Faculty Opinions recommendation of Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery.

The effects of Vernonia amygdalina and metformin in lowering glucose in streptozotocin-induced diabetic rats were evaluated. A total of 120 Wistar albino males and females rats weighing approximately 200 g were used for the study. Diabetes was induced in the rats using 50 mg/kg of streptozotocin, and it was confirmed by checking the glucose levels of the rats. Rats with glucose level greater than 10 mmol/L were considered diabetic. The extract, metformin and a combination of the extract and metformin were given orally to different groups of diabetic rats daily for 10 weeks. Four rats were sacrificed every 2 weeks, and blood samples were collected from all the groups to estimate glucose, total protein and liver enzymes. The data obtained were compared using analysis of variance (ANOVA) and the differences between groups were established using Dunnets. The extract and metformin produced significant (P<0.05) decrease in plasma glucose concentrations in the diabetic rats. There was also a reduction in the plasma glucose of the rats that received a combination of the extract and metformin. The decrease in the blood glucose concentrations of the diabetic rats following the administration of the extract suggests that it possesses hypoglycemic effects on streptozotocin-induced diabetic rats. The presence of flavonoids, saponins and other phytochemicals in the extract must have acted to potentiate the hypoglycemic role of the extract.

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Amino Acids as Substrates in Children with Growth Hormone Deficiency and Hypoglycemia

PEDIATRICS ◽

10.1542/peds.68.2.260 ◽

1981 ◽

Vol 68 (2) ◽

pp. 260-264

Author(s):

Stephen LaFranchi ◽

Neil R. M. Buist ◽

Banoo Jhaveri ◽

Harvey Klevit

Keyword(s):

Growth Hormone ◽

Blood Glucose ◽

Fasting Blood Glucose ◽

Human Growth ◽

Hormone Deficiency ◽

Total Serum ◽

Control Subjects ◽

Fasting Hypoglycemia ◽

Blood Glucose Concentrations

In order to investigate the role of amino acid (AA) substrates in the hypoglycemia associated with human growth hormone (hGH) deficiency, we measured 12-hour fasting blood glucose and total quantitative AA concentrations in 11 children with hGH deficiency during three study periods: (1) before hGH replacement; (2) after 12 months of hGH treatment; and (3) after discontinuation of hGH for three months. The results were compared to studies in 16 control subjects. Fasting blood glucose concentrations were significantly (P < .05) lower in the hGH-deficient children prior to hGH treatment as compared to the control subjects (67.0 ± 5.3 vs 80.7 ± 5.3 mg/100 ml, X ± SE). Fasting total serum AA concentrations were similar in the patients and in the control subjects; however, after 12 months of hGH replacement, there was a significant (P < .01) elevation of serum AA (2,750 ± 170 vs 2,283 µmoles/liter). Fasting serum concentrations of alanine, glycine, arginine, and tryptophan were also significantly elevated (P < .01) with hGH treatment; ornithine, tyrosine, lysine, methionine, and phenylalanine showed lesser elevations (P < .05), whereas threonine decreased significantly (P < .01). The fasting hypoglycemia seen with isolated hGH deficiency is not an AA substrate-limited disorder. The finding of increased concentrations of AA with hGH replacement suggests increased retention of nitrogen and synthesis of AA or a decreased requirement of AA for gluconeogenesis due to availability of other substrates.

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Insulin administration abrogates perturbation of methyl group and homocysteine metabolism in streptozotocin-treated type 1 diabetic rats

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00105.2011 ◽

2011 ◽

Vol 301 (3) ◽

pp. E560-E565 ◽

Cited By ~ 11

Author(s):

Kristin M. Nieman ◽

Kevin L. Schalinske

Keyword(s):

Blood Glucose ◽

Regulatory Protein ◽

Diabetic Rats ◽

Plasma Homocysteine ◽

Future Research ◽

Sprague Dawley ◽

Methyl Group ◽

Sprague Dawley Rats ◽

Blood Glucose Concentrations

Modifications in methyl group and homocysteine metabolism are associated with a number of pathologies, including vascular disease, cancer, and neural tube defects. A diabetic state is known to alter both methyl group and homocysteine metabolism, and glycine N-methyltransferase (GNMT) is a major regulatory protein that controls the supply and utilization of methyl groups. We have shown previously that diabetes induces GNMT expression and reduces plasma homocysteine pools by stimulating both its catabolism and folate-independent remethylation. This study was conducted to determine whether insulin plays a role in the control of homocysteine concentrations and GNMT as well as other key regulatory proteins. Male Sprague-Dawley rats were randomly assigned to one of three groups: control, streptozotocin (STZ)-induced diabetic (60 mg/kg body wt), and insulin-treated diabetic (1.0 U bid). After 5 days, rats were anesthetized (ketamine-xylazine) for procurement of blood and tissues. A 1.5-fold elevation in hepatic GNMT activity and hypohomocysteinemia in diabetic rats was completely prevented by insulin treatment. Additionally, diabetes-mediated alterations in methionine synthase, phosphatidylethanolamine N-methyltransferase, and DNA methylation were also prevented by insulin. We hypothesize that the concentration of blood glucose may represent a regulatory signal to modify GNMT and homocysteine. In support of this, blood glucose concentrations were negatively correlated with total plasma homocysteine ( r = −0.75, P < 0.001) and positively correlated with GNMT activity ( r = 0.77, P < 0.001). Future research will focus on further elucidating the role of glucose or insulin as a signal for regulating homocysteine and methyl group metabolism.

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Blood glucose concentrations after cardiac surgery: the impact of preoperative quality of life

International Journal of Diabetes in Developing Countries ◽

10.1007/s13410-012-0075-1 ◽

2012 ◽

Vol 32 (2) ◽

pp. 93-97 ◽

Cited By ~ 1

Author(s):

Mahdi Najafi ◽

Mehrdad Sheikhvatan ◽

Ali Montazeri

Keyword(s):

Quality Of Life ◽

Cardiac Surgery ◽

Blood Glucose ◽

Blood Glucose Concentrations ◽

The Impact

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Poor Intraoperative Blood Glucose Control Is Associated with a Worsened Hospital Outcome after Cardiac Surgery in Diabetic Patients

Anesthesiology ◽

10.1097/00000542-200510000-00006 ◽

2005 ◽

Vol 103 (4) ◽

pp. 687-694 ◽

Cited By ~ 251

Author(s):

Alexandre Ouattara ◽

Patrick Lecomte ◽

Yannick Le Manach ◽

Marc Landi ◽

Sophie Jacqueminet ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Glucose ◽

Glycemic Control ◽

Insulin Therapy ◽

Postoperative Morbidity ◽

Heart Surgery ◽

Blood Glucose Control ◽

Diabetic Patients ◽

Hospital Outcome ◽

Blood Glucose Concentrations

Background Tight perioperative control of blood glucose improves the outcome of diabetic patients undergoing cardiac surgery. Because stress response and cardiopulmonary bypass can induce profound hyperglycemia, intraoperative glycemic control may become difficult. The authors undertook a prospective cohort study to determine whether poor intraoperative glycemic control is associated with increased intrahospital morbidity. Methods Two hundred consecutive diabetic patients undergoing on-pump heart surgery were enrolled. A standard insulin protocol based on subcutaneous intermediary insulin was given the morning of the surgery. Intravenous insulin therapy was initiated intraoperatively from blood glucose concentrations of 180 mg/dl or greater and titrated according to a predefined protocol. Poor intraoperative glycemic control was defined as four consecutive blood glucose concentrations greater than 200 mg/dl without any decrease in despite insulin therapy. Postoperative blood glucose concentrations were maintained below 140 mg/dl by using aggressive insulin therapy. The main endpoints were severe cardiovascular, respiratory, infectious, neurologic, and renal in-hospital morbidity. Results Insulin therapy was required intraoperatively in 36% of patients, and poor intraoperative glycemic control was observed in 18% of patients. Poor intraoperative glycemic control was significantly more frequent in patients with severe postoperative morbidity (37% vs. 10%; P < 0.001). The adjusted odds ratio for severe postoperative morbidity among patients with a poor intraoperative glycemic control as compared with patients without was 7.2 (95% confidence interval, 2.7-19.0). Conclusion Poor intraoperative control of blood glucose concentrations in diabetic patients undergoing cardiac surgery is associated with a worsened hospital outcome after surgery.

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