Metabolic Control in Diabetic Subjects following Myocardial Infarction: Difficulties in Improving Blood Glucose Levels by Intravenous Insulin Infusion

1991 ◽  
Vol 36 (3) ◽  
pp. 74-76 ◽  
Author(s):  
R.R. Davies ◽  
R.W. Newton ◽  
G.P. McNeill ◽  
B.M. Fisher ◽  
C.M. Kesson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Metabolic Control ◽  
Insulin Infusion ◽  
Glucose Levels ◽  
Intravenous Insulin ◽  
Blood Glucose Levels

scholarly journals Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients—a feasibility study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029997
Author(s):  
Mais Hasan Iflaifel ◽  
Rosemary Lim ◽  
Kath Ryan ◽  
Clare Crowley ◽  
Rick Iedema
Keyword(s):  
Blood Glucose ◽  
Phase I ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
University Hospitals ◽  
Glucose Levels ◽  
Oxford University ◽  
Intravenous Insulin ◽  
Blood Glucose Levels

BackgroundIntravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Healthcare proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed.Methods and analysisThe study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases. Phase I: explore how work is imagined by analysing intravenous insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients’ electronic records. Qualitative data will include video reflexive ethnography: video recording healthcare practitioners using intravenous insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from phase I and phase II to develop a model for using intravenous insulin infusions.Ethics and disseminationEthical approvals have been granted by the South Central—Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.

Clinical Usefulness of a Bolus Calculator in Maintaining Normoglycaemia in Active Professional Patients with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Infusion

2008 ◽  
Vol 36 (5) ◽  
pp. 1112-1116 ◽  
Author(s):  
T Klupa ◽  
T Benbenek-Klupa ◽  
M Malecki ◽  
M Szalecki ◽  
J Sieradzki
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Metabolic Control ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Target Range ◽  
Subcutaneous Insulin ◽  
Glucose Levels ◽  
Blood Glucose Levels

This observational study assessed metabolic control in young, active professionals with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) with or without the use of a bolus calculator. Eighteen patients aged 19 − 51 years with diabetes duration of 6 − 22 years were included; eight patients used a bolus calculator and 10 did not. Metabolic control was assessed by glycosylated haemoglobin (HbA1c) measurements and blood glucose profiles. A continuous glucose monitoring system (CGMS) was also used by three patients from each group. Mean HbA1c and fasting blood glucose levels were not significantly different between the two groups, but mean post-prandial blood glucose was significantly lower in bolus calculator users than non-users. The CGMS showed more blood glucose levels within the target range in bolus calculator users than non-users, but statistical significance was not achieved. In conclusion, a bolus calculator may help to improve post-prandial blood glucose levels in active professional type 1 diabetes patients treated with CSII, but does not have a major impact on HbA1c levels.

Narcolepsy and Hypoglycaemia

1959 ◽  
Vol 105 (438) ◽  
pp. 163-170 ◽  
Author(s):  
Colin M. Smith ◽  
R. A. Schneider
Keyword(s):  
Blood Glucose ◽  
Clinical Symptoms ◽  
Sleep Patterns ◽  
Glucose Levels ◽  
Intravenous Insulin ◽  
Blood Glucose Levels ◽  
Eeg Changes ◽  
Clinical Description ◽  
Eeg Pattern ◽  
Light Sleep

For some years now it has been recognized that the symptoms induced by hypoglycaemia may resemble narcolepsy. Cases of islet-celled pancreatic adenomas simulating narcolepsy have been described by Harris (7), Delay (4) and Wyke (18). The resemblance may be a superficial one, however, and Wyke observed in his case during a “sleepy attack” that “the EEG pattern bore no resemblance to that of natural or artificial sleep”. In a more recent paper Ziegler and Presthus (19) described thirteen patients who showed normal EEGs at blood glucose levels (induced by fasting and intravenous insulin) of from under 15 mg. per cent. to 54 mg. per cent. In eight of these patients there were no clinical symptoms; in the remaining five patients the symptoms were described as follows: “feel like a ton of lead”, “warm and sleepy”, “tired”, “drowsy and sweaty” and “dizzy and tired”. It seems, in fact, that the clinical description of drowsiness in hypoglycaemia may correspond either to no EEG changes or to various degrees of slowing rather than to the typical recurrent light sleep patterns characteristic of narcolepsy. It will be recalled that hypnosis too is ushered in by a sense of drowsiness but that the EEG changes are not those of sleep (1, 2, 5). Many hysterical trance states—often loosely, and unfortunately, described as narcolepsy—come into this category. In short, it is apparent that all that sleeps is not narcolepsy (6, 12, 13, 14).

Abstract 13039: Loss of Visceral Adipose Tissue Macrophage Subsets Induces Myocardial Infarction Induced Insulin Resistance: Role of Adiponectin

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sathish Babu B Vasamsetti ◽  
xinyi zhang ◽  
Emillie M Coppin ◽  
Jonathan Florentin ◽  
Sasha Koul ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Insulin Resistance ◽  
Adipose Tissue ◽  
Blood Glucose ◽  
Visceral Adipose Tissue ◽  
Fasting Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Systemic Insulin Resistance ◽  
Visceral Adipose

Introduction: Myocardial infarction (MI) is the major cause of morbidity and mortality in the western world. Insulin resistance is a major complication in patients with MI. Hypothesis: Loss of visceral adipose tissue (VAT) resident macrophages in MI results in diminished adiponectin production causing systemic insulin resistance. Methods: To understand if MI results in insulin resistance, we analyzed UPMC patient records and identified patients who had normal fasting blood glucose levels on average 15 days before ST elevation myocardial infarction (STEMI) and checked their fasting blood glucose levels 30 days after STEMI. To understand the mechanisms of MI-induced insulin resistance, we used a mouse model of coronary ligation in C57BL/6 mice and analyzed the features of insulin resistance by measuring serum insulin, serum adiponectin, AKT activation status in the liver and muscle. Results: We found that 50% of non-diabetic patients (fasting blood glucose levels 99±2.5 mg/ dl) developed hyperglycemia (141±13 mg/dl) after MI, suggesting that MI causes insulin resistance. Consistently, mice with MI had higher fasting blood insulin, and reduced p-Akt levels in the liver and skeletal muscles confirming insulin resistance. Concomitantly, mice and patients with MI had reduced number of visceral adipose tissue (VAT) resident macrophages. In line with this, MI resulted in marked reduction in the level of macrophage colony stimulating factor (M-CSF), a cytokine required for tissue resident macrophage survival. M-CSF supplementation in mice with MI improved insulin sensitivity and decreased inflammatory phenotype of VAT macrophages. Furthermore, the systemic level of adiponectin, which is reported to augment insulin sensitivity, was profoundly reduced in mice after MI. Specific depletion of VAT resident macrophages resulted in lower levels of adiponectin in the serum, indicating that this macrophage subset is necessary for adiponectin production by adipocytes. Conclusions: Our data demonstrate that diminished M-CSF levels after MI triggers apoptosis of VAT resident macrophages, resulting in reduced adiponectin secretion and systemic insulin resistance.

Conventional approach to glucose management for diabetic patients undergoing coronary artery bypass surgery

Perfusion ◽  
2002 ◽  
Vol 17 (2) ◽  
pp. 141-144 ◽  
Author(s):  
Patricia A Gustafson ◽  
Debra L Zarro ◽  
David A Palanzo ◽  
Norman J Manley ◽  
Ralph M Montesano ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Insulin Infusion ◽  
Diabetic Patients ◽  
Type I ◽  
Cardioplegic Solution ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Continuous insulin infusion was not an effective mode of treatment in maintaining safe blood glucose levels (<200 mg/dl) during the intraoperative period of diabetic patients requiring open-heart surgery. The two modifications investigated to gain better control of the blood glucose were a change in the base solution of the cardioplegia and the use of a sliding insulin scale. Fifty patients including Type I and Type II diabetics were selected for the purpose of this study. The patients were then randomly divided into two groups categorized by the type of cardioplegic solution administered and the mode of insulin treatment. Group I patients received a dextrose 5%-based cardioplegic solution and blood glucose was treated via continuous intravenous insulin infusion. Group II patients received normal saline 0.9%-based cardioplegic solution and blood glucose was treated via sliding scale. Blood glucose levels were monitored pre- and postcardio- pulmonary bypass (CPB) and every 30 min while on CPB. Glucose values were analyzed by group t test. A p value of < 0.05 was considered statistically significant. When comparing Group I (mean=258 mg/dl) with Group II (mean= 158 mg/dl), there was a statistically significant difference between the glucose values at each of the time intervals when the glucose values were recorded. In conclusion, Group II maintained an acceptable blood glucose level (<200 mg/dl) throughout the entire intra- operative period, which suggests that the combination of the sliding insulin scale and modification of the base cardioplegic solution was an effective mode of treatment.

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