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Nondiabetic hypoglycemia

Michael R Rickels, Amy J Pelekis, Eileen Markmann, Cornelia Dalton-Bakes, Stephanie M Kong, Karen L Teff, Ali Naji
CONTEXT: Islet transplantation has been shown to improve glucose counterregulation and hypoglycemia symptom recognition in patients with type 1 diabetes (T1D) complicated by severe hypoglycemia episodes and symptom unawareness, but long-term data are lacking. OBJECTIVE: To assess the long-term durability of glucose counterregulation and hypoglycemia symptom responses 18 months after intrahepatic islet transplantation, and associated measures of glycemic control during a 24 month follow-up period...
August 29, 2016: Journal of Clinical Endocrinology and Metabolism
Avital Adler, Michal-Yackobovitz Gavan, Riva Tauman, Moshe Phillip, Shlomit Shalitin
BACKGROUND: Sleep has been shown to impact glucose regulation, and may be altered in persons with type 1 diabetes (T1D). OBJECTIVE: To assess sleep characteristics in T1D patients and the possible association between sleep disturbances and diabetes-related variables. SUBJECTS AND METHODS: In a cross-sectional study in 154 young patients with T1D and 154 age-range-matched nondiabetic controls subjective sleep characteristics were assessed using validated questionnaires: Sleep Disturbance Scale for Children (SDSC), Adolescent Sleep-Wake Scale (ASWS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS)...
August 3, 2016: Pediatric Diabetes
Monica Nannipieri, Anna Belligoli, Daniela Guarino, Luca Busetto, Diego Moriconi, Roberto Fabris, Andrea Mari, Simona Baldi, Marco Anselmino, Mirto Foletto, Roberto Vettor, Ele Ferrannini
CONTEXT: Postprandial hypoglycemia (PPHG) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Data on PPHG after laparoscopic sleeve gastrectomy (LSG) are scant. OBJECTIVE: The objective of the study was to identify preoperative predictors of PPHG in subjects spontaneously self-reporting PPHG after RYGB or LSG. Patients, Setting, and Intervention: Nondiabetic patients spontaneously self-reporting symptoms/signs of PPHG (PPHG group, 21 RYGB and 11 LSG) were compared in a case-control design with subjects who never experienced spontaneous or oral glucose tolerance test (OGTT)-induced hypoglycemia over 24 months after surgery (No-PPHG group, 13 RYGB and 40 LSG)...
October 2016: Journal of Clinical Endocrinology and Metabolism
Clare J Lee, G Craig Wood, Mariana Lazo, Todd T Brown, Jeanne M Clark, Christopher Still, Peter Benotti
OBJECTIVE: The epidemiology of post-gastric bypass surgery hypoglycemia (PGBH) is incompletely understood. This study aimed to evaluate the risk of PGBH among nondiabetic patients and associated factors. METHODS: A cohort study of nondiabetic patients who underwent Roux-en-Y gastric bypass (RYGB) was conducted. PGBH was defined by any postoperative record of glucose < 60 mg/dL, diagnosis of hypoglycemia, or any medication use for treatment of PGBH. Kaplan-Meier analysis was used to describe PGBH occurrence, log-rank tests, and Cox regression to examine associated factors...
June 2016: Obesity
Guntram Schernthaner, Marie Helene Schernthaner-Reiter, Gerit-Holger Schernthaner
During the last decade, the armamentarium for glucose-lowering drugs has increased enormously by the development of DPP-4 inhibitors, GLP-1 receptor agonists and SGLT2 inhibitors, allowing individualization of antidiabetic therapy for patients with type 2 diabetes (T2DM). Some combinations can now be used without an increased risk for severe hypoglycemia and weight gain. Following a request of the US Food and Drug Administration, many large cardiovascular (CV) outcome studies have been performed in patients with longstanding disease and established CV disease...
June 2016: Clinical Therapeutics
Delphine Vezzosi, Antoine Bennet, Solange Grunenwald, Philippe Caron
Whereas hypoglycaemia is uncommon in nondiabetic patients, it is a frequent reason for consultation. Hypoglycaemia is confirmed when criteria of Whipple's triad are fulfilled. If a venous sample cannot be collected when hypoglycemia occurs spontaneously, a 72-hour-fast test should be performed firstly to affirm the reality of hypoglycaemia and secondly to make the etiological diagnosis. Before carrying out this long and expensive test, the obvious causes of hypoglycaemia must be ruled out: iatrogenic, severe prolonged undernutrition, liver or renal deficiency, adrenal insufficiency, IGFII or pro-IGFII secreting tumours…At the time of hypoglycemia, plasma insulin≥3mUI/L, C-peptide≥0...
June 2016: La Presse Médicale
Thomas O Mundinger, Qi Mei, Alan K Foulis, Corinne L Fligner, Rebecca L Hull, Gerald J Taborsky
In humans, the glucagon response to moderate-to-marked insulin-induced hypoglycemia (IIH) is largely mediated by the autonomic nervous system. Because this glucagon response is impaired early in type 1 diabetes, we sought to determine if these patients, like animal models of autoimmune diabetes, have an early and severe loss of islet sympathetic nerves. We also tested whether this nerve loss is a permanent feature of type 1 diabetes, is islet-selective, and is not seen in type 2 diabetes. To do so, we quantified pancreatic islet and exocrine sympathetic nerve fiber area from autopsy samples of patients with type 1 or 2 diabetes and control subjects without diabetes...
August 2016: Diabetes
Vivi Flou Hjorth Jensen, Anne-Marie Mølck, Annette Heydenreich, Karin Juul Jensen, Line Olrik Bertelsen, Lene Alifrangis, Lene Andersen, Henrik Søeborg, Melissa Chapman, Jens Lykkesfeldt, Ingrid Brück Bøgh
New insulin analogues with a longer duration of action and a flatter pharmacodynamic profile are developed to improve convenience and safety for diabetic patients. During the nonclinical development of such analogues, safety studies must be conducted in nondiabetic rats, which consequently are rendered chronically hypoglycemic. A rat comparator model using human insulin would be valuable, as it would enable differentiation between effects related to either persistent insulin-induced hypoglycemia (IIH) or a new analogue per se...
January 2016: Journal of Toxicologic Pathology
Jean Chen, Amy Diesburg-Stanwood, Geza Bodor, Neda Rasouli
Hemoglobin A1c (A1c) is used frequently to diagnose and treat diabetes mellitus. Therefore, it is important be aware of factors that may interfere with the accuracy of A1c measurements. This is a case of a rare hemoglobin variant that falsely elevated a nondiabetic patient's A1c level and led to a misdiagnosis of diabetes. A 67-year-old male presented to endocrine clinic for further management after he was diagnosed with diabetes based on an elevated A1c of 10.7%, which is approximately equivalent to an average blood glucose of 260 mg/dL...
January 2016: Journal of Investigative Medicine High Impact Case Reports
Marilyn J Hammer, Gail D'Eramo Melkus, M Tish Knobf, Corey Casper, Jason Fletcher, Charles M Cleland
BACKGROUND: Patients undergoing hematopoietic cell transplantation (HCT) for hematological malignancies experience a number of challenges during treatment. There is growing evidence that malglycemia (hyperglycemia, hypoglycemia, and/or increased glycemic variability) contributes to HCT-related complications, even in patients without preexisting diabetes. The purpose of this pilot study was to investigate factors influencing glycemic status and associated infection occurrences in nondiabetic autologous HCT recipients...
May 2016: Biological Research for Nursing
Michael A Mancano
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers. Write to Dr. Mancano at ISMP, 200 Lakeside Drive, Suite 200, Horsham, PA 19044 (phone: 215-707-4936; e-mail: Your report will be published anonymously unless otherwise requested...
September 2015: Hospital Pharmacy
Ranjita Santra Dhali, Prithwijit Banerjee, Santanu Munshi, Patralekha Ray Chaudhuri
Sertraline is a selective serotonin reuptake inhibitor. It has been shown to blunt postprandial hyperglycemia in rats and to potentiate the hypoglycemic effects of sulfonylurea agents in humans. Here, we report a case of a 33-year-old nondiabetic patient with no history of glucose intolerance, who experienced multiple episodes of hypoglycemia that resolved after discontinuation of the drug. Healthcare professionals should consider sertraline among the possible causes of hypoglycemia occurring in patients receiving antidepressants...
September 2015: Indian Journal of Pharmacology
Jacques M Himpens, Ramon Vilallonga, Guy-Bernard Cadière, Guido Leman
BACKGROUND: In the technique used in our department, Roux-en-Y gastric bypass (RYGB) anatomically only differs from the mini- or omega loop gastric bypass (OLGB) by the incorporation of an isolated alimentary limb, called the Roux limb. The metabolic consequences of the incorporation of a Roux limb are unknown. OBJECTIVES: To evaluate differences in glucose and insulin dynamics between RYGB and OLGB in normoglycemic patients, by submitting them to a glucose challenge after stabilization of their weight...
July 2016: Surgical Endoscopy
Chin-Li Lu, Pei-Chun Hsu, Hsiu-Nien Shen, Ya-Hui Chang, Hua-Fen Chen, Chung-Yi Li
To compare the incidence and relative risk of falls between adults with and without diabetes, and to prospectively assess the role of history of severe hypoglycemia in the putative relationship between diabetes and falls in younger and older people, respectively.The National Health Insurance Research Database in Taiwan was used in this cohort study. Diabetic cases (with and without history of severe hypoglycemia) and nondiabetic people were followed from 2000 to 2009. There were 31,049 people enrolled in each of the 3 groups...
August 2015: Medicine (Baltimore)
Nicolas R Bolo, Gail Musen, Donald C Simonson, Lisa D Nickerson, Veronica L Flores, Tamar Siracusa, Brandon Hager, In Kyoon Lyoo, Perry F Renshaw, Alan M Jacobson
UNLABELLED: Human brain networks mediating interoceptive, behavioral, and cognitive aspects of glycemic control are not well studied. Using group independent component analysis with dual-regression approach of functional magnetic resonance imaging data, we examined the functional connectivity changes of large-scale resting state networks during sequential euglycemic-hypoglycemic clamp studies in patients with type 1 diabetes and nondiabetic controls and how these changes during hypoglycemia were related to symptoms of hypoglycemia awareness and to concurrent glycosylated hemoglobin (HbA1c) levels...
August 5, 2015: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Thomas O Mundinger, Ellis Cooper, Michael P Coleman, Gerald J Taborsky
Short-term hyperglycemia suppresses superior cervical ganglia neurotransmission. If this ganglionic dysfunction also occurs in the islet sympathetic pathway, sympathetically mediated glucagon responses could be impaired. Our objectives were 1) to test for a suppressive effect of 7 days of streptozotocin (STZ) diabetes on celiac ganglia (CG) activation and on neurotransmitter and glucagon responses to preganglionic nerve stimulation, 2) to isolate the defect in the islet sympathetic pathway to the CG itself, and 3) to test for a protective effect of the WLD(S) mutation...
August 1, 2015: American Journal of Physiology. Endocrinology and Metabolism
Wissam K Kabbara, Wijdan H Ramadan, Peggy Rahbany, Souhaila Al-Natour
BACKGROUND: Fluoroquinolones are among the most widely prescribed antibiotics. However, concerns about increasing resistant microorganisms and the risk of dysglycemia associated with the use of these agents have emerged. OBJECTIVE: The primary objective of the study was to evaluate the appropriate use of commonly prescribed fluoroquinolones, including appropriate indication, dose, dose adjustment in renal impairment, and duration of treatment. The secondary objective was to investigate the dysglycemic effect of fluoroquinolone use (hypoglycemia and/or hyperglycemia) in diabetic and nondiabetic patients...
2015: Therapeutics and Clinical Risk Management
Ran Lou, Li Jiang
OBJECTIVE: To explore the association between glucose variability and poor prognosis in critically ill patients. METHODS: This prospective study was undertaken in a 24-bed intensive care unit (ICU). A total of 145 patients staying for over 24 hours in ICU were enrolled. Their arterial levels of blood glucose were measured four times daily routinely. And the mean glucose level (MGL), standard deviation (SD) and coefficient of variation (CV) were calculated. The incidence of moderate hypoglycemia (MH), severe hypoglycemia (SH), total dosage of hormone, average daily dosage of insulin, duration of renal replacement- therapy (RRT), mechanical ventilation and ICU free days were also recorded...
February 17, 2015: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Trevor J Orchard, David M Nathan, Bernard Zinman, Patricia Cleary, David Brillon, Jye-Yu C Backlund, John M Lachin
IMPORTANCE: Whether mortality in type 1 diabetes mellitus is affected following intensive glycemic therapy has not been established. OBJECTIVE: To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT) cohort. DESIGN, SETTING, AND PARTICIPANTS: After the DCCT (1983-1993) ended, participants were followed up in a multisite (27 US and Canadian academic clinical centers) observational study (Epidemiology of Diabetes Control and Complications [EDIC]) until December 31, 2012...
January 6, 2015: JAMA: the Journal of the American Medical Association
Michael R Rickels, Carissa Fuller, Cornelia Dalton-Bakes, Eileen Markmann, Maral Palanjian, Kevin Cullison, Janice Tiao, Shiv Kapoor, Chengyang Liu, Ali Naji, Karen L Teff
Patients with long-standing type 1 diabetes (T1D) may exhibit defective glucose counterregulation and impaired hypoglycemia symptom recognition that substantially increase their risk for experiencing severe hypoglycemia. The purpose of this study was to determine whether intrahepatic islet transplantation improves endogenous glucose production (EGP) in response to hypoglycemia in T1D patients experiencing severe hypoglycemia. We studied longitudinally subjects (n = 12) with ∼30 years, disease duration before and 6 months after intrahepatic islet transplantation using stepped hyperinsulinemic-hypoglycemic and paired hyperinsulinemic-euglycemic clamps with infusion of 6,6-(2)H2-glucose and compared the results with those from a nondiabetic control group (n = 8)...
May 2015: Diabetes
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