Effect of Acute Mild Hypoglycaemia on Counterregulatory Responses to Moderate Hypoglycaemia Induced Immediately Afterwards in Healthy Men

1993 ◽  
Vol 85 (5) ◽  
pp. 537-542 ◽  
Author(s):  
K. T. Moriarty ◽  
E. J. Simpson ◽  
N. S. Brown ◽  
I. A. MaCdonald ◽  
R. B. Tattersall
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Glucose ◽  
Symptom Score ◽  
Random Order ◽  
Sweating Rate ◽  
Hormonal Responses ◽  
Healthy Men ◽  
Mild Hypoglycaemia ◽  
Single Blind

1. This study was designed to determine whether a 1 h period of mild hypoglycaemia (33 or 3.7 mmol/l) affected the response to an episode of moderate hypoglycaemia (2.5 mmol/l) immediately afterwards. 2. Eleven non-obese healthy men (age 26 + 1 years, mean + SEM) underwent three separate 3 h hyperinsulinaemic glucose clamps in single-blind, random order. On all three occasions, blood glucose was 4.5 mmol/l for the first hour, and on a control visit was maintained at this level for the second hour. In the other two visits, blood glucose was lowered to 3.7 or 33 mmol/l during the second hour. In the third hour, blood glucose was lowered to 2.5 mmol/l on all three visits. 3. In the second hour, adrenaline rose significantly (P <0.05, analysis of variance) with a blood glucose of 33 and 3.7 mmol/l, as did cortisol and heart rate at 33 mmol/l, but glucagon, prolactin, sweating rate, symptom score and blood pressure were the same during the second hour on all three visits. 4. In the final hour at 2.5 mmol/l, there were no differences in adrenaline, noradrenaline, glucagon, prolactin, cortisol, symptom score, heart rate, blood pressure or sweating rate. 5. Thus, the overall magnitude of hormonal responses to moderate hypoglycaemia (2.5 mmol/l) are not modified by exposure to mild hypoglycaemia (33 or 3.7 mmol/l) for 1 h immediately beforehand.

Ketone infusion lowers hormonal responses to hypoglycaemia: Evidence for acute cerebral utilization of a non-glucose fuel

1991 ◽  
Vol 81 (2) ◽  
pp. 189-194 ◽  
Author(s):  
Stephanie A. Amiel ◽  
Helen R. Archibald ◽  
Gary Chusney ◽  
Alistair J. K. Williams ◽  
Edwin A. M. Gale
Keyword(s):  
Body Weight ◽  
Blood Glucose ◽  
Glucose Concentration ◽  
Blood Glucose Concentration ◽  
Random Order ◽  
Plasma Insulin Concentration ◽  
Hormonal Responses ◽  
Soluble Insulin ◽  
Hormone Responses ◽  
Single Blind

1. The effect of hyperketonaemia on counter-regulatory hormone responses to hypoglycaemia has been examined in six healthy subjects. 2. A controlled, step-wise reduction in blood glucose concentration was achieved by adjusting the rate of glucose infusion during a primed-continuous infusion of soluble insulin (1.5 m-units min−1 kg−1 body weight, plasma insulin concentration approximately 90 m-units/l). Simultaneous infusion of either saline or β-hydroxybutyrate (3 mg min−1 kg−1 body weight) was administered in a single-blind fashion, in random order. Despite a need for 40% more glucose during the ketone infusion, an identical fall in blood glucose concentration was achieved in each study. 3. The glycaemic threshold for stimulating an adrenaline response of 0.41 nmol/l was reduced from 3.1 to 2.8 mmol/l (P < 0.05) during ketone infusion, and that for stimulating a response of more than 50% of basal from 3.6 to 3.1 mmol/l (P < 0.001). The peak adrenaline response fell from 7.97 to 2.6 nmol/l (P < 0.04). Peak noradrenaline, cortisol and growth hormone responses were also significantly lower during ketone infusion (P = 0.04, 0.001 and 0.006, respectively). Glucagon responses alone were unaffected by hyperketonaemia. 4. The provision of an alternate metabolic fuel thus produced immediate changes in the neurohumoral responses to hypoglycaemia. This is consistent with the hypothesis that human nervous tissue can metabolize ketones acutely.

scholarly journals Efficacy of Diltiazem for the Control of Blood Pressure in Puerperal Patients with Severe Preeclampsia: A Randomized, Single-Blind, Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Gilberto Arias-Hernández ◽  
Cruz Vargas-De-León ◽  
Claudia C Calzada-Mendoza ◽  
María Esther Ocharan-Hernández
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Severe Preeclampsia ◽  
Secondary Outcome ◽  
Control Group ◽  
Single Blind

Background. Postpartum preeclampsia is a serious disease related to high blood pressure that occurs commonly within the first six days after delivery. Objective. To evaluate if diltiazem improves blood pressure parameters in early puerperium patients with severe preeclampsia. Methodology. A randomized, single-blind longitudinal clinical trial of 42 puerperal patients with severe preeclampsia was carried out. Patients were randomized into two groups: the experimental group (n = 21) received diltiazem (60 mg) and the control group (n = 21) received nifedipine (10 mg). Both drugs were orally administered every 8 hours. Systolic, diastolic, and mean blood pressures as well as the heart rate were recorded and analyzed (two-way repeated measures ANOVA) at baseline and after 6, 12, 18, 24, 30, 36, 42, and 48 hours. Primary outcome measures were all the aforementioned blood pressure parameters. Secondary outcome measures included the number of hypertension and hypotension episodes along with the length of stay in the intensive care unit. Results. No statistical differences were found between groups (diltiazem vs. nifedipine) regarding basal blood pressure parameters. Interarm differences in blood pressure (systolic, diastolic, and mean) and heart rate were statistically significant between treatment groups from 6 to 48 hours. Patients in the diltiazem group had lower blood pressure levels than patients in the nifedipine group. Significantly, patients who received diltiazem had fewer hypertension and hypotension episodes and stayed fewer days in the intensive care unit than those treated with nifedipine. Conclusions. Diltiazem controlled arterial hypertension in a more effective and uniform manner in patients under study than nifedipine. Patients treated with diltiazem had fewer collateral effects and spent less time in the hospital. This trial is registered with NCT04222855.

Hypoxemia raises muscle sympathetic activity but not norepinephrine in resting humans

1989 ◽  
Vol 66 (4) ◽  
pp. 1736-1743 ◽  
Author(s):  
L. B. Rowell ◽  
D. G. Johnson ◽  
P. B. Chase ◽  
K. A. Comess ◽  
D. R. Seals
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Nervous Activity ◽  
Plasma Concentrations ◽  
Random Order ◽  
Sympathetic Nervous Activity ◽  
Severe Hypoxemia ◽  
Arterial Blood ◽  
End Tidal ◽  
Venous Plasma

The experimental objective was to determine whether moderate to severe hypoxemia increases skeletal muscle sympathetic nervous activity (MSNA) in resting humans without increasing venous plasma concentrations of norepinephrine (NE) and epinephrine (E). In nine healthy subjects (20–34 yr), we measured MSNA (peroneal nerve), venous plasma levels of NE and E, arterial blood pressure, heart rate, and end-tidal O2 and CO2 before (control) and during breathing of 1) 12% O2 for 20 min, 2) 10% O2 for 20 min, and 3) 8% O2 for 10 min--in random order. MSNA increased above control in five, six, and all nine subjects during 12, 10, and 8% O2, respectively (P less than 0.01), but only after delays of 12 (12% O2) and 4 min (8 and 10% O2). MSNA (total activity) rose 83 +/- 20, 260 +/- 146, and 298 +/- 109% (SE) above control by the final minute of breathing 12, 10, and 8% O2, respectively. NE did not rise above control at any level of hypoxemia; E rose slightly (P less than 0.05) at one time only with both 10 and 8% O2. Individual changes in MSNA during hypoxemia were unrelated to elevations in heart rate or decrements in blood pressure and end-tidal CO2--neither of which always fell. We conclude that in contrast to some other sympathoexcitatory stimuli such as exercise or cold stress, moderate to severe hypoxemia increases leg MSNA without raising plasma NE in resting humans.

Effect of adrenaline on basal and ovine corticotrophin-releasing factor-stimulated ACTH secretion in man

1987 ◽  
Vol 112 (1) ◽  
pp. 145-150 ◽  
Author(s):  
S. Al-Damluji ◽  
D. Cunnah ◽  
A. Grossman ◽  
L. Perry ◽  
G. Ross ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Biological Effects ◽  
Random Order ◽  
Normal Male ◽  
Plasma Acth ◽  
Plasma Adrenaline ◽  
Corticotrophin Releasing Factor ◽  
Cortisol Responses ◽  
Male Subjects ◽  
Single Blind

ABSTRACT Six normal male subjects were given, in single blind random order on six separate occasions, i.v. bolus doses of synthetic ovine corticotrophin-releasing factor-41 (oCRF-41; 25 and 50 μg) with and without adrenaline (3 μg/min) i.v. for 150 min, the adrenaline infusions alone and saline placebo. The adrenaline infusions resulted in plasma adrenaline concentrations of 4·33 ± 0·82 (s.e.m.) nmol/l and were associated with an increase in blood glucose, heart rate and systolic blood pressure and a reduction of diastolic blood pressure. Despite these evident biological effects at several sites, there was no stimulation of plasma ACTH or cortisol by adrenaline in comparison with the effect of saline, and no enhancement of the stimulatory effect of either dose of oCRF-41 on ACTH or cortisol secretion. The ACTH response to 50 μg oCRF-41 was greater than that to 25 μg, indicating that the 25 μg dose of oCRF-41 was sub-maximal and capable of further enhancement. As the plasma adrenaline concentrations during the adrenaline infusions reached the upper limit of the physiological range of plasma adrenaline in man, yet failed to enhance the ACTH or cortisol responses to a sub-maximal dose of oCRF-41, we conclude that circulating adrenaline neither exerts a direct stimulatory effect on pituitary corticotrophs nor enhances the effect of CRF under physiological circumstances. The adrenaline infusions attenuated the ACTH and cortisol responses to oCRF-41 and were associated with a transient reduction of basal concentrations of both hormones. J. Endocr. (1987) 112, 145–150

Renal extraction and acute effects of glucagon-like peptide-1 on central and renal hemodynamics in healthy men

2015 ◽  
Vol 308 (8) ◽  
pp. E641-E649 ◽  
Author(s):  
Ali Asmar ◽  
Lene Simonsen ◽  
Meena Asmar ◽  
Sten Madsbad ◽  
Jens J. Holst ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Renal Hemodynamics ◽  
Acute Effects ◽  
Primary Metabolite ◽  
Healthy Men ◽  
Glucagon Like Peptide

The present experiments were performed to elucidate the acute effects of intravenous infusion of glucagon-like peptide (GLP)-1 on central and renal hemodynamics in healthy men. Seven healthy middle-aged men were examined on two different occasions in random order. During a 3-h infusion of either GLP-1 (1.5 pmol·kg−1·min−1) or saline, cardiac output was estimated noninvasively, and intraarterial blood pressure and heart rate were measured continuously. Renal plasma flow, glomerular filtration rate, and uptake/release of hormones and ions were measured by Fick's Principle after catheterization of a renal vein. Subjects remained supine during the experiments. During GLP-1 infusion, both systolic blood pressure and arterial pulse pressure increased by 5 ± 1 mmHg ( P = 0.015 and P = 0.002, respectively). Heart rate increased by 5 ± 1 beats/min ( P = 0.005), and cardiac output increased by 18% ( P = 0.016). Renal plasma flow and glomerular filtration rate as well as the clearance of Na+ and Li+ were not affected by GLP-1. However, plasma renin activity decreased ( P = 0.037), whereas plasma levels of atrial natriuretic peptide were unaffected. Renal extraction of intact GLP-1 was 43% ( P < 0.001), whereas 60% of the primary metabolite GLP-1 9-36amide was extracted ( P = 0.017). In humans, an acute intravenous administration of GLP-1 leads to increased cardiac output due to a simultaneous increase in stroke volume and heart rate, whereas no effect on renal hemodynamics could be demonstrated despite significant extraction of both the intact hormone and its primary metabolite.

scholarly journals Differential effects of four intramuscular sedatives on cardiorespiratory stability in juvenile guinea pigs (Cavia porcellus)

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259559
Author(s):  
Ryan P. Sixtus ◽  
Cholawat Pacharinsak ◽  
Clint L. Gray ◽  
Mary J. Berry ◽  
Rebecca M. Dyson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Guinea Pigs ◽  
Random Order ◽  
Microvascular Perfusion ◽  
Laboratory Animals ◽  
Physiological Monitoring ◽  
Non Invasive ◽  
Effective Doses

Background Non-invasive physiological monitoring can induce stress in laboratory animals. Sedation reduces the level of restraint required, thereby improving the validity of physiological signals measured. However, sedatives may alter physiological equilibrium introducing unintended bias and/or, masking the experimental outcomes of interest. We aimed to investigate the cardiorespiratory effects of four short-acting sedatives in juvenile guinea pigs. Method 12 healthy, 38 (26–46) day-old Dunkin Hartley guinea pigs were included in this blinded, randomised, crossover design study. Animals were sedated by intramuscular injection using pre-established minimum effective doses of either alfaxalone (5 mg/kg), diazepam (5 mg/kg), ketamine (30 mg/kg), or midazolam (2 mg/kg) administered in random order with a minimum washout period of 48 hours between agents. Sedative depth, a composite score comprised of five assessment criteria, was observed every 5-min from dosing until arousal. Physiological monitoring of cardiorespiratory status included measures of heart rate, blood pressure, respiratory rate, and peripheral microvascular perfusion. Results Ketamine and alfaxalone were most effective in inducing stable sedation suitable for physiological monitoring, and diazepam less-so. Midazolam was unsuitable due to excessive hypersensitivity. All sedatives significantly increased heart rate above non-sedated control rates (P<0.0001), without altering blood pressure or microvascular perfusion. Alfaxalone and ketamine reduced respiratory rate relative to their control condition (P<0.0001, P = 0.05, respectively), but within normative ranges. Conclusion Ketamine and alfaxalone are the most effective sedatives for inducing short duration, stable sedation with minimal cardiorespiratory depression in guinea pigs, while diazepam is less-so. However, alfaxalone is the most appropriate sedative for longitudinal studies requiring multiple physiological timepoints.

scholarly journals The features of the pain syndrome in diabetic patients with myocardial infarction

2021 ◽  
Vol 17 (2) ◽  
pp. 72-78
Author(s):  
M.V. Boliuk ◽  
O.A. Halushko
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Severe Pain ◽  
Pain Syndrome ◽  
Coronary Syndrome

Background. Due to the frequent development of neuropathy in diabetic patients, it is believed that this category of patients is characterized by a high incidence of atypical acute coronary syndrome, but data about this are quite contradictory. The purpose of the study was to determine pain syndrome features and its severity in patients with acute coronary syndrome and diabetes mellitus. Materials and methods. The study involved 24 patients with diabetes (19 men and 5 women) aged 45–83 years, hospitalized urgently for the acute coronary syndrome. Assessment of pain syndrome was performed at the time of hospitalization and immediately after coronary artery revascularization according to the following criteria: visual analogue scale (VAS), numerical rating scale (NRS), clinical data (sweating, tremor, blood pressure, pulse), blood glucose level. Results. Most patients (87.5 %) at the time of hospitalization complained of chest pain, the rest were not bothered by any pain. Patients described pain as “burning” (29.17 %), “squeezing” (29.17 %), “tightness” (25.0 %), “tingling” (4.17 %). There were also complaints of difficulty breathing (12.5 %), shortness of breath (12.5 %), palpitations (41.67 %), excessive sweating (16.67 %). There was no statistically significant difference between the results of pain assessment by VAS and NRS (p > 0.1). The results of the subjective assessment of pain syndrome by VAS and NRS indicate that before revascularization, moderate and severe pain occurred with equal frequency. There were no statistically significant fluctuations in blood pressure and heart rate before and after the intervention in patients with different pain severity (p > 0.1). At the time of hospitalization, the mean systolic blood pressure was 135.71 ± 18.70 mmHg, diastolic blood pressure was 83.71 ± 14.67 mmHg, heart rate was 73.08 ± 11.35 bpm. The mean value of glycemia at the time of hospitalization was 8.19 ± 3.45 mmol/l (8.17 ± 3.61 mmol/l in men, 8.28 ± 3.13 mmol/l in women). Blood glucose level ≥ 10.0 mmol/l was detected in 5 patients, i.e. in 20.83 % of all patients. The majority of these individuals had severe pain (60.0 %). Conclusions. In patients with myocardial infarction and diabetes mellitus, the typical clinical picture of ACS (87.5 %) prevailed over the painless form. Before revascularization, moderate and severe pain occurred with equal frequency; there is no statistical difference between blood pressure, heart rate and blood glucose level (p > 0.1) in patients with severe and moderate pain. Hyperglycemia (≥ 10.0 mmol/l) was detected in 20.83 % of patients, most of them had severe pain (60.0 %). The lack of difference between the values of the studied pain criteria may be due to the sample size, the low sensitivity of the criteria, the development of diabetic neuropathy. As a result, there is a need for further study of the phenomenon of pain syndrome in patients with ACS and diabetes mellitus.

scholarly journals Effects of meal ingestion on blood pressure and regional hemodynamic responses after exercise

2016 ◽  
Vol 120 (11) ◽  
pp. 1343-1348 ◽  
Author(s):  
Masako Yamaoka Endo ◽  
Chizuko Fujihara ◽  
Akira Miura ◽  
Hideaki Kashima ◽  
Yoshiyuki Fukuba
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cardiac Output ◽  
Young Male ◽  
Random Order ◽  
Carbohydrate Ingestion ◽  
Liquid Meal ◽  
Severe Hypotension ◽  
Meal Ingestion

This study investigated the combined effects of consuming a meal during postexercise hypotension (PEH) on hemodynamics. Nine healthy young male subjects performed each of three trials in random order: 1) cycling at 50% of heart rate reserve for 60 min, 2) oral ingestion of a carbohydrate liquid meal (75 g glucose), or 3) carbohydrate ingestion at 40 min after cycling exercise. Blood pressure, heart rate, cardiac output, and blood flow in the superior mesenteric (SMA), brachial, and popliteal arteries were measured continuously before and after each trial. Regional vascular conductance (VC) was calculated as blood flow/mean arterial pressure. Blood pressure decreased relative to baseline values ( P < 0.05) after exercise cessation. Blood flow and VC in the calf and arm increased after exercise, whereas blood flow and VC in the SMA did not. Blood pressure did not change after meal ingestion; however, blood flow and VC significantly decreased in the brachial and popliteal arteries and increased in the SMA for 120 min after the meal ( P < 0.05). When the meal was ingested during PEH, blood pressure decreased below PEH levels and remained decreased for 40 min before returning to postexercise levels. The sustained increase in blood flow and VC in the limbs after exercise was reduced to baseline resting levels immediately after the meal, postprandial cardiac output was unchanged by the increased blood flow in the SMA, and total VC and SMA VC increased. Healthy young subjects can suppress severe hypotension by vasoconstriction of the limbs even when carbohydrate is ingested during PEH.

Abstract P204: Sinusoidal Galvanic Stimulation Improves Orthostatic Symptoms In Patients With Postural Tachycardia.

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Vasile Urechie ◽  
Emily Smith ◽  
Dmitri Ogorodnikov ◽  
Italo Biaggioni ◽  
Andre Diedrich
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Symptom Score ◽  
Rate Increase ◽  
Vestibular Stimulation ◽  
Galvanic Vestibular Stimulation ◽  
Orthostatic Tolerance ◽  
Heart Rate Increase ◽  
Postural Tachycardia ◽  
Orthostatic Symptoms

Postural Tachycardia Syndrome (POTS) is characterized by frequent orthostatic symptoms and excessive heart rate increase (>= 30 bpm) on standing in the absence of orthostatic hypotension for more than 6 months. We and others have described a vestibulo-sympathetic reflex that can be engaged by galvanic vestibular stimulation to modulate sympathetic activity (Biaggioni et al., 2000; Kaufmann et al., 2002; Monahan & Ray, 2002; Ray & Carter, 2003, Bent, Macefield et al. 2006). We hypothesize that habituation to sinusoidal galvanic vestibular stimulation will improve orthostatic tolerance. We studied 6 patients with POTS (30.5+/6.0 years, BMI 22.8+/-2.9 kg/m 2 ) in two sessions using sinusoidal galvanic vestibular stimulation (sGVS 0.025 Hz, 2mA) or sham (0.01 mA). Stimulation was applied near mastoid process for 30 min in semi-recumbent position before orthostatic challenge. Patient were upright for a maximum of 15 minutes after each stimulation. Orthostatic change in Vanderbilt Orthostatic Symptom Score (dVOSS), orthostatic heart rate increase (dHR) and blood pressure response were recorded. Non-parametric Wilcoxon test for paired measures with significance level p<0.05 was used. sGVS stimulation reduced overall orthostatic symptom score (dVOSS sham: 32.5+/-9.3 bpm vs dVOSS sGVS: 10.5+/-5.5, p=0.03) and tended to reduce orthostatic HR increase (dHR sham: 65.83+/-11.5 vs dHR sGVS: 46.5+/-10.7 bpm, p=0.06). Blood pressure and tilt time did not change. This pilot study suggests that habituation to sinusoidal vestibular could be used to improve orthostatic symptoms and orthostatic tolerance.

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