Further Observations on the Blood Glucose Level in Channa punctatus (Bloch.)

There is a significant rise in the blood glucose level of Channa punctatus following surgical extirpation of the principal islets. The hyperglycemia persists for nearly 30 days in the isletectomized fish. A transient hyperglycemia is exhibited by the sham operated control fish also. If the isletectomized fish are force-fed, a further increase in the blood glucose level is obtained. The force feeding of normal, unoperated fish results in an alimentary hyperglycemia at about 10–24 hours post-prandial.     

Flight is the key to postprandial blood glucose balance in the fruit bats Eonycteris spelaea and Cynopterus sphinx

Excessive sugar consumption could lead to high blood glucose levels that are harmful to mammalian health and life. Despite consuming large amounts of sugar‐rich food, fruit bats have a longer lifespan, raising the question of how these bats overcome potential hyperglycemia. We investigated the change of blood glucose level in nectar‐feeding bats (Eonycteris spelaea) and fruit‐eating bats (Cynopterus sphinx) via adjusting their sugar intake and time of flight. We found that the maximum blood glucose level of C. sphinx was higher than 24 mmol/L that is considered to be pathological in other mammals. After C. sphinx bats spent approximately 75% of their time to fly, their blood glucose levels dropped markedly, and the blood glucose of E. spelaea fell to the fast levels after they spent 70% time of fly. Thus, the level of blood glucose elevated with the quantity of sugar intake but declined with the time of flight. Our results indicate that high‐intensive flight is a key regulator for blood glucose homeostasis during foraging. High‐intensive flight may confer benefits to the fruit bats in foraging success and behavioral interactions and increases the efficiency of pollen and seed disposal mediated by bats.     

The secretory dynamics of the CHH-producing cell group in the eyestalk of the crayfish,Astacus leptodactylus,in the course of the day/night cycle

Summary The secretory dynamics of the Crustacean Hyperglycemic Hormone (CHH)-producing cells in the eyestalk of the crayfish Astacus leptodactylus were studied during the daily cycle (12 h light/12 h dark). The different secretory stages of individual cells were determined by means of immunocytochemistry combined with morphometric analysis at the light-microscopic level. The data obtained were correlated with the 24-h rhythmicity of blood glucose concentration. The results suggest the following hypothesis. The synthetic activity of the CHH cells receives a stimulus 2 h before the beginning of the dark period, resulting in a pronounced transfer of CHH granules into the axons. These CHH granules reach the axon terminals after the onset of the dark period. At that time a burst of exocytotic activity occurs, causing a strong release of CHH into the hemolymph. Four hours later this CHH release results in hyperglycemia. The same process, though with less intensity, is repeated and causes a second smaller glucose peak at the beginning of the light period.     

Comparison of vildagliptin twice daily vs. sitagliptin once daily using continuous glucose monitoring (CGM): Crossover pilot study (J-VICTORIA study)

ABSTRACT: BACKGROUND: No previous studies have compared the DPP-4 inhibitors vildagliptin and sitagliptin in terms of blood glucose levels using continuous glucose monitoring (CGM) and cardiovascular parameters. METHODS: Twenty patients with type 2 diabetes mellitus were randomly allocated to groups who received vildagliptin then sitagliptin, or vice versa. Patients were hospitalized at 1 month after starting each drug, and CGM was used to determine: 1) mean (+/- standard deviation) 24-hour blood glucose level, 2) mean amplitude of glycemic excursions (MAGE), 3) fasting blood glucose level, 4) highest postprandial blood glucose level and time, 5) increase in blood glucose level after each meal, 6) area under the curve (AUC) for blood glucose level [greater than or equal to]180 mg/dL within 3 hours after each meal, and 7) area over the curve (AOC) for daily blood glucose level <70 mg/dL. Plasma glycosylated hemoglobin (HbA1c), glycoalbumin (GA), 1,5-anhydroglucitol (1,5AG), immunoreactive insulin (IRI), C-peptide immunoreactivity (CPR), brain natriuretic peptide (BNP), and plasminogen activator inhibitor-1 (PAI-1) levels, and urinary CPR levels, were measured. RESULTS: The mean 24-hour blood glucose level was significantly lower in patients taking vildagliptin than sitagliptin (142.1 +/- 35.5 vs. 153.2 +/- 37.0 mg/dL; p = 0.012). In patients taking vildagliptin, MAGE was significantly lower (110.5 +/- 33.5 vs. 129.4 +/- 45.1 mg/dL; p = 0.040), the highest blood glucose level after supper was significantly lower (206.1 +/- 40.2 vs. 223.2 +/- 43.5 mg/dL; p = 0.015), the AUC ([greater than or equal to]180 mg/dL) within 3 hours was significantly lower after breakfast (484.3 vs. 897.9 mg/min/dL; p = 0.025), and urinary CPR level was significantly higher (97.0 +/- 41.6 vs. 85.2 +/- 39.9 mug/day; p = 0.008) than in patients taking sitagliptin. There were no significant differences in plasma HbA1c, GA, 1,5AG, IRI, CPR, BNP, or PAI-1 levels between patients taking vildagliptin and sitagliptin. CONCLUSIONS: CGM showed that mean 24-hour blood glucose, MAGE, highest blood glucose level after supper, and hyperglycemia after breakfast were significantly lower in patients with type 2 diabetes mellitus taking vildagliptin than those taking sitagliptin. There were no significant differences in BNP and PAI-1 levels between patients taking vildagliptin and sitagliptin. Trial registration UMIN000007687 KEYWORDS: Vildagliptin; Sitagliptin; Continuous glucose monitoring (CGM); Brain natriuretic peptide (BNP); plasminogen activator inhibitor-1 (PAI-1).     

冠状动脉旁路移植术后血糖变化临床分析

目的：分析冠状动脉旁路移植术（CABG）后患者高血糖的发生率及血糖的变化规律。方法：回顾性分析我院2005年1月～2009年12月行CABG的冠心病患者138例的糖尿病史、术前术后血糖水平、后高血糖和血糖峰值的出现时间等资料。按术前有无糖尿病分为糖尿病组和非糖尿病组,比较析两组的差异。结果：138例患者中有101例发生术后高血糖,发生率为73.2%,非糖尿病组发生率为69.7%;糖尿病组发生率为77.4%,2组术后高血糖发生率未见统计学差异（x2=1.027,P=0.3109）。术前血糖水平与术后高血糖发生率呈正相关,99.0%的患者出现在入住重症强医疗病房（ICU）24h以内,术后血糖峰值的出现时间入住ICU16h,且非糖尿病组出现时间较糖尿病组早。结论：CABG后高血糖的发生率较高,且绝大多数出现在术后24 h以内,术后高血糖发生率与术前血糖水平呈正相关。     

应激性高血糖与急性自发性脑出血患者术后并发症和早期预后的相关性研究

目的:探讨应激性高血糖与自发性脑出血患者术后并发症及早期预后的关系。方法:回顾性分析我院收治的自发性脑出血患者358例,根据入院时血糖水平、糖化血红蛋白(HbAlc)及既往有无糖尿病史分为血糖正常组(96例)、应激性高血糖组(107例)及糖尿病组(155例),记录和比较各组入院时的血糖、格拉斯哥昏迷评分(GCS)、平均出血量及入院后30 d时各组的术后并发症发生情况、格拉斯哥预后评分(GOS)的差异。结果:糖尿病组入院时血糖水平、平均出血量、重型患者所占比率、脑出血破入脑室、颅内再出血、颅内感染、肺部感染、尿路感染及上消化道出血发生率、GOS分级植物状态或死亡发生率均明显高于应激性高血糖组(P0.05),GOS分级良好率低于应激性高血糖组(P0.05);而应激性高血糖组入院时血糖水平、平均出血量、重型患者所占比率、脑出血破入脑室、颅内再出血发生率、GOS分级植物状态或死亡发生率均明显高于血糖正常组(P0.05)。结论:自发性脑出血患者入院时应激性高血糖与患者的病情显著相关,可加重急性脑出血的不良预后。     

Taurine Alters Respiratory Gas Exchange and Nutrient Metabolism in Type 2 Diabetic Rats

Objective: To assess the effect of taurine supplementation on respiratory gas exchange, which might reflect the improved metabolism of glucose and/or lipid in the type 2 diabetic Otsuka Long‐Evans Tokushima Fatty (OLETF) rats. Research Methods and Procedures: Male OLETF rats (16 weeks of age) were randomly divided into two groups: unsupplemented group and taurine‐supplemented (3% in drinking water) group. After 9 weeks of treatment, indirect calorimetry and insulin tolerance tests were conducted. The amounts of visceral fat pads, tissue glycogen, the blood concentrations of glucose, triacylglycerol, taurine, and electrolytes, and the level of hematocrit were compared between groups. A nondiabetic rat strain (Long‐Evans Tokushima Otsuka) was used as the age‐matched normal control. Results: The indirect calorimetry showed that the treatment of OLETF rats with taurine could reduce a part of postprandial glucose oxidation possibly responsible for the increase of triacylglycerol synthesis in the body. Taurine supplementation also improved hyperglycemia and insulin resistance and increased muscle glycogen content in the OLETF rats. Supplementation with taurine increased the blood concentration of taurine and electrolyte and fluid volume, all of which were considered to be related to the improvement of metabolic disturbance in OLETF rats. Discussion: Taurine supplementation may be an effective treatment for glucose intolerance and fat/lipid accumulation observed in type 2 diabetes associated with obesity. These metabolic changes might be ascribed, in part, to the alteration of circulating blood profiles, where the improved hyperglycemia and/or the blood accumulation of taurine itself would play roles.     

Contribution of the Dawn Phenomenon to the Fasting and Postbreakfast Hyperglycemia In Type 1 Diabetes Treated With Once-Nightly Insulin Glargine

ObjectiveTo observe the effect of the dawn phenomenon on basal glucose and postbreakfast hyperglycemia in patients with type 1 diabetes treated with once-nightly insulin glargine and premeal insulin lispro.MethodsIn 49 study subjects consuming a fixed isocaloric (50% carbohydrate) diet of usual food, the insulin glargine dose was titrated from daily continuous glucose monitoring downloads to achieve a basal glucose goal of < 130 mg/dL 4 hours after meals and during serial meal omissions but with fewer than 10% of readings at < 70 mg/ dL during 24 hours. Patients also performed self-monitoring of plasma glucose 7 times a day (before and 2 hours after each meal or omitted meal and at bedtime).ResultsThe target mean basal glucose level was achieved only during the non-dawn phenomenon period (1400 hours to 0400 hours). During the dawn phenomenon, the mean (standard deviation) basal glucose level increased from 118 (57) mg/dL at 0400 hours to 156 (67) mg/dL before the breakfast meal, a 32% increase (P = .00149). The mean self-monitored plasma glucose level with meal omission was 63.8% of that increase with a breakfast meal.ConclusionThe fasting morning glucose concentration is considerably elevated because of the dawn phenomenon. Targeting insulin titration to this glucose level may result in excessive basal insulin dosing for the non-dawn phenomenon periods of the day. The dawn phenomenon is a large component of the postbreakfast hyperglycemia. Rather than increasing the morning premeal insulin bolus, consideration should be given to pretreating the earlier dawn phenomenon with an insulin pump with use of a variable basal insulin rate. (Endocr Pract. 2012;18:558-562)     

Toxic effect of high glucose on cardiomyocytes,H9c2 cells: Induction of oxidative stress and ameliorative effect of trolox

Oxidative stress (OS) has been implicated in a variety of pathological conditions, including diabetes mellitus, characterized by hyperglycemia. In the present study, OS induced by hyperglycemia and the effect of trolox, a vitamin E analog, were studied in cardiomyocytes and H9c2 cells exposed to 15 to 33 mM glucose (HG) for 24 to 72 hours in Dulbecco modified Eagle medium. Cells treated wirh 24 or 33 mM glucose for 24 hours or above showed decreased viability and adenosine triphosphate (ATP) content with a concomitant increase in radicals of oxygen species, calcium (Ca²⁺), mitochondrial permeability transition, and oxidative markers, confirming that the cells were under stress. However, upon exposure to 15 mM glucose for 24 hours, H9c2 cells maintained homeostasis and ATP generation. Pretreatment of cells with trolox reduced HG‐induced OS to control levels. Here, we report that the toxic effect of HG is highly regulated and that OS induction can be prevented with Trolox, a potential inhibitor of membrane damage.     

Induction of hyperglycemia in adult intrauterine growth-restricted rats: effects on renal function

Intrauterine growth restriction (IUGR) leads to a reduction in nephron endowment at birth and is linked to renal dysfunction in adulthood. The aim of the present study was to determine whether kidneys of IUGR rat offspring are more vulnerable to a secondary insult of hyperglycemia. IUGR was induced in Wistar-Kyoto rats by maternal protein restriction. At 24 wk of age, diabetes was induced in male IUGR and non-IUGR offspring by streptozotocin injection; insulin was injected daily to maintain blood glucose levels at either a mild (7-10 mmol/l; n=8/group) or a moderate (10-15 mmol/l; n=8/group) level. At 32 wk of age, renal function was assessed using ultrasound and [(3)H]inulin and [(14)C]para-aminohippurate clearance techniques. Conscious mean arterial blood pressure and heart rate were unchanged in IUGR offspring. Relative kidney length was increased significantly in IUGR offspring, and renal function was altered significantly; of importance, there was a significant increase in filtration fraction, indicative of glomerular hyperfiltration. Induction of hyperglycemia led to marked impairment of renal function. However, the response to hyperglycemia was not different between IUGR and non-IUGR offspring. Maintaining blood glucose levels at a mild hyperglycemic level led to marked improvement in all measures of renal function in IUGR and non-IUGR offspring. In conclusion, while the IUGR offspring showed evidence of hyperfiltration, the response to hyperglycemia was similar in IUGR and non-IUGR kidneys in adulthood. Importantly, maintaining blood glucose levels at a mild hyperglycemic level markedly attenuated the renal dysfunction associated with diabetes, even in IUGR offspring.     

Chromium Infusion In Hospitalized Patients with Severe Insulin Resistance: A Retrospective Analysis

ObjectiveTo investigate the effects of intravenous chromium on serum glucose and insulin infusion rates in hospitalized patients with severe insulin resistance.MethodsIn this retrospective study, we reviewed hospital records from January 1, 2008, to December 1, 2008, to identify patients for whom intravenous chromium was ordered at our academic medical center. To be included, patients were required to demonstrate profound insulin resistance and uncontrolled hyperglycemia (defined as the inability to achieve a blood glucose value less than 200 mg/ dL during the 12 hours before chromium was given despite administration of continuous insulin infusion at a rate of 20 or more units/h) and to have received a continuous infusion of chromium chloride at 20 mcg/h for 10 to 15 hours for a total dose of 200 to 240 mcg.ResultsFourteen patients met our inclusion criteria. Over the hour preceding intravenous chromium infusion, the mean ± standard deviation rate of insulin infusion was 31 ± 15 units/h, and blood glucose was 326 ± 86 mg/dL. Twelve hours after the initiation of chromium, these values were 16 ± 16 units/h and 162 ± 76 mg/dL, respectively (P = .011 for difference in mean insulin rate from baseline, P <.001 for difference in mean blood glucose from baseline) and 24 hours after, these values were 12 ± 15 units/h and 144 ± 48 mg/dL, respectively (P <.001 for both).ConclusionsIntravenous chromium decreases insulin needs and improves glucose control at 12 and 24 hours compared with baseline values. Chromium appears to improve hyperglycemia and insulin resistance in acutely ill patients and represents a potential new therapy. Future prospective randomized controlled trials are needed to confirm these results. (Endocr Pract. 2012;18:394-398)     

Stress Induced Hyperglycemia and the Subsequent Risk of Type 2 Diabetes in Survivors of Critical Illness

ObjectiveStress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness.DesignRetrospective cohort study.SettingAll adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011.PatientsStress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression.ConclusionsStress induced hyperglycemia identifies patients at subsequent risk of incident diabetes.     

外源性胰岛素对斑马鱼血糖及其转运的影响

斑马鱼（Danio rerio）在糖负荷状态下表现出持续高血糖现象。与对照组（仅腹腔注射灭菌去离子水）相比,葡萄糖组（仅腹腔注射葡萄糖）血浆胰岛素水平无显著差异,胰岛素基因表达显著上调,肝胰脏葡萄糖转运蛋白（glucose transporters,GLUTs）基因表达无显著差异,说明斑马鱼自身胰岛素分泌不足和葡萄糖转运迟缓是导致其在糖负荷状态下持续高血糖的原因。为了观察外源性胰岛素对斑马鱼血糖及其在体内转运的影响,设计低（1.25 IU/kg）、中（12.5 IU/kg）、高（125 IU/kg）3个浓度的胰岛素,分别与葡萄糖溶液（0.1 g/mL）共注射斑马鱼并观察其血糖变化。结果表明,低剂量胰岛素能有效促进斑马鱼血糖的降低,且能直观反映糖负荷后血糖的变化情况,为最适注射浓度。此外,研究显示斑马鱼血糖变化不受性别影响。在胰岛素最适注射浓度下,与葡萄糖组相比,胰岛素组（葡萄糖与胰岛素共注射）可以显著减少斑马鱼血糖恢复到正常水平的时间,进一步分析发现,斑马鱼血浆胰岛素水平增加,肝胰脏葡萄糖转运蛋白基因表达显著上调,但胰岛素基因表达却被显著抑制。综上所述,胰岛素分泌不足和葡萄糖转运迟缓是造成斑马鱼持续高血糖的原因;外源性胰岛素能够促进糖负荷状态下斑马鱼血糖的降低,但是具有反馈抑制斑马鱼肝胰脏胰岛素基因表达的作用。     

Changes in leukocyte count, blood glucose and coagulation system in calves injected with Escherichia coli endotoxin

Responses of leukocyte, blood glucose and coagulation system in calves were investigated to injection with Escherichia coli endotoxin. Severe leukopenia and hyperglycemia following transient hypoglycemia were noted within 24 hours after injection. In the coagulation system, a definite decrease in platelet count, prolongation of prothrombin time and activated partial thromboplastin time were observed. Fibrinogen, soluble fibrin monomer complex and clotting time, however, varied.     

Inpatient Management of Diabets Mellitus Among Noncritically Ill Patients at the University Hospital of Puerto Rico

ObjectiveTo describe the state of glycemic control in noncritically ill diabetic patients admitted to the Puerto Rico University Hospital and adherence to current standard of care guidelines for the treatment of diabetes.MethodsThis was a retrospective study of patients admitted to a general medicine ward with diabetes mellitus as a secondary diagnosis. Clinical data for the first 5 days and the last 24 hours of hospitalization were analyzed.ResultsA total of 147 noncritically ill diabetic patients were evaluated. The rates of hyperglycemia (blood glucose ≥ 180 mg/dL) and hypoglycemia (blood glucose < 70 mg/dL) were 56.7 and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hours of hospitalization (mean random blood glucose, 226.5 mg/dL), and 54.2% were hyperglycemic during the last 24 hours of hospitalization (mean random blood glucose, 196.51 mg/dL). The mean random last glucose value before discharge was 189.6 mg/dL. Most patients were treated with subcutaneous insulin, with basal insulin alone (60%) used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60% on day 5, with 40% continuing to receive only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%); however, a substantial proportion had no change (23.7%) or even a decrease (6.2%) in their insulin dose.ConclusionThe management of hospitalized diabetic patients is suboptimal, probably due to clinical inertia, manifested by absence of appropriate modification of insulin regimen and intensification of dose in uncontrolled diabetic patients. A comprehensive educational diabetes management program, along with standardized insulin orders, should be implemented to improve the care of these patients. (Endocr Pract. 2014;20:452-460)     

Effect of adrenaline on blood glucose and glycogen in catfish tissues

The effects of epinephrine injected intraperitoneally (5 mg/kg body weight) on the catfish carbohydrate metabolism were studied. Epinephrine caused a very high and persisting hyperglycemia, the highest value of which was 340 +/- 21 mg/100 ml of blood (control value: 75 +/- 6 mg/100 ml) at 24th hour after the administration. Moreover, epinephrine caused glycogenolysis in liver: from 127 +/- 10 to 95 +/- 8 mg/g of tissue. In white muscle the lowering of glycogen happened just after the epinephrine injection and reached the lowest value (1,6 +/- 0,3 mg/g) at 2,5 hours after the administration (control value: 2,9 +/- 0,4 mg/g). A glycogen decrease took place in red muscle with a great delay, but was still present 48 hours after administration (control value: 17,5 +/- 1,8 mg/g; sample value: 11,2 +/- 3,2 mg/g). The increase of glucose level in blood could be referred to glycogenolytic processes in liver. As far as musculature is concerned, red muscle probably plays a role in recovering the glycogen level in white muscle.     

Effect of streptozotocin on the blood glucose level and histology of the principal islets of Channa punctatus (Bloch).

The effect of streptozotocin, an antibiotic and diabetogenic drug, has been studied on the blood glucose level and islet histology of a freshwater fish, Channa punctatus. The drug elicits a triphasic response in the blood glucose level, comprising an initial hyperglycemia followed by a transient fall, and restitution of normal values 3...4 days after the treatment. Significant degenerative changes occur in the islet beta cells. Severity of the beta cell damage is dose dependent and the drug has been found to be beta-cytotoxic to a considerable extent. Unlike mammals, Channa punctatus does not become diabetic following the streptozotocin administration, at doses varying 200-400 mg/kg b.wqnd over a period of 96 hours post-injection.     

Scanning electron microscopic analysis of intramyocellular lipid droplets in an animal model of type 2 diabetes

Objective: To evaluate the accumulation pattern of intramyocellular lipids (IMCLs) in striated muscle during the development and progression of diabetes, using a novel scanning electron microscopic method. Methods and Procedures: Hyperglycemia was induced by feeding diabetes‐prone (DP) Psammomys obesus a high‐energy (HE) diet. Lipid accumulation within gastrocnemius muscle fibers was assessed in formalin‐fixed muscle samples during the development of hyperglycemia using high resolution imaging in a scanning electron microscope. We evaluated the temporal relationship between changes in IMCL quantity and morphology and the altered glucose metabolism and assessed the effect of reversal of hyperglycemia on IMCL level and morphology. Diabetes‐resistant (DR) P. obesus served as controls. Results: Lipid accumulation in the muscle fibers of DP animals was increased with the development of hyperglycemia. This was characterized by increased lipid density as well as by an abundance of large lipid droplets. Reversal of the phenotype resulted in the disappearance of large lipid droplets. The IMCL level and the distribution of lipid droplet size were similar in muscles of both the normoglycemic DR and DP animals, with an abundance of small lipid droplets. This profile was changed following a HE diet only in the DP animals. Discussion: Lipid accumulation in the muscle of P. obesus during the development of hyperglycemia is characterized by increased quantity and accumulation of large lipid droplets. These changes were reversible upon normalization of blood glucose. The evaluated methodology is a useful tool for the study of the dynamics of lipid accumulation in different metabolic conditions.     

Development and implementation of evidence-based guidelines for IV insulin: A statewide collaborative approach

Purpose: Recent studies have shown that the outcomes of hospitalized patients are greatly enhanced when steps are taken to improve control of their blood glucose levels. The Georgia Hospital Association Research and Education Foundation's Partnership for Health Accountability established a Diabetes Special Interest Group (D-SIG) in February 2003. Goals of the D-SIG were to enlighten health care professionals in Georgia hospitals about the benefits of controlling hyperglycemia in hospitalized patients and to develop processes to assist hospitals in the adoption of an IV insulin dosing algorithm, development of an IV insulin standing order set, and implementation of a hyperglycemia management plan.Methods: The D-SIG created an assessment tool titled “Key Elements of IV Insulin Guidelines” and evaluated numerous published IV insulin administration algorithms and protocols. After an extensive literature review, including international protocols and guidelines, user-friendly guidelines for subcutaneous and IV insulin were developed by a multidisciplinary work group, with members representing hospitals and other stakeholders from throughout the state. The group chose a well-researched method that was available in both computerized and hand-calculated formats and developed a Columnar Insulin Dosing Chart to assist with IV insulin infusions. This insulin-infusion table stems from mathematical formulas published by multiple investigators since the 1980s. The D-SIG guidelines and dosing chart were evaluated for ease of use, effectiveness, and safety in 3 settings: a small, rural critical-access hospital (CAH); an intensive care unit (ICU) in the trauma center of a large Georgia teaching hospital; and a surgical ICU in a midsize metropolitan hospital.Results: After implementation of the guidelines, the incidence of hypoglycemia (blood glucose level <60 mg/dL) was 0.9% in the trauma center ICU and 0.6% in the surgical ICU. All hypoglycemic patients in these 2 settings were asymptomatic, remained hypoglycemic only for a short time, and experienced no complications attributable to hypoglycemia. Using a moderate insulin sensitivity level for dosing initiations resulted in a time to target blood glucose level (80–110 mg/dL) of 6.4 hours, whereas using the most conservative approach required 12.8 hours to attain target range. At the CAH, time to reach the target blood glucose level (90–140 mg/dL) was 5.8 hours, and no episodes of hypoglycemia were reported. Although not part of the pilot initiative, the surgical ICU also reported a 5-fold reduction in surgical infection rates. The success of the dosing chart and standing order set paralleled that of the computerized formula when similar initiation doses were used.Conclusions: The Columnar Insulin Dosing Chart and sample clinical guidelines were piloted at 3 different settings and found to be safe and effective. Furthermore, by including the treatment for hypoglycemia in the guidelines, nurses in all patient care areas were able to manage blood glucose levels below the target range in a safe and timely manner. Use of the dosing chart and guidelines reduced blood glucose levels to the target range with no clinically significant hypoglycemia.     

Decreased cerebral blood flow and hemodynamic parameters during acute hyperglycemia in mice model observed by dual‐wavelength speckle imaging

In this study, we use dual‐wavelength optical imaging‐based laser speckle technique to assess cerebral blood flow and metabolic parameters in a mouse model of acute hyperglycemia (high blood glucose). The effect of acute glucose levels on physiological processes has been extensively described in multiple organ systems such as retina, kidney, and others. We postulated that hyperglycemia also alters brain function, which in turn can be monitored optically using dual‐wavelength laser speckle imaging (DW‐LSI) platform. DW‐LSI is a wide‐field, noncontact optical imaging modality that integrates the principles of laser flowmetry and oximetry to obtain macroscopic information such as hemoglobin concentration and blood flow. A total of eight mice (C57/BL6) were used, randomized into two groups of normoglycemia (control, n = 3) and hyperglycemia (n = 5). Hyperglycemia was induced by intraperitoneal injection of a commonly used anesthetic drug combining ketamine and xylazine (KX combo). We found that this KX combo increases blood glucose (BG) levels from 150 to 350 mg/dL, approximately, when measured 18 minutes post‐administration. BG continues to increase throughout the test period, with BG reaching an average of 463 ± 20.34 mg/dL within 60 minutes. BG levels were measured every 10 minutes from tail blood using commercially available glucometer. Experimental results demonstrated reductions in cerebral blood flow (CBF) by 55%, tissue oxygen saturation (SO₂) by 15%, and cerebral metabolic rate of oxygen (CMRO₂) by 75% following acute hyperglycemia. The observed decrease in these parameters was consistent with results reported in the literature, measured by a variety of experimental techniques. Measurements with laser Doppler flowmetry (LDF) were also performed which confirmed a reduction in CBF following acute hyperglycemia. In summary, our findings indicate that acute hyperglycemia modified brain hemodynamic response and induced significant changes in blood flow and metabolism. As far as we are aware, the implementation of the DW‐LSI to monitor brain hemodynamic and metabolic response to acute hyperglycemia in intact mouse brain has not been previously reported.