SEVERE INSULIN RESISTANCE - A POTENTIAL HANDICAP FOR EFFICIENT ARTIFICIAL NUTRITION IN CRITICALLY ILL PATIENTS: RESULTS OF A EUGLYCEMIC HYPERINSULINEMIC CLAMP STUDY

1999 ◽  
Vol 27 (Supplement) ◽  
pp. A119
Author(s):  
Christian Zauner ◽  
Petra Nimmerrichter ◽  
Klaus M Ratheiser
Keyword(s):  
Insulin Resistance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Artificial Nutrition ◽  
Euglycemic Hyperinsulinemic Clamp ◽  
Severe Insulin Resistance ◽  
Clamp Study

Effects of exercise on insulin distribution and action in testosterone-treated oophorectomized female rats

2000 ◽  
Vol 88 (6) ◽  
pp. 2116-2122 ◽  
Author(s):  
Maria Niklasson ◽  
Peter Daneryd ◽  
Peter Lönnroth ◽  
Agneta Holmäng
Keyword(s):  
Insulin Resistance ◽  
Physical Exercise ◽  
Insulin Action ◽  
Female Rats ◽  
Control Group ◽  
Free Access ◽  
Euglycemic Hyperinsulinemic Clamp ◽  
Severe Insulin Resistance ◽  
Ovx Rats ◽  
Running Wheels

Administration of testosterone (T) to oophorectomized (Ovx) female rats is followed by severe insulin resistance, localized to postreceptor cellular events in the muscle. In this study, intervention by exercise was introduced to examine whether circulatory adaptations are involved in insulin resistance. Two groups of Ovx rats were studied: one group was given T (Ovx+T); another group had free access to running wheels (Ovx+T+Ex). In addition, one control group (sham operated) was studied. Insulin sensitivity was measured with the euglycemic hyperinsulinemic clamp technique (submaximal) for 150 min. Muscle interstitial glucose and insulin concentrations were measured by microdialysis. The measurements showed that, in Ovx+T rats, the onset of insulin action was significantly ( P < 0.05) slower during the first 95 min of the clamp compared with that in Ovx+T+Ex and controls. Muscle interstitial concentrations of insulin but not glucose were lower in both Ovx+T and Ovx+T+Ex rats than in controls throughout the clamp. It was concluded that physical exercise prevented the slow onset of insulin action in Ovx+T rats without changing the distribution time of muscle interstitial insulin. The results indicate that hyperandrogenicity is characterized by delayed muscle insulin action. Physical exercise reverses these defects without any beneficial effect on muscle interstitial insulin concentrations.

Parenteral nutrition in the ICU

2016 ◽  
Author(s):  
Jonathan Cohen ◽  
Shaul Lev
Keyword(s):  
Animal Models ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Support ◽  
Glutamine Supplementation ◽  
Artificial Nutrition ◽  
Omega 3 ◽  
Aspen Guidelines

Parenteral nutrition (PN) is a technique of artificial nutrition support, which consists of the intravenous administration of macronutrients, micronutrients, and water. PN has become integrated into intensive care unit (ICU) patient management with the aim of preventing energy deficits and preserving lean body mass. The addition of PN to enteral nutrition is known as supplemental PN. Parenteral feeding should be considered whenever enteral nutritional support is contraindicated, or when enteral nutrition alone is unable to meet energy and nutrient requirements. International guidelines differ considerably regarding the indications for PN. Thus, the ESPEN guidelines recommend initiating PN in critically-ill patients who do not meet caloric goals within 2–3 days of commencing EN, while the Canadian guidelines recommend PN only after extensive attempts to feed with EN have failed. The ASPEN guidelines advocate administering PN after 8 days of attempting EN unsuccessfully. Several studies have demonstrated that parenteral glutamine supplementation may improve outcome, and the ESPEN guidelines give a grade A recommendation to the use of glutamine in critically-ill patients who receive PN. Studies on IV omega-3 fatty acids have yielded promising results in animal models of acute respiratory distress syndrome and proved superior to solutions with omega -6 compositions. The discrepancy between animal models and clinical practice could be related to different time frames.

scholarly journals Cytokines associated with insulin resistance in critically ill patients

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P120
Author(s):  
S Omar ◽  
U Wilgen ◽  
N Crowther
Keyword(s):  
Insulin Resistance ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals 449: CHANGES IN SERUM ADIPOKINES ARE ASSOCIATED WITH INSULIN RESISTANCE IN CRITICALLY ILL PATIENTS

2021 ◽  
Vol 50 (1) ◽  
pp. 214-214
Author(s):  
Marco Castillo-Rodriguez ◽  
Miguel Perez-Viloria ◽  
Jose Maria Nicolas
Keyword(s):  
Insulin Resistance ◽  
Critically Ill ◽  
Critically Ill Patients

Insulin resistance in critically ill patients with acute renal failure

2005 ◽  
Vol 289 (2) ◽  
pp. F259-F264 ◽  
Author(s):  
Seema Basi ◽  
Lara B. Pupim ◽  
Edith M. Simmons ◽  
M. Tugrul Sezer ◽  
Yu Shyr ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Glucose ◽  
Adverse Outcomes ◽  
Icu Patients ◽  
Metabolic Monitoring ◽  
Igfbp 3

Mortality in critically ill patients with acute renal failure (ARF) remains high. Hyperglycemia associated with insulin resistance has been associated with adverse outcomes in critically ill intensive care unit (ICU) patients but has not been examined specifically in patients with ARF. We used data from a subcohort ( n = 90) of the Program to Improve Care in Acute Renal Disease (PICARD), an observational study of 618 adult ICU patients with ARF in whom nephrology service consultation was obtained. We obtained simultaneous measurements of serum glucose, insulin, insulin-like growth factor (IGF)-I, and IGF-1 binding proteins (IGFBP) in 90 patients. Daily glucose determinations were obtained from a larger fraction of the PICARD cohort ( n = 509). Among the 90 patients with intensive metabolic monitoring, glucose concentrations in survivors were significantly lower than in nonsurvivors throughout the 5-wk period ( P = 0.008, adjusted P = 0.013). In the larger PICARD cohort ( n = 509), hyperglycemia was also significantly associated with in-hospital mortality. Mean insulin concentrations were significantly higher (431 ± 508 vs. 234 ± 189 pmol/l, P = 0.03), mean homeostasis model of insulin resistance levels were significantly higher (24.1 ± 30.0 vs. 11.7 ± 12.5, P = 0.04), and IGFBP-3 concentrations were significantly lower (1,190 ± 498 vs. 1,470 ± 581 μg/l, P = 0.02) among nonsurvivors compared with survivors. Insulin resistance as defined by hyperglycemia in the setting of higher insulin concentrations may be associated with mortality in critically ill patients with ARF. The IGF-IGFBP axis may play an important role in this process.

Effect of Magnesium Loading Dose on Insulin Resistance in Patients With Stress-Induced Hyperglycemia: A Randomized Clinical Trial

2018 ◽  
Vol 35 (7) ◽  
pp. 687-693 ◽  
Author(s):  
Zinat Heidary ◽  
Hossein Khalili ◽  
Mostafa Mohammadi ◽  
Mohammad-Taghi Beigmohammadi ◽  
Alireza Abdollahi
Keyword(s):  
Insulin Resistance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Model Assessment ◽  
Loading Dose ◽  
Homeostasis Model Assessment ◽  
Magnesium Supplementation ◽  
Intracellular Magnesium ◽  
The Mean ◽  
To Receive

Objectives: There is currently no evidence that whether magnesium supplementation would improve stress-induced hyperglycemia (SIH) in critically ill patients. In this study, effects of magnesium loading dose on insulin resistance (IR) indices were evaluated in critically ill patients without diabetes having SIH. Methods: Seventy critically ill patients with SIH were assigned to receive a loading dose of magnesium (7.5 g of magnesium sulfate in 500 mL normal saline as intravenous infusion over an 8-hour period) or placebo. Changes in baseline of serum and intracellular magnesium and serum adiponectin (AD) levels, homeostasis model assessment of IR (HOMA-IR), and HOMA-AD ratio were assessed in this study. Results: Serum and intracellular magnesium levels increased significantly in patients in the magnesium group ( P < .001). At day 3, there were significant differences between the magnesium group and the placebo group in the mean changes from baseline in the HOMA (between-group difference: −0.11; 95% confidence interval [CI]: −0.19 to −0.01; P = .02), the AD (between-group difference: 0.94; 95% CI: 0.41-1.48; P = .04), and the HOMA-AD ratio (between-group difference: −0.03; 95% CI: −0.04 to −0.01; P < .001). Conclusion: In the present study, a single-loading dose of intravenous magnesium improved IR indices in critically ill patients with SIH.

scholarly journals Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2113
Author(s):  
Quirin Notz ◽  
Johannes Herrmann ◽  
Tobias Schlesinger ◽  
Philipp Helmer ◽  
Stephan Sudowe ◽  
...  
Keyword(s):  
Critically Ill ◽  
Clinical Significance ◽  
Critically Ill Patients ◽  
Severe Disease ◽  
Organ Damage ◽  
Data Management System ◽  
Artificial Nutrition ◽  
Inflammatory Parameters ◽  
Icu Discharge ◽  
And Oxidative Stress

The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (rs = −0.495), PCT (rs = −0.413), IL-6 (rs = −0.429), IL-1β (rs = −0.440) and IL-10 (rs = −0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = 0.772), total IgG (rs = 0.493) and PaO2/FiO2 ratios (rs = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.

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