Advances in exercise, physical activity, and diabetes mellitus.

Type 1 Diabetes Mellitus

Background: Cerebral oxygenation monitored non-invasively by near-infrared spectroscopy (NIRS) is of increasing interest in neonatal care. Cerebral oxygenation is determined by cerebral oxygen delivery and cerebral oxygen consumption. Oxygen delivery as well as oxygen consumption might be influenced by metabolic parameters like blood glucose and lactate.Objective: The aim of the present systematic qualitative review is therefore to identify and summarize all studies, which describe cerebral oxygenation measured with NIRS and blood glucose and/or blood lactate levels in neonates.Data sources: A systematic search of Ovid Embase and PubMed was performed. Search terms included near-infrared spectroscopy, fractional tissue oxygen extraction, cerebral tissue oxygen saturation, regional cerebral tissue oxygen saturation, oxygenation, term, and preterm neonates, cesarean delivery, transition, after-birth, newborn, vaginal delivery, cesarean delivery, baby, neonatal transition, metabolism, lactate, glucose, and blood glucose level.Study selection/data synthesis: Studies analyzing cerebral oxygenation and blood glucose and/or blood lactate levels in neonates were included. Animal studies, duplicates, or studies in non-English language were excluded.Results: Twenty-five studies were identified that describe blood glucose and/or blood lactate levels as primary or secondary outcome parameters with additional measured cerebral oxygenation by NIRS in neonates. Twelve studies were included with blood glucose measurements: four described an association between blood glucose levels and cerebral oxygenation, two show no association, and six do not report on possible associations. Eighteen studies were included with lactate measurements: one describe an association between lactate levels and cerebral oxygenation, while three show no association and 14 do not report on possible associations.Discussion: The influence of blood glucose and blood lactate levels on the cerebral oxygenation in neonates is still controversial. However, there seems to be an association between cerebral oxygenation and the metabolic parameter blood glucose and lactate, which need further investigation.

Diseases involving inflammation and oxidative stress can be exacerbated by high blood glucose levels. Due to tight metabolic regulation, safely reducing blood glucose can prove difficult. The ketogenic diet (KD) reduces absolute glucose and insulin, while increasing fatty acid oxidation, ketogenesis, and circulating levels of β-hydroxybutyrate (βHB), acetoacetate (AcAc), and acetone. Compliance to KD can be difficult, so alternative therapies that help reduce glucose levels are needed. Exogenous ketones provide an alternative method to elevate blood ketone levels without strict dietary requirements. In this study, we tested the changes in blood glucose and ketone (βHB) levels in response to acute, sub-chronic, and chronic administration of various ketogenic compounds in either a post-exercise or rested state. WAG/Rij (WR) rats, a rodent model of human absence epilepsy, GLUT1 deficiency syndrome mice (GLUT1D), and wild type Sprague Dawley rats (SPD) were assessed. Non-pathological animals were also assessed across different age ranges. Experimental groups included KD, standard diet (SD) supplemented with water (Control, C) or with exogenous ketones: 1, 3-butanediol (BD), βHB mineral salt (KS), KS with medium chain triglyceride/MCT (KSMCT), BD acetoacetate diester (KE), KE with MCT (KEMCT), and KE with KS (KEKS). In rested WR rats, the KE, KS, KSMCT groups had lower blood glucose level after 1 h of treatment, and in KE and KSMCT groups after 24 h. After exercise, the KE, KSMCT, KEKS, and KEMCT groups had lowered glucose levels after 1 h, and in the KEKS and KEMCT groups after 7 days, compared to control. In GLUT1D mice without exercise, only KE resulted in significantly lower glucose levels at week 2 and week 6 during a 10 weeks long chronic feeding study. In 4-month and 1-year-old SPD rats in the post-exercise trials, blood glucose was significantly lower in KD and KE, and in KEMCT groups, respectively. After seven days, the KSMCT group had the most significantly reduced blood glucose levels, compared to control. These results indicate that exogenous ketones were efficacious in reducing blood glucose levels within and outside the context of exercise in various rodent models of different ages, with and without pathology.

To investigate the association between change in bone mineral density (BMD) and change in usual walking speed in elderly community-living Japanese women during 2 years of follow-up. Longitudinal cohort study. Community-based. A total of 182 women aged 70 to 84 who completed a baseline survey and a follow-up survey 2 years later. An interview, anthropometric measurements, blood analysis, and physical performance tests were performed at baseline and at follow-up 2 years later. BMD was evaluated using dual-energy X-ray absorptiometry measured at the forearm. Annual percentage changes in BMD and usual walking speed during the 2-year follow-up period were calculated; annual percentage changes in BMD were summarized in quartiles. The association between annual bone loss rate and decline in usual walking speed was analyzed using multiple linear regression adjusted for changes in muscle strength, balance capability, and other potential confounders. Change in BMD was significantly related to change in usual walking speed during the 2-year follow-up. After multivariate adjustment, usual walking speed declined significantly more in elderly women whose BMD decreased (-3.5% change in walking speed in the first quartile of percentage change in BMD and -3.1% in the second quartile) than in women whose BMD increased (+1.5% in fourth quartile). Elderly women whose BMD decreased had a significantly greater decline in usual walking speed than women whose BMD increased, even after multivariate adjustment of potential confounders.

Objective To investigate the changes of serum inflammatory factors and blood glucose in patients with systemic inflammatory response syndrome (SIRS) . Methods Seventy eight SIRS patients were divided into survival subgroup (n =37) and fatal subgroup ( n = 41), 35 non-SIRS patients were designated as control group. Thirty eight out 76 patients whose blood glucose was higher than 6. 1 mmol/L were randomly selected for intensive insulin therapy. Serum IL-6, IL-10, IL-13, TNF-α and blood glucose were measured; HLA-DR expression on monocytes was detected. Results Serum IL-6, TNF-αand blood glucose levels were (80±8) vs. (42±7)×10~3μg/L, (52±20) vs. (17±6) ×10~3μg/L and (11.9±1.1)vs.(6.5±1.5)mmoL/L in SIRS vs.non-SIRS group respectively(all P＜0.05);those were(108±21)vs.(66±22)×10~3μg/L,(28±8)vs.(16±9)×10~3μg/L,(14.4±2.1)vs.(7.0±1.0)mmol/L in fatal vs.survival group,respectively(all P＜0.05).The changes of IL-10,IL-13 and HLA-DR expression intensity of monocyte showed a reverse trend.The intensive insulin therapy reversed the above tendency and reduced the fatality rate.Conclusions Blood glucose levels are corrected with serum cytokines in SIRS patients and reflex the immune status and disease prognosis.Intensive insulin therapy can improve the prognosis of SIRS patients. Key words: Systemic inflammatory response syndrome; Cytokines; Blood glucose

Background: A high incidence of diabetes mellitus has been reported among patients diagnosed with lumbar degenerative spinal diseases. Although epidural steroid injections are known to increase the postprocedure blood glucose level, it has not been investigated whether a lower steroid dose can reduce blood glucose excursions and still be effective in controlling patients’ subjective pain. Objective: We compared the effects of 2 common doses of triamcinolone administered via epidural steroid injections on blood glucose levels and pain control in patients with diabetes mellitus to determine an adequate epidural steroid dose. Study Design: A prospective observational study. Methods: One hundred patients with diabetes mellitus were enrolled. They received lumbar transforaminal, lumbar interlaminar, or caudal epidural triamcinolone for radiculopathy, spinal stenosis, or failed back surgery syndrome. After the type of procedure was clinically determined, the doses of triamcinolone given were randomly chosen, either 40 mg (Group 40) or 20 mg (Group 20). The patients were asked to measure their finger stick blood glucose level twice daily (fasting and postprandial) for 3 days before the injection, on the day of the injection, for 7 days after the injection, and at 14 days after the injection. They also kept a blood glucose diary. Employment status and clinical outcome were evaluated at 8 weeks after the procedure. Results: There were significant increases in fasting blood glucose (FBG) level on postprocedure day (PPD) #1 to PPD #3 in Group 40, but on PPD #1 in Group 20. Moreover, there was a significant difference in FBG between groups on PPD #1 and PPD #2 (FBG on PPD #1: 179 [51]) mg/dL in Group 40 versus 146 [50] mg/dL in Group 20, P < 0.001]. Postprandial blood glucose (PBG) level was significantly elevated in both groups from PPD #0 to PPD #3. Notably, the increase in PBG was significantly greater in Group 40 than Group 20 on PPD #0 and #1 (PBG on PPD #0: 288 [57] mg/dL versus 242 [94] mg/dL in Groups 40 and 20, respectively, P = 0.004). The numeric rating scale for pain reported by the patients decreased for 2 weeks after treatment with no difference between groups. Employment status and clinical outcome was not different between groups. Limitations: The patients who chose to participate in this study may be a cohort of well-controlled patients with diabetes mellitus. The type of procedure performed was determined by a clinical decision and not randomized. The different routes of administration and diagnosis of failed back surgery syndrome can result in different levels of systemic absorption, thereby influencing the degree and duration of hyperglycemia. In patients with FBSS, the epidural space may be destructed by surgery and adhesive changes in epidural space could be extensive. Therefore, we thought that the absorption of epidural space in these patients would be incomplete or slow compared with those without FBSS. Conclusion: Epidural steroid injections were associated with statistically significant elevations in PBG in patients with diabetes for up to 4 days after the procedure. The higher dose of triamcinolone increased FBG and PBG greater than a lower dose did without affecting pain control, employment status, or clinical outcome. Thus, with respect to glucose and pain control, 20 mg of triamcinolone appears to be recommended rather than 40 mg in patients with diabetes. Clinical Trials registration : NCT01435707 Key words: Epidural steroid injection, low back pain, diabetes, blood glucose

BackgroundGait speed is a strong predictor of a wide range of adverse health outcomes in older adults. Mean values for gait speed in community-dwelling older adults vary substantially depending on population characteristics, suggesting that social, biological, or health factors might explain why certain groups tend to self-select their gait speed in different patterns. The vast majority of studies reported in the literature present data from North American and European populations. There are few population-based studies from other regions with a different ethnicity and/or social and health conditions. To address this, the present study identified the mean usual and fast gait speeds in a representative multiracial population of community-dwelling older adults living in a developing country, and explored their association with sociodemographic, mental and physical health characteristics.MethodsThis was a cross-sectional population-based study of a sample of 137 men and 248 women, aged 65 years and over. Usual gait speed and fast gait speed were measured on a 4.6 m path. Participants were classified into slow, intermediate, and faster groups by cluster analysis. Logistic regression analysis was used to estimate the independent effect of each factor on the odds of presenting with a slower usual and slower fast gait speeds.ResultsParticipants had a mean (SD) usual gait speed of 1.11 (0.27) m/s and a mean fast gait speed of 1.39 (0.34) m/s. We did not observe an independent association between gait speed and race/ethnicity, educational level, or income. The main contributors to present a slower usual gait speed were low physical activity level, stroke, diabetes, urinary incontinence, high concern about falling, and old age. A slower fast gait speed was associated with old age, low physical activity, urinary incontinence and high concern about falling.ConclusionA multiracial population of older adults living in a developing country showed a similar mean gait speed to that observed in previously studied populations. The results suggest that low physical activity, urinary incontinence and high concern about falling should not be neglected and may help identify those who might benefit from early intervention.

ABSTRACTThe discovery of insulin in 1920s revolutionized the management of Type 1 Diabetes Mellitus. The evolution of insulin over the last nine decades has seen three phases, namely discovery and understanding of the molecule, advances in synthesis of the molecule and advancements in the optimization of insulin structure and delivery. These advances aim to minimize hypoglycemia while simultaneously improving anti-hyperglycemic efficacy. Glucose-responsive insulin (GRI) systems were first conceptualized in 1979. These are novel insulin formulations that provide anti hyperglycemic activity appropriate to circulating glucose levels but with a mechanism to avoid hypoglycemia, that often accompanies stringent glycemic control. GRIs are of three major typesalgorithm-based mechanical, polymer-based, molecular GRI analog systems. They differ in the mechanisms of achieving glucose responsiveness. Algorithm-based systems are closed loop insulin pumps that adjust insulin delivery commensurate with blood glucose levels on the basis of predetermined algorithms, that terminate or increase insulin delivery according to blood glucose trends. The second category of GRI includes glucose-responsive polymer-based matrices that house insulin, releasing insulin as needed based on ambient glucose levels. The third approach is to incorporate glucose sensitive motifs in the insulin molecule itself that would decrease or increase insulin availability based on blood glucose levels. The mechanisms behind these novel approaches to insulin delivery and action will be the focus of this review article.

Chronic restraint stress (CRS) induces insulin-resistant hyperglycemia by inducing injury to the brain neurons in the nucleus tractus solitarius (NTS). However, the CRS mice did not suffer from hypoglycemia. In this study, mice of both CRS and NTS mechanical injury models were induced to investigate whether impaired glucose metabolism has changed upon the extension of the survival time after modeling. Body weight, food and water intake, fasting blood glucose, glucose tolerance, and glucose metabolism related to blood hormone levels were monitored for 12 weeks following the induction of injury. The mice were also administered with insulin intraperitoneally, and the blood glucose and glucagon levels were measured and compared to those in the control mice administered with saline. The results showed that the body weights of CRS-hyperglycemic mice were significantly higher than those in the control group, while the body weights of NTS mechanically injured mice were significantly lower than those in the control group. The food and water intake of both CRS-hyperglycemic and NTS mechanically injured mice were significantly more than those in the control groups. Although the levels of fasting blood glucose and resting serum hormone in the injured mice have returned to normal levels, the utilization of glucose and hypoglycemic counterregulation (the response that raises the blood glucose levels) was impaired in either CRS-hyperglycemic or NTS mechanically injured mice. The blood glucagon levels following insulin administration showed abnormal increase. These findings suggest that the CRS-induced NTS injury resulted not only in early insulin-resistant hyperglycemia but also impaired the ability to raise blood glucose and glucagon levels when blood glucose levels plummet in the later stage.

Objective 
\nThe study is to explore the relationship between antipsychotics and blood glucose level or lipid level of patients with mental illness in psychiatric outpatient clinic of Queen Mary Hospital.
\nParticipants and Methods 
\nCase reviews through Clinical Management System were carried out. Total 108 psychotic cases involved in the study. 24 were excluded as the patients did not have any treatment of antipsychotics. 84 patients were qualified for review. 40 females and 68 males involved. Their ages are between 13 and 68. 
\nPatients’ demographics information, blood glucose level or lipid level were retrieved. Some important findings are also noted. Data collection carried in May 2014.
\nResults 
\nThere are no significant changes in fasting blood glucose or lipid level for either typical or atypical antipsychotics. We found that the frequency of checking blood glucose or lipid level was too low and not regular. 
\nRisperidone and Olanzapine are the most commonly used in this psychiatric outpatient clinic. Moreover, 9 cases change from psychosis to Paranoid type schizophrenia. The most frequent diagnosis in the clinic is Paranoid type schizophrenia. 36 cases, one third of the samples, are diagnosed as Paranoid type schizophrenia.
\nConclusions 
\nAlthough we cannot conclude the effect of antipsychotics on blood glucose level or lipid level of patients with mental illness, there is an increasing concern about antipsychotics leading to metabolic problems through the case reviews. We suggest that routine physical health screening, guidelines setting up, predictors should be carried out in the clinic.

Background: The etiology of ovarian cancer is not well-understood; numerous metabolomics profiling, epidemiological, and hospital-based case control studies have associated abnormal levels of blood glucose and serum lipids with the risk and the prognosis of various types of cancers including ovarian cancer. The association between the risk of the incidence of ovarian cancer and the alterations in the levels of blood glucose and serum lipids is not well defined. Objective: In this study we aimed to compare the levels of blood glucose, triacylglycerols, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in patients with different stages of ovarian cancer and healthy controls to determine how they relate to the risk and prognosis of ovarian cancer. Methodology: In a case-control cross sectional study, we enrolled ninety-nine Sudanese women, diagnosed with ovarian cancer but had not received any kind of treatment as the study group, and a control group of forty-one age-matched, apparently healthy women. The patients were classified according to the International Federation of Obstetricians and Gynecologists staging system into two groups: early stages (stage I & II) and late stages (stages III & IV). Blood glucose and serum lipids; triacylglycerols, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were determined by enzymatic colorimetric methods using commercially available analytical kits. The IBM SPSS version 20 software was used for statistical analysis. A Mann-Whitney U test was used for comparison of the median concentrations of blood glucose, triacylglycerols, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in the study groups. Logistic regression model was used to estimate the relative risk of ovarian cancer in relation to levels of blood glucose and serum lipids. P value of 0.05 was considered significant. Results: Our data indicated significantly higher levels of blood glucose (p , triacylglycerols (p = 0.002), and low-density lipoprotein cholesterol (p , and lower levels of high-density lipoprotein cholesterol (p = 0.023), in ovarian cancer patients compared to the control subjects. No significant difference was found in the levels of blood glucose or any of the serum lipids between patients in the early stages (stage I & II) and those in late stages (stage III & IV) of ovarian cancer. The logistic regression analysis indicated significant association between the elevated levels of the blood glucose, triacylglycerols and low-density lipoprotein cholesterol and the risk of the ovarian cancer. Conclusion: We conclude that the levels of blood glucose, triacylglycerols, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol differ significantly between ovarian cancer patients and the healthy control subjects. The risk of ovarian cancer was positively associated with the levels of blood glucose, triacylglycerols and low-density lipoprotein cholesterol, and negatively associated with levels of high-density lipoprotein cholesterol. Therefore, determination of blood glucose and serum lipids, particularly, triacylglycerols, low-density lipoprotein cholesterol may be helpful as diagnostic indicators of ovarian cancer (OC).

Sumithion is extensively used in the agricultural land to control brittle and larval rearing aquaculture ponds to control tiger bug. The present study was conducted to evaluate the effects of sumithion on blood glucose and hemoglobin levels in zebrafish, Danio rerio. At first acute toxicity (96 h LC50 value 7.89 mg/L) of sumithion was determined for sexually matured zebrafish. Then the fish were exposed to four concentrations (0, 0.5, 1.0 and 2.0 mg/L) of sumithion for a period of 7 days. The sexual dimorphic changes in blood glucose levels were observed in the present study. In male, the blood glucose levels were significantly (P<0.05) increased in all concentrations (0.5, 1.0 and 2.0 mg/L) of sumithion compared to control (0 mg/L), while in female the blood glucose levels were significantly (P<0.05) increased only in high concentration (2.0 mg/L). Interestingly, the blood glucose level was higher in females than the males of zebrafish. The recorded hemoglobin values were significantly decreased with the increasing concentration of sumithion in both male and female. The present investigation revealed the toxic potentiality of sumithion on the zebrafish.Progressive Agriculture 27 (2): 216-221, 2016

Higher plasma pyridoxal 5′-phosphate is associated with better blood glucose responses in critically ill surgical patients with inadequate vitamin B-6 status

Diabetes is a common complication in older children and adults with thalassemia major. During insulin therapy we often observe discrepancies between blood and urine glucose levels. In order to assess the renal threshold for glucose, the relation of blood glucose to urinary was studied in 15 insulin and in 9 glibenclamide treated diabetic patients with thalassemia. Mean age 16.4 years, M/F ratio 9/15, frequently transfused, serum ferritin (500-12.800ng/ml). None had consumed ascorbic or salicylic acid prior to testing. Blood area and creatinine normal. Blood and urine glucose were tested simultaneously on several occasions in each diabetic and in ten during O.G.T.T. Blood glucose was estimated by glucose oxidase method and urine glucose by Clinistix and Benedict's method. In 3/24 renal threshold for glucose was <10mmol/L. In 21/24 although blood glucose were 11.6-20.1mmol/L, glycosuria did not occur. These patients showed glycosuria with blood glucose levels (13.8-22.6mmol/L). We have no obvious explanation for this phenomenon. It is concluded that thalassemic patients with diabetes have raised renal threshol for glucose. Metabolic control should be assessed by frequent blood glucose estimations.

Objective To study the changes of blood glucose and insulin following acute spinal cord injury in rats. Methods A total of 192 male rats were randomly divided into sham group, mild injury group and severe injury group. Animal model with spinal cord injury was made by Allen's method.Blood glucose levels were measured by OneTouch(R) Ultra~(TM) glucose measurer and blood insulin value by radioimmunoassay at pre-injury and at 1,4, 8,12 hours, 1,3 and 5 days post-injury. Later, the insulin sensitivity index (ISI) was calculated. Results The blood glucose levels increased markedly after spi-nal cord injury. The severer trauma resulted in faster increase of the blood glucose and insulin levels. ISI is decreased in mild and severe injury groups, with more significant in severe injury group. ISI decreased with higher severity of spinal cord injury. Conclusion The hyperglycemia after spinal cord injury is probably associated with insulin resistance. Key words: Spinal cord injuries; Blood glucose; Insulin; Radioirmnunoassay