Blood insulin responses to blood glucose levels in high output sepsis and septic shock

Insulin secretion is impaired in type 2 diabetes (T2D). The insulin and glucose responses to central autonomic activation induced by excitation of brain medullary TRH receptors were studied in T2D Goto-Kakizaki (GK) rats. Blood glucose levels in normally fed, pentobarbital-anesthetized GK and nondiabetic Wistar rats were 193 and 119 mg/100 ml in males and 214 and 131 mg/100 ml in females. Intracisternal injection (ic) of the stable TRH analog RX 77368 (10 ng) induced significantly higher insulin response in both genders of overnight-fasted GK rats compared with Wistar rats and slightly increased blood glucose in female Wistar rats but significantly decreased it from 193 to 145 mg/100 ml in female GK rats. RX 77368 (50 ng) ic induced markedly greater glucose and relatively weaker insulin responses in male GK rats than Wistar rats. Bilateral vagotomy blocked ic RX 77368-induced insulin secretion, whereas adrenalectomy abolished its hyperglycemic effect. In adrenalectomized male GK but not Wistar rats, ic RX 77368 (50 ng) dramatically increased serum insulin levels by 6.5-fold and decreased blood glucose levels from 154 to 98 mg/100 ml; these changes were prevented by vagotomy. GK rats had higher basal pancreatic insulin II mRNA levels but a lower response to ic RX 77368 (50 ng) compared with Wistar rats. These results indicate that central-vagal activation-induced insulin secretion is susceptible in T2D GK rats. However, the dominant sympathetic-adrenal response to medullary TRH plays a suppressing role on vagal-mediated insulin secretion. This unbalanced vago-sympathetic activation by medullary TRH may contribute to the impaired insulin secretion in T2D.

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The Effect of Oral Alanine on Blood Glucose and Glucagon in the Human Newborn Infant

PEDIATRICS ◽

10.1542/peds.56.1.78 ◽

1975 ◽

Vol 56 (1) ◽

pp. 78-81

Author(s):

R. H. Fiser ◽

P. R. Williams ◽

D. A. Fisher ◽

P. V. DeLameter ◽

M. A. Sperling ◽

...

Keyword(s):

Blood Glucose ◽

Newborn Infant ◽

Plasma Glucose ◽

Cell Secretion ◽

Term Infants ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Human Newborn ◽

Glucagon And Insulin ◽

Insulin Responses

Plasma, glucose, glucagon, and insulin responses to oral feedings of l-alanine were assessed in 44 healthy term infants during the first three days of life. Alanine administration produced significant increases in glucagon and glucose concentrations on day 1, but not on days 2 and 3. These increases occurred within 30 minutes (mean and SEM for glucagon, 127 ± 7 to 219 ± 16 pg/ml, P < 0.001; glucose, 45 ± 3 to 60 ± 7 mg/100 ml, P < 0.01) and persisted at the P < 0.05 level at four hours. Responsiveness to alanine seemed to be related to the baseline blood glucose levels since constant infusions of glucose inhibited the response. These results indicate that the pancreatic islet alpha cell secretion mechanism(s) is functioning in the newborn.

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Intensive Insulin Therapy and Pentastarch Resuscitation in Sepsis

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0021 ◽

2018 ◽

pp. 109-113

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Blood Glucose ◽

Insulin Therapy ◽

Fluid Resuscitation ◽

Intensive Insulin Therapy ◽

Safety And Efficacy ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Ringer’S Lactate

This case focuses on the use of intensive insulin therapy with sepsis by asking the question: What are the safety and efficacy of intensive insulin therapy compared with conventional therapy and hydroxyethyl starch (HES) compared with Ringer’s lactate in patients with severe sepsis or septic shock? This study demonstrated that critically ill patients did not benefit from intensive insulin therapy targeting blood glucose levels of 80–110 mg/dL vs. conventional insulin therapy nor from fluid resuscitation with HES vs. Ringer’s lactate. Neither intensive insulin therapy nor fluid resuscitation with HES is currently recommended in major sepsis guidelines.

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Feeding and metabolic patterns in rats with truncular vagotomy or with transplanted beta-cells.

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1978.235.2.e119 ◽

1978 ◽

Vol 235 (2) ◽

pp. E119 ◽

Cited By ~ 5

Author(s):

J Louis-Sylvestre

Keyword(s):

Blood Glucose ◽

Beta Cells ◽

Diurnal Rhythms ◽

Intravenous Glucose ◽

Glucose Levels ◽

Diurnal Patterns ◽

Blood Glucose Levels ◽

Basal Plasma ◽

Insulin Responses ◽

The Relationship

The night- and daytime basal plasma insulin levels and insulin responses to an intravenous glucose load, basal blood glucose levels and rates of glucose uptake, and, finally, the diurnal patterns of blood glucose levels were investigated in normal compared to vagotomized Wistar rats. The same comparisons were made between normal and diabetic Lewis rats recovered after fetal pancreas transplantation in the kidney capsule. In an attempt to clarify the relationship between the metabolic and feeding diurnal patterns, a detailed study of the meal pattern of vagotomized and transplanted rats was performed. It was shown that 1) a truncular vagotomy abolished both the metabolic and feeding diurnal cyclicity; 2) both the metabolic and feeding diurnal rhythms were maintained in case of a selective denervation beta-cells. The relationship between the metabolic and feeding diurnal rhythms and the role of the vagus nerve are discussed.

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