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Hypoglycemia prevention

Yosefa Bar-Dayan, Julio Wainstein, Louis Schorr, Estela Derazne, Yehudith Schorr, Daniela Jakubowicz, Yonit Wohl
OBJECTIVE: To examine the association between hypoglycemic events and inpatient and outpatient mortality rates, and to characterize the profile of patients with diabetes who develop hypoglycemia during hospitalization in order to identify risk factors and potentially avoid it. RESEARCH DESIGN AND METHODS: This retrospective cohort study analyzed data of 3410 patients with diabetes hospitalized during 2012. The associations among biochemical measures, severity of hypoglycemia, inpatient length of stay, and mortality during hospitalization, one month and within one year after discharge were evaluated...
November 28, 2018: European Journal of Internal Medicine
Santosh K Mandal, Karen P Briski
Pharmacologic activation of the hindbrain dorsal vagal complex energy sensor 5'-adenosine monophosphate-activated protein kinase (AMPK) causes site-specific adjustments in hypothalamic AMPK activity. DVC A2 noradrenergic neurons are a likely source of metabolo-sensory cues to downstream network components as they express substrate fuel-sensitive AMPK. This study investigated the hypothesis that DVC AMPK controls hypothalamic sensor, metabolic effector transmitter, and counter-regulatory hormone responses to insulin-induced hypoglycemia...
November 24, 2018: Brain Research Bulletin
Saleh Aldasouqi, Samia Mora, Gaurav Bhalla, Naveen Kakumanu, William Corser, George Abela, Mohammad Dlewati, Kathleen Estrada, Abdul Almounajed, Tarek Tabbaa, Jamal Hammoud, Cathy Newkirk
Objective: Many patients with diabetes opt to fast for lab tests, especially for lipid profiles, thus missing breakfast. In parallel, recent studies and international guidelines have indicated that routine fasting for lipid panels may not be necessary. Missing breakfast while fasting for lab tests may invoke hypoglycemia, if patients are not properly instructed about adjusting diabetes medications on the night before or on the day of the lab test. Our group described this form of hypoglycemia and introduced the term FEEHD to refer to it (fasting-evoked en route hypoglycemia in diabetes)...
2018: International Journal of Endocrinology
N D Goncharova, O A Chigarova, T E Oganyan
The effect of selective antagonist of the arginine vasopressin (AVP) V1b receptors on the secretion of ACTH and corticosteroids in response to insulin-induced hypoglycemia and injection of AVP is studied in old Macaca mulatta females with depression-like and anxious behavior. Intravenous antagonist in a dose of 1.1-1.7 μg/kg inhibits the increase of ACTH concentration, induced by hypoglycemia or injection of AVP. The degree of increase in the concentrations of hydrocortisone and dehydroepiandrosterone sulfate has not changed or increased...
November 2018: Bulletin of Experimental Biology and Medicine
Mary L Puchalski, Terri L Russell, Kristine A Karlsen
Hypoglycemia is one of the most common neonatal problems. Despite increasing evidence that hypoglycemia is linked to neurologic impairment, knowledge regarding the specific value or duration of hypoglycemia that results in injury to the brain remains unclear. Current published statements/guidelines focused on preventing clinically significant hypoglycemia are conflicting and continue to be based on low evidence. This article reviews transitional events leading to extrauterine euglycemia, risk factors contributing to transient or persistent hypoglycemia, and common treatment approaches...
December 2018: Critical Care Nursing Clinics of North America
Iman Hajizadeh, Mudassir Rashid, Ali Cinar
Adaptive and personalized model predictive control (MPC) algorithms that explicitly consider insulin dosing constraints are necessary to prevent overdose-induced hypoglycemia in type 1 diabetes. A personalized plasma insulin concentration (PIC) estimator is integrated with adaptive models to characterize the temporal dynamics of PIC and blood glucose concentration (BGC). The dynamic profile trajectories of the PIC and BGC are used to adapt the control problems and constraints on-line to accurately reflect the concurrent metabolic state of the individuals and improve glucose regulation...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Kris van Keulen, Wilma Knol, Svetlana V Belitser, Irene J Zaal, Paul D van der Linden, Eibert R Heerdink, Toine C G Egberts, Arjen J C Slooter
PURPOSE: To determine whether glucose variability is altered during delirium days compared to non-delirious days in critically ill patients with and without diabetes in the intensive care unit (ICU). MATERIALS AND METHODS: Critically ill patients with delirious and non-delirious days during ICU stay were included from a prospective cohort study which was conducted from January 2011- June 2013. Glucose variability was measured each observation day using various definitions (change in mean glucose, standard deviation, mean absolute glucose, daily delta and occurrence of hypo- and hyperglycemia)...
2018: PloS One
Kyungdo Han, Jae-Seung Yun, Yong-Moon Park, Yu-Bae Ahn, Jae-Hyoung Cho, Seon-Ah Cha, Seung-Hyun Ko
Purpose: There is a scarcity of long-term prediction models for severe hypoglycemia (SH) in subjects with type 2 diabetes mellitus (T2DM). In this study, a model was developed and validated to predict the risk of SH in adult patients with T2DM. Patients and methods: Baseline and follow-up data from patients with T2DM who received health evaluations from January 1, 2009, to December 31, 2010 (n=1,676,885) were analyzed as development (n=1,173,820) and validation (n=503,065) cohorts using the National Health Insurance Database (DB) in Korea...
2018: Clinical Epidemiology
Nikki Treskes, Wilhelmina Aria Christina Koekkoek, Arthur Raymond Hubert van Zanten
BACKGROUND: Stress-induced hyperglycemia is common among septic shock patients. Nutritional support influences glucose homeostasis but this effect has never been studied in septic shock. We aimed to determine the course of hyperglycemia and serum insulin levels in critically ill septic shock patients and to address the effects of caloric intake on glycemia, insulin levels, and exogenous insulin requirements. METHODS: A prospective observational study of 24 ventilated septic shock patients for 72 hours...
November 6, 2018: Shock
Jane E Yardley, Jordan L Rees, Deanna R Funk, Saeed Reza Toghi-Eshghi, Normand G Boulé, Peter A Senior
Context: Islet transplantation is effective in preventing hypoglycemia in individuals with type 1 diabetes (T1D). However, it is currently unknown whether transplanted islets regulate plasma glucose concentrations appropriately during and after exercise in human islet transplant recipients (ITx). Objective: To determine the effect of exercise on plasma glucose, insulin, and glucagon concentrations in ITx compared to individuals without diabetes (CON). Intervention: Participants completed two conditions in random order, 1) 45 minutes of aerobic exercise (60% VO2peak), and 2) 45 minutes of seated rest...
November 6, 2018: Journal of Clinical Endocrinology and Metabolism
Philippe Klee, Catherine Bussien, Montserrat Castellsague, Christophe Combescure, Mirjam Dirlewanger, Celine Girardin, Jean-Luc Mando, Luz Perrenoud, Carole Salomon, Franck Schneider, Valerie M Schwitzgebel
BACKGROUND: Prevention of type 1 diabetes mellitus (T1DM)-related complications is dependent on metabolic control. The recommended glycated hemoglobin (HbA1c) values <7.5% (58.5 mmol/mol) are met only by a minority of diabetic children and especially adolescents. The aim of this study was to evaluate the impact of an intervention comprising the use of Webdia, a patient-designed app for smartphones, on metabolic control of T1DM in children. METHODS: Fifty-five patients with T1DM, 10-18 years of age, were included in this single-center, randomized double-crossover study...
November 7, 2018: Diabetes Technology & Therapeutics
Saima Hasan, Sian M Shaw, Leslie H Gelling, Catherine J Kerr, Catherine A Meads
Objective: Type 1 diabetes mellitus rates are rising worldwide. The health benefits of physical exercise in this condition are many, but more than 60% do not participate, mainly from fear of hypoglycemia. This systematic review explores the effects of physical exercise modes on blood glucose levels in adults for hypoglycemia prevention. Research design and methods: Predefined inclusion criteria were randomized or non-randomized cross-over trials of healthy non-obese adults with type 1 diabetes mellitus...
2018: BMJ Open Diabetes Research & Care
Spencer Frank, Abdulrahman Jbaily, Ling Hinshaw, Rita Basu, Ananda Basu, Andrew J Szeri
Our objective is to develop a physiology-based model of insulin kinetics to understand how exercise alters insulin concentrations in those with type 1 diabetes (T1D). We reveal the relationship between the insulin absorption rate ([Formula: see text]) from subcutaneous tissue, the insulin delivery rate ([Formula: see text]) to skeletal muscle, and two physiological parameters that characterize the tissue: the perfusion rate (Q) and the capillary permeability surface area (PS), both of which increase during exercise because of capillary recruitment...
December 2018: Journal of Pharmacokinetics and Pharmacodynamics
Cong Zhang, Mao Huang, Ri Hong, Hongman Chen
Polysaccharides comprise the major bioactive components in Momordica charantia L. We here synthesized and characterized a novel M. charantia polysaccharide‑chromium (III) complex (MCPIIaC) and assessed its anti-diabetic effects in mice with streptozotocin (STZ)-induced diabetes mellitus (DM) and its mechanism underlying hypoglycemia. MCPIIaC is a novel polysaccharide‑chromium (III) complex containing 14.68% elemental chromium. A Fourier transform infrared (FTIR) spectrogram experiment showed that the chromium ions are linked to the polysaccharide's hydroxyl groups...
November 2, 2018: International Journal of Biological Macromolecules
Zhihua Pu, Jiaan Tu, Ruixue Han, Xingguo Zhang, Jianwei Wu, Chao Fang, Hao Wu, Xiaoli Zhang, Haixia Yu, Dachao Li
A novel cylindrical flexible enzyme-electrode sensor was fabricated with a bigger working electrode (WE) surface than the traditional pin-like one for implantable continuous glucose monitoring. On the WE surface, a 3D nanostructure consisting of graphene and platinum nanoparticles was constructed to enhance the sensitivity; in conjunction with the bigger WE, this nanostructure enabled hypoglycemia detection, which is still a big challenge in clinics. The cylindrical sensor was fabricated by rotated inkjet printing which enabled direct patterning of microstructures on a curved surface, thus overcoming the restriction of the traditional planar micromachining by photolithography...
October 30, 2018: Lab on a Chip
Leen Vandermosten, Thao-Thy Pham, Sofie Knoops, Charlotte De Geest, Natacha Lays, Kristof Van der Molen, Christopher J Kenyon, Manu Verma, Karen E Chapman, Frans Schuit, Karolien De Bosscher, Ghislain Opdenakker, Philippe E Van den Steen
Malaria reduces host fitness and survival by pathogen-mediated damage and inflammation. Disease tolerance mechanisms counter these negative effects without decreasing pathogen load. Here, we demonstrate that in four different mouse models of malaria, adrenal hormones confer disease tolerance and protect against early death, independently of parasitemia. Surprisingly, adrenalectomy differentially affects malaria-induced inflammation by increasing circulating cytokines and inflammation in the brain but not in the liver or lung...
October 30, 2018: Nature Communications
Meaghan Rempel, Jane E Yardley, Andrea MacIntosh, Jacqueline L Hay, Danielle Bouchard, Stephen Cornish, Seth D Marks, Yan Hai, Joseph W Gordon, Jonathan McGavock
Adding vigorous-intensity intervals (VII) to moderate-intensity exercise prevents immediate declines in blood glucose in type 1 diabetes (T1D) however the intensity required to minimize post-exercise hypoglycemia is unknown. To examine this question, ten sedentary T1D individuals completed four treadmill exercise sessions: a control session of 45 minutes of walking at 45-55% of heart rate reserve (HRR) and three sessions consisting of 60 seconds (VII) at 70%, 80%, or 90% of HRR every 4 minutes during exercise at 45-55% of HRR...
October 26, 2018: Scientific Reports
N Scott Adzick, Diva D De Leon, Lisa J States, Katherine Lord, Tricia R Bhatti, Susan A Becker, Charles A Stanley
BACKGROUND: Congenital Hyperinsulinism (HI) causes severe hypoglycemia in neonates and children. We reviewed our experience with pancreatectomy for the various types of HI. METHODS: From 1998 to 2018, 500 patients with HI underwent pancreatectomy: 246 for focal HI, 202 for diffuse HI, 37 for atypical HI (16 for Localized Islet Nuclear Enlargement [LINE], 21 for Beckwith-Wiedemann Syndrome), and 15 for insulinoma. Focal HI neonates were treated with partial pancreatectomy...
October 5, 2018: Journal of Pediatric Surgery
Sakaewan Ounjaijean, Sukanya Chachiyo, Voravuth Somsak
During Plasmodium malaria parasite infection in a human, the intraerythrocytic stages lead to the clinical manifestations of the disease, especially hypoglycemia. Hypoglycemia is a recognized feature of severe malaria and linked with a high risk of mortality for children. Hence, the present study aimed to investigate the protective effect of T. crispa stem extract on hypoglycemia induced by P. berghei infection tested with a mouse model. ICR mice were inoculated with 1 × 107 parasitized erythrocytes of P...
October 18, 2018: Parasitology International
Akihiko Soyama, Tota Kugiyama, Takanobu Hara, Masaaki Hidaka, Takashi Hamada, Satomi Okada, Tomohiko Adachi, Shinichiro Ono, Mitsuhisa Takatsuki, Susumu Eguchi
BACKGROUND: Intraoperative hyperglycemia during liver transplantation can induce infectious bacterial complications after surgery. The aim of this study was to evaluate the efficacy of the artificial endocrine pancreas in achieving perioperative blood glucose control and preventing infection in patients undergoing living donor liver transplantation. METHODS: We compared the 14 patients with an artificial endocrine pancreas device to 14 patients who underwent glycemic control using the sliding scale method with respect to perioperative blood glucose level and postoperative infection...
October 17, 2018: Artificial Organs
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