variation in blood glucose levels and severe toxicity of STZ in the liver and kidney. The low-dose STZ-diabetic model showed less toxicity, but the survival rate was very low. STZ-diabetic mice had much more variation of glomerular hypertrophy and sclerosis. Furthermore, non-specific toxicity of STZ or insulin injections to maintain optimal blood glucose levels might have another effect upon the diabetic renal changes. In contrast, ICER Igamma Tg mice exhibited a stable and progressive phenotype of diabetic kidney disease solely due to chronic hyperglycemia without other modulating factors. Thus, ICER Igamma Tg mouse has advantages for examining diabetic renal disease, and offers unique and very different perspectives compared to STZ model.