Comparison of Effects of The Hypoglycemia Management Protocol with 40% Dextrose Concentrated Solution to the Post-Correction Blood Sugar Response through Intravenous Infusion and Intravenous Bolus

Hypoglycemic patients who receive 40% dextrose (D40%) concentrated solution in the correction process need to avoid excessive blood glucose spikes. Administration of D40% was found in two different ways, through intravenous infusion (iv infusion) and intravenous bolus (iv bolus) and the effects of both types of administration were unknown. The purpose of this study was to compare the effect of a hypoglycemia treatment protocol using D40% concentrated solution to the post-correction blood sugar response through iv infusion and iv bolus at two different hospitals with two distinct protocols. This comparative analytical cross-sectional study was conducted retrospectively at St. Carolus Hospital (D40% iv infusion group) and Bella Hospital (D40% iv bolus group). Blood glucose responses, in form of coefficient of variation and degree of overcorrection, were compared between groups. The overall median blood glucose response was 69.5 (3–195) mg/dL for iv infusion group (n=60) and 77 (15–249) mg/dL for iv bolus group (n=62) (p=0.259). The coefficient of variation with iv infusion and iv bolus group were 47.18% and 52.75%, respectively. The median of degree of overcorrection in iv infusion group was lower compared with iv bolus group, 10% (0–138%) versus 23% (0–195%), respectively. Both D40% protocols did not have a significant correlation with the degree of overcorrection (Mann-Whitney test; p=0.099). D40% iv infusion and bolus administration had no effect to the post-correction blood sugar response.Keywords: Blood glucose, dextrose 40%, hypoglycemia, intravenous bolus, intravenous infusion Perbandingan Efek Protokol Manajemen Hipoglikemia dengan Larutan Pekat Dekstrosa 40% secara Intravena Infus dan Intravena Bolus terhadap Respon Gula Darah PascakoreksiAbstrakPasien hipoglikemia yang menerima larutan pekat dekstrosa 40% (D40%) dalam proses koreksinya perlu menghindari lonjakan gula darah yang berlebih. Cara pemberian D40% diberikan dengan dua cara yang berbeda yaitu melalui intravena infus (iv infus) dan intravena bolus (iv bolus), dan efek dari kedua jenis pemberian tersebut belum diketahui. Tujuan dari penelitian ini adalah membandingkan efek protokol manajemen hipoglikemia dengan larutan pekat D40% secara iv infus dan iv bolus terhadap respon gula darah pascakoreksi di dua rumah sakit dengan protokol yang berbeda. Penelitian analitik komparatif secara potong lintang ini dilakukan secara retrospektif di RS St. Carolus (kelompok iv infus D40%) dan RS Bella (kelompok iv bolus D40%). Respon gula darah, dalam bentuk koefisien variasi dan derajat overkoreksi, dibandingkan antara kedua kelompok. Median kenaikan gula darah pada kelompok iv infus D40% 69,5 (3–195) mg/dL (n=60 pasien) dan kelompok iv bolus D40% 77 (15–249) mg/dL (n=62 pasien) (p=0,259). Koefisien variasi dengan iv infus adalah 47,18% dan iv bolus 52,75%. Median derajat overkoreksi iv infus D40% lebih rendah dibandingkan iv bolus D40%, dengan masing-masing 10% (0–138%) dan 23% (0–195%). Kedua cara pemberian D40% tidak memiliki hubungan yang bermakna dengan derajat overkoreksi (uji Mann-Whitney; p=0,099). Pemberian iv infus dan bolus D40% tidak memiliki pengaruh terhadap respon gula darah pascakoreksi.Kata kunci: Dekstrosa 40%, gula darah, hipoglikemia, intravena bolus, intravena infus

CARBOHYDRATE METABOLISM IN PREGNANCY

ABSTRACT The effects of pregnancy and dietary status upon the blood sugar response to exogenous insulin in the rat were evaluated. Unanaesthetized 19-day pregnant, postpartum, and age-matched virgin rats were challenged with intravenous insulin (10 U/kg) after unrestricted access to food or fasting for 48 hours. Appropriate control studies were instituted to correct for the effects of 'handling' upon blood sugar. Fed as well as fasted pregnant rats displayed diminished absolute hypoglycaemic responses to insulin and attenuated rates of blood sugar fall. The relative resistance of pregnant rats to the blood sugar lowering actions of insulin was documented during group comparisons with virgin rats as well as upon reexamination of the same animals postpartum.

BLOOD GLUCOSE LEVEL IN MICE.

ABSTRACT Multiple serial blood glucose level determinations in individual mice were performed on small blood samples (10–25 μl) using the orbital bleeding technique. Glucose was determined specifically by a known enzymatic reaction. Blood glucose determined in this way was found a parameter of high reproducibility and precision, the latter being shown by the finding that differences between individual animals were highly significant in practically all the experiments. The standard deviation of the single measurement in normal mice was ± 8.2 mg/100 ml as determined from 600 samples, which indicated that the technique allows of the detection of blood sugar level changes of about 15 mg/100 ml or more with very high significance, in a group of 5 mice. In the sampling procedure as such, intravenous or subcutaneous saline injections did not necessarily have any effect on the blood glucose level, but interpretation of slight blood sugar changes under experimental conditions should always be based on a comparison with control groups, since the latter may sometimes show a slight but significant change. In normal non-fasting mice (NMRI strain) significant differences in homoeostatic blood glucose level adjustments were demonstrated. In acutely adrenalectomized mice blood glucose levels were lower and more variable than in normals. Alloxan injection (70 mg/kg) was followed in individual mice by a triphasic blood sugar response, as is known from other species.