Dissertations / Theses on the topic 'Hypoglycemia'
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1
Dodd, Will. "Hypoglycemia." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/8922.
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Schutz, Peter W. "Neuroprotective effects of ketone bodies during hypoglycemia." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/34014.
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The ketone body D-3-hydroxybutyrate (3OHB) is an alternative energy substrate for the brain during hypoglycemia. The capacity and limitations of 3OHB to compensate for cerebral glucose depletion in developing brain is insufficiently understood.
We studied the effect of 3OHB treatment in a newly developed infant rat model of insulin induced, sustained, and EEG-controlled hypoglycemia. Continuous treatment with 3OHB during hypoglycemia resulted in increased 3OHB plasma levels in hypoglycemic animals and delayed the onset of clinical coma and of EEG burst-suppression (burst-suppression coma). 3OHB treated animals did not survive after resuscitation with glucose, compared to 80% survival of untreated hypoglycemic pups. Cleaved-caspase-3 immunohistochemistry and double labelling studies demonstrated a 20-fold increase of apoptotic mature oligodendrocytes in white matter of 3OHB treated animals, indicating a limited protective effect of 3OHB treatment.
In contrast to glucose, D-3-hydroxybutyrate is not an anaplerotic substrate. Anaplerosis plays in important role in cerebral glutamate glutamine metabolism. Combination of D-3-hydroxybutyrate with the anaplerotic substrate propionate could enhance its protective effect during hypoglycemia.
We compared the effectiveness of treatment with a single dose D-3-hydroxybutyrate alone or combined with propionate at the time of EEG burst-suppression coma. Both treatments resulted in a reversion of EEG activity from burst suppression to continuity, but only combined treatment resulted in clincal improvement of the comatose state. 3OHB alone largely corrected pathometabolic changes of glutamate metabolism but not of glycolytic and pentose phosphate pathway intermediates or of long chain acylcarnitines. Combined treatment was not associated with biochemical corrections over and above those achieved by 3OHB alone for the metabolites measured.
3OHB treatment has a limited effectiveness on clinical and neuropathology outcome after hypoglycemia in infant rats. The limited effectiveness of 3OHB treatment may be related to its inability to support glycolysis with associated pentose phosphate pathway and anaplerotic activity. Combined treatment with propionate enhances 3OHB’s protective effect during hypoglycemic coma. Future protective treatment should be based on complementary metabolic substrates.
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Eckert, Bodil. "Hypoglycaemia studies on central and peripheral nerve function /." Lund : Dept. of Internal Medicine, University of Lund, 1998. http://catalog.hathitrust.org/api/volumes/oclc/57426099.html.
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Ciraolo, Susan Taylor. "Model of extreme hypoglycemia in the ketotic dog." Case Western Reserve University School of Graduate Studies / OhioLINK, 1994. http://rave.ohiolink.edu/etdc/view?acc_num=case1057250332.
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Minić, Marina. "Investigation of a syndrome of non insulin-dependent hypoglycaemia and overgrowth." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708929.
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Sami, Sumrin Ramiza. "Islet Transplantation in Type I Diabetes Patients with Hypoglycemia." Thesis, Umeå universitet, Farmakologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-126081.
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Isom, Amanda M. "The Cellular Consequences of Combining Antipsychotic Medications and Hypoglycemia." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1407407111.
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Clark, DessyeDee M. "Computer-aided hypoglycemia detection in adolescents with insulin-dependent diabetes mellitus /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/7368.
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Kalergis, Maria. "Prevention of noctural hypoglycemia in adults with type 1 diabetes undergoing intensive management." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=19501.
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The objectives of this research were to determine the impact of 4 different bedtime snack compositions on prevention of nocturnal hypoglycemia and to determine whether optimized titration and delivery of bedtime insulin using multiple daily injections of insulin (MDI) or continuous subcutaneous insulin infusion (CSII) could prevent nocturnal hypoglycemia in the absence of bedtime snacks. We also sought to determine whether 3 months of CSII therapy would improve catecholamine response and symptom awareness to experimentally-induced hypoglycemia. The need for and the most appropriate composition of bedtime snacks were dependent on the glycemic level at bedtime. No bedtime snacks were necessary at bedtime glycemic levels > 10 mmol/L. At bedtime glycemic levels between 7-10 mmol/L , a standard snack and cornstarch-containing snack worked best and at bedtime glycemic levels < 7mmol/L, a standard and protein-rich snack were most effective. Despite optimized titration and delivery of bedtime insulin, including the use of CSII, "the gold standard" of nocturnal insulin replacement, the incidence of nocturnal hypoglycemia over 181 nights was 54 episodes per 100 patientnights. However, there was a substantial reduction, by 36% (p=0.17), in the incidence of nocturnal hypoglycemia with the use of bedtime snacks. Therefore bedtime snacks, tailored to the bedtime glycemic level, are recommended for ail adults undergoing intensive management with MDI or CSII. Although, 3 months of CSII therapy did not improve catecholamine response and symptom awareness to experimentally-induced hypoglycemia, it did not deteriorate the responses either. Therefore, CSII therapy is a viable option in intensive management of adults with type 1 diabetes.
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Leelarathna, Lalantha Harendra. "Improving glucose control and reducing the burden of hypoglycaemia : use of novel diabetes technology in type 1 diabetes and critical illness." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648482.
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Schenk, Sarah E. "Acute and recurrent hypoglycemia modulates brain glycogen metabolism in the mouse." Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/618.
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Guelfi, Kym Janese. "Glucoregulatory responses to intermittent high-intensity exercise in individuals with type 1 diabetes mellitus : insight into the risk of hypoglycaemia." University of Western Australia. School of Human Movement and Exercise Science, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0078.
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[Truncated abstract] Exercise is generally recommended for individuals with type 1 diabetes mellitus since it is associated with numerous physiological and psychological benefits. However, participation in exercise can also increase the risk of experiencing severe hypoglycaemia both during exercise and recovery. Unfortunately, existing guidelines to minimise the risk of exercise-induced hypoglycaemia are often general and fail to take into account that different precautions are required for exercise of varying type, duration and intensity. Specifically, there are no evidence-based guidelines for safe participation in intermittent high-intensity exercise (IHE), which characterises the activity patterns of most team and field sports, manual labour occupations and spontaneous play in children. This is because the response of blood glucose levels to this type of exercise is not known. Consequently, the purpose of this thesis was to investigate the glucoregulatory responses to IHE that replicates the high-intensity work-to-recovery ratios observed in intermittent sports in individuals with type 1 diabetes, in order to assess the associated risk of hypoglycaemia. The first study of this thesis examined the effect of the repeated bouts of high-intensity exercise that characterise IHE compared to remaining inactive, on blood glucose and glucoregulatory hormone levels in individuals with type 1 diabetes. Eight healthy individuals with type 1 diabetes were tested on two separate occasions during which either a 20 minute rest (CON) or an IHE protocol designed to simulate the activity patterns of team sports was performed (repeated 4 second sprints every 2 minutes). ... During the second hour of recovery, Ra and Rd returned to baseline following MOD, but remained elevated after IHE. These changes in Ra and Rd were consistent with a lower glucose infusion rate (GIR) during early recovery from IHE and a higher GIR after 2 hours of recovery compared to MOD. In conclusion, the repeated bouts of high-intensity exercise associated with IHE stimulate a more rapid and greater increment in Ra during exercise and attenuate glucose Rd during early recovery. These findings assist in explaining, in part, the previous observation that the risk of hypoglycaemia might be lower during IHE and early recovery compared to MOD. Overall, the findings of this thesis have implications for current recommendations aimed at managing blood glucose levels during and after exercise to avoid hypoglycaemia.
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Dankwa, Joel. "Role of the mineralocorticoid receptor in hypoglycemia-induced inflammation in humans." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12342.
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Thesis (M.A.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Hypoglycemia has been implicated in the pathophysiology of cardiovascular disease. Hypoglycemia is also known to increase both inflammatory factors and counterregulatory hormones. Although the mechanism by which hypoglycemia contributes to cardiovascular injury is unclear, it is suspected that elevation of inflammatory factors and counterregulatory hormones are associated with this injury. Several studies have demonstrated a possible role of the mineralocorticoid receptor in hypoglycemia-associated autonomic failure and thus diminished autonomic control of the heart. Furthermore, activation of the mineralocorticoid receptor is pro-inflammatory. Cortisol and aldosterone, both of which are ligands to the mineralocorticoid receptor, are elevated during hypoglycemia. Our aim in conducting this study was to test the hypothesis that blockade of the mineralocorticoid receptor will reduce the pro- inflammatory effects of hypoglycemia-induced inflammation. In a clinical study of 7 healthy men and women, we found that administration of a mineralocorticoid receptor antagonist blunted the elevation of IL-6 during hypoglycemia. Results in this thesis demonstrate that antagonism at the mineralocorticoid receptor may minimize elevation of inflammation via IL-6, and suggest that activity at the mineralocorticoid receptor may be a means to address the effects of hypoglycemia-induced inflammation.
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Rubega, Maria. "Quantitative analysis of hypoglycemia-induced EEG alterations in type 1 diabetes." Doctoral thesis, Università degli studi di Padova, 2017. http://hdl.handle.net/11577/3425362.
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The main risk for patients affected by type 1 diabetes (T1D) is to fall in hypoglycemia, an event which leads to both short and long-terms automatic failure and can be life-threatening especially when occurs at night without subject awareness. Moreover, T1D patients can develop asymptomatic hypoglycemia, reducing the prompt response of the counterregulatory system triggered by the fall in blood glucose. Avoiding hypoglycemia is important in children and adolescents because hypoglycemia episodes may have clinically relevant effects on cognition. Also in adults, cognitive tests assessed that hypoglycemia results in altered cerebral activity, most likely due to the complete dependence of the brain for glucose supply.
The first organ influenced by this fall of glucose in the blood is the brain. Indeed, a lot of studies proved the mirroring of cognitive dysfunction due to hypoglycemia in the spectral power of the electroencephalogram (EEG) signal. In particular, the increase of the power in low frequency EEG bands is a well-known effect during hypoglycemia that seems more pronounced in the EEG recording in the posterior areas of the brain. Pilot studies about the real-time processing of the EEG signal to detect hypoglycemia have indicated that it might be possible to alert the patients by means of EEG analysis. The main advantages in exploiting EEG analysis is that the blood glucose threshold to enter in hypoglycemia has large inter-subjects variations, on the contrary the EEG onset in general occurs before the state of hypoglycemia is critical, i.e., the brain starts to experience neuroglycopoenia and its functions completely fail.
The main aim of this work is to broaden out the quantitative analysis on the altered EEG activity due to hypoglycemia in T1D patients to identify potential margins of improvement in EEG processing and further features sensitive to hypoglycemia. In particular, the analyses are extended to different domains, i.e., time and frequency domains, to deepen the knowledge on the effects of hypoglycemia in the brain. So far, studies in the literature have mainly evaluated these changes only on a single EEG channel level on the frequency domain, but limited information is available on the hypoglycemia influence on brain network dynamics and on connection between different brain areas. To do so, this dissertation is structured in 7 chapters, briefly presented below.
Chapter 1 will start with a brief overview about the impact of T1D and its main effects on daily life. Moreover, the main consequences of hypoglycemia in human brain will be described by reporting the main findings in the literature.
Chapter 2 will present the database where EEG data and blood glucose samples were collected in parallel for about 8 h in 31 T1D hospitalized patients during an hyperinsulinemic - hypoglycemic clamp experiment.
Chapter 3 will address on the main effects of hypoglycemia in the frequency domain. After testing the well-known changes in the spectral power of the EEG signal during hypoglycemia, a multivariate analysis based on the concept of Information Partial Directed Coherence will be presented. In particular, we will confirm the general slowing in the frequency domain and we will show how hypoglycemia affects the EEG functional connectivity.
Chapter 4 will consider the effects of hypoglycemia on EEG complexity. Fractal dimension features, describing both amplitude and frequency properties, will be computed and compared with the results based on Sample Entropy. We will reveal a decrease of EEG signal complexity in the hypoglycemic condition.
Chapter 5 will focus on the consequences of hypoglycemia in the so-called microstates or "athoms of thought". We will hypothesize that the changes in the frequency domain and the decrease of the EEG signal complexity in hypoglycemia have in common the same resting EEG electric potential amplitude map.
Chapter 6 will describe how hypoglycemia influences the results of cognitive tests, and the relationship between the drop in the tests performance and the EEG quantitative measures presented in the previous chapters. We will find a direct correlation among the changes in the power spectra, the cognitive tests performance and the changes of one resting EEG electric potential amplitude map.
Eventually, Chapter 7 will close the dissertation by interpreting the ensemble of the results from both the medical and engineering point of view, and presenting the possible future developments of this work.Il principale rischio per i pazienti colpiti dal diabete di tipo 1 (T1D) è cadere in ipoglicemia, un evento che provoca una nutrita serie di sintomi ed effetti a breve e lungo termine e può essere particolarmente pericoloso quando si verifica durante la notte senza averne coscienza. Inoltre, questi pazienti rischiano di sviluppare una forma di ipoglicemia senza sintomi, riducendo la risposta ormonale controregolatoria innescata dalla diminuzione della concentrazione di glucosio nel sangue. Evitare questo stato patologico, è particolarmente importante sia nei bambini e adolescenti per evitare possibili distorsioni cognitive, sia negli adulti dove test cognitivi hanno dimostrato un’alterata condizione cerebrale durante l’ipoglicemia. Infatti l’ipoglicemia provoca una diminuzione delle funzioni cerebrali e l’organo maggiormente affetto da questo stato patologico è il cervello. Si trovano vari studi in letteratura che provano come la riduzione delle funzioni cognitive si rifletta in cambiamenti della potenza spettrale del segnale elettroencefalografico (EEG). In particolare, la crescita della potenza delle basse frequenza nel segnale EEG è un effetto ben noto in letteratura. Studi pilota hanno dimostrato che potrebbe essere possibile utilizzare il segnale EEG per segnalare l’entrata in ipoglicemia. Il maggiore vantaggio è che se la soglia di concentrazione di glucosio nel sangue è variabile da soggetto a soggetto, l’onset dei cambiamenti del segnale EEG avviene solitamente prima che lo stato di ipoglicemia sia così grave da causare una marcata neuroglicopenia con conseguente disfunzione cerebrale. Il principale scopo di questa tesi è approfondire l’analisi delle alterazioni del segnale EEG nel T1D causate dall’ipoglicemia per identificare potenziali margini di miglioramento nell’analisi del segnale EEG e ulteriori caratteristiche sensibili all’ipoglicemia. In particolare, le analisi sono estese a diversi domini, il dominio del tempo e il dominio della frequenza, per approfondire la conoscenza sugli effetti dell’ipoglicemia sul cervello. Fino ad ora, gli studi in letteratura hanno principalmente valutato questi cambiamenti a livello di singolo canale EEG e nel dominio della frequenza, ma una limitata informazione è disponibile sull’influenza dell’ipoglicemia sulla dinamica della rete cerebrale e sulla connessione tra le diverse aree cerebrali. Per affrontare questi temi, la tesi è strutturata in 7 capitoli, brevemente descritti di seguito. Il Capitolo 1 presenta una panoramica sulle conseguenze e sull’impatto nella vita di tutti i giorni del T1D. Inoltre, si descrivono brevemente i risultati sugli effetti dell’ipoglicemia sull’attività cerebrale riportati in letteratura. Il Capitolo 2 riporta il database su cui sono basate tutte le analisi presentate in questa tesi. Il segnale EEG e la concentrazione di glucosio nel sangue sono state raccolte in parallelo per circa 8 ore in 31 pazienti ospedalizzati affetti da T1D indotti in ipoglicemia attraverso un clamp ipoglicemico iperinsulinemico. Il Capitolo 3 tratta degli effetti dell’ipoglicemia sull’EEG nel dominio della frequenza. Dopo aver confermato la presenza di cambiamenti nel valore della potenza del segnale EEG durante l’ipoglicemia, si riporta un’analisi multivariata basata sulla stima della connettività funzionale del segnale EEG durante questo stato patologico. In particolare, confermeremo il rallentamento del segnale EEG nel dominio della frequenza e dimostreremo come lo stato ipoglicemico influenza la connettività funzionale del segnale EEG. Il Capitolo 4 si concentra sugli effetti dell’ipoglicemia sulla complessità del segnale EEG. In particolare, le analisi sono basate su indicatori frattali e sul confronto dei loro valori con i risultati di indicatori basati sulla definizione di entropia. Riveleremo una decrescita della complessità del segnale EEG durante lo stato di ipoglicemia. Il Capitolo 5 tratta le conseguenze dello stato ipoglicemico sui microstati, definiti anche "atomi del pensiero". Ipotizzeremo che i cambiamenti nel dominio della frequenza e la decrescita della complessità del segnale EEG possano essere originati da una stessa mappa delle ampiezze del potenziale elettrico del segnale EEG. Il Capitolo 6 si focalizza sull’influenza dell’ipoglicemia sui risultati di test cognitivi come lo Stroop test. Inoltre, tratta la relazione tra il calo nella performance in questi test e le misure quantitative del segnale EEG presentate nei capitoli precedenti. Troveremo una correlazione diretta tra i cambiamenti della potenza spettrale, dei test cognitivi e di una mappa EEG. Infine, il Capitolo 7 conclude la tesi cercando di interpretare tutti i risultati nel dominio del tempo e della frequenza sia da un punto di vista clinico sia da un punto di vista ingegneristico e presenta i possibili sviluppi futuri.
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Frey, Paul, Yong Gu Lee, Holly Paddock, Brian Erstad, and Sid Patanwala. "Continuous Intravenous Insulin Weight Based Dose-Related Hypoglycemia in Critically Ill Patients." The University of Arizona, 2014. http://hdl.handle.net/10150/614183.
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Class of 2014 AbstractSpecific Aims: To evaluate the association of weight-based insulin dose with hypoglycemia in critically ill patients receiving continuous intravenous insulin infuions. To determine whether higher weight-based doses of insulin were associated with a higher incidence of hypoglycemia Methods: This was a retrospective, case-control study conducted at a tertiary care, academic medical center. Adult (>18 years) patients admitted to the intensive care unit (ICU) receiving intravenous (IV) regular insulin infusions for the management of hyperglycemia between 1 January 2008 and 30 March 2013 were included. Medical records were retrospectively reviewed. Each patient with hypoglycemia was matched with a non-hypoglycemic control subject, based on age range and sex. Laboratory data, patient demographics, hypoglycemic events, insulin infusion data, SOFA scores, length of hospital and ICU stay, and patient outcomes were collected and evaluated. Main Results: Sixty-one patients experienced a hypoglycemic event and were matched with 61 non-hypoglycemic control subjects for statistical analysis. With the exception of ethnicity (p = 0.041) as a demographic predictor of hypoglycemia; age, sex, weight, height, and BMI were not significant. The starting insulin infusion rate and the total number of insulin units per day administered were not found to be associated with hypoglycemia, p=0.107 and p=0.357, respectively. Conclusion: This study failed to show significance in the total units per day of insulin and the incidence of hypoglycemia. There was no statistical significance in BMI between case and control groups, thus no clear conclusion can be made associating hypoglycemia with weight-based insulin dosing.
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Piotrowicz, Agata. "Exploring Exercise In Type 1 Diabetes: Intervention With An On-Line Educational Tool." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/20244.
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In day to day life, people living with type 1 diabetes, commonly experience non-severe or mild hypoglycaemia. Depending on the duration of type 1 diabetes and the method of data collection, mild hypoglycaemia occurs on average 1-3 times per week. Multiple studies have shown that mild hypoglycaemia also commonly occurs following exercise, which contributes to the frequency of non-severe hypoglycaemia. Recurrent hypoglycaemia leads to blunting of counter-regulatory hormones which increases risk of further hypoglycaemia, including severe episodes and reduced awareness of hypoglycaemia. In addition, hypoglycaemia and fear of hypoglycaemia are well established barriers to exercise in people with type 1 diabetes. This data compliments epidemiological studies that show people with type 1 diabetes tend to exercise less than their peers who do not have diabetes. Despite hypoglycaemia being a recognized acute complication of physical activity in type 1 diabetes, regular exercise is recommended due to its multiple potential cardiovascular benefits. International guidelines recommend that people with type 1 diabetes, similar to healthy peers, undertake at least 150 min per week of moderate intensity aerobic physical activity, or at least 75 min per week of vigorous intensity aerobic physical activity. The aim of the body of research in this thesis was firstly to define the amount and type of exercise that is undertaken by people with type 1 diabetes under regular specialist care in a diabetes centre, and what percentage of non-severe or mild hypoglycaemia is related to exercise. Secondly, the research aimed to show whether intervention with an established educational online tool for people with type 1 diabetes, exT1D, can lead to a reduction in exercise-related hypoglycaemia. Chapter 3 was dedicated to a pilot study, undertaken to develop study procedures that would also be further employed in both the type 1 Diabetes Clinic Audit Survey as well as the randomised controlled trial, T1EX. It also served to aid the power calculation for the main endpoint of the T1EX trial. In Chapter 3 it is reported that most of the non-severe episodes of hypoglycaemia was related to exercise, defined as episodes of hypoglycaemia that occurred within 24 hrs of the onset of an exercise session. Those findings were seen in 5 adults with type 1 diabetes who at baseline undertook regular exercise, were physically fit and had good metabolic control with an average HbA1c level of 7.0% NGSP units. Those participants attempted to prevent their exercise-related hypoglycaemia mainly by consuming carbohydrates. This approach was particularly implemented for exercise duration longer than 60 min; however, the approach was typically not successful in preventing some degree of exercise-related hypoglycaemia. In addition, a positive relationship between self-reported fear of hypoglycaemia score and exercise-related hypoglycaemia was detected. In chapter 4 through use of series of established, validated questionnaires, it was found on subsequent analysis that most patients attending the type 1 diabetes clinic at the Royal Prince Alfred Hospital, undertook physical activity. However less than 50% fulfilled international guideline recommendations. Furthermore, in analyzing exercise type, it was found that people with type 1 diabetes who engage in weekly resistance training by self-report, as opposed to only aerobic exercise, had a particular profile as a group that included: a trend to greater fear of hypoglycaemia; being more confident in their overall diabetes self-management; and they were able to exercise for longer before experiencing an episode of severe, as well as non-severe, hypoglycaemia. This finding was reflected in an observational part of the randomized controlled trial. In the randomised controlled trial using the CGM generated hypoglycaemia data and actual undertaken exercise, participants who undertook resistance training were able to exercise for longer rather than their peers who solely undertook aerobic exercise before experiencing an episode of non-severe hypoglycaemia. As exercise commonly contributes to hypoglycaemia, a method to potentially reduced this complication was then studied. A commercial educational website, ext1d.com.au was developed for people with type 1 diabetes to improve glycaemia around exercise. Modules describe glucose physiology in the context of exercise and offer suggestions on glycaemia management. The main prospective study in this thesis, examined this pre-existing online tool in a randomised controlled trial. Chapter 5, described the type 1 diabetes and exercise (T1EX) trial, which was a randomised controlled trial with partial crossover of the control group into the intervention arm and related main outcomes. There was no significant reduction in exercise related hypoglycaemia, despite observed 37% reduction in exercise related hypoglycaemia compared with exercise session number in the intervention part of the RCT (primary end-point), and a median 50% reduction in the frequency of exercise-related hypoglycaemia in the intervention compared with Control. However, in the longitudinal study as pre-defined secondary end-points, a reduction from baseline in the frequency (43%, NS with p=0.088), and to a greater and statistically significant degree in the duration of exercise-related hypoglycaemia (71% reduction, p=0.03), was observed by the intervention. The overall reduction in hypoglycaemia duration, observed in the intervention group after the 5 weeks of the study, was sustained in a further 5-week time interval. These benefits in T1EX occurred with overall stable glycaemic control throughout the trial, as expressed by HbA1c and fructosamine levels, as well as an improvement in confidence in managing glycaemia around exercise following intervention by self-report. In post-hoc analysis, these benefits of a reduction in exercise-related hypoglycaemia were particularly seen in the 50% of participants who at baseline had the highest frequency of exercise-related hypoglycaemia (more than 3 episodes at baseline). These subjects collectively had a highly statistically significant reduction in hypoglycaemia number (p=0.002) and duration (p=0.004). In addition, they had significant reductions in nocturnal hypoglycaemia duration (p<0.001) and a significant 30% reduction in overall fear of hypoglycaemia (p=0.041). In Chapter 6 the potential behavioural changes undertaken by participants that may have resulted in the observed reduction in exercise-related hypoglycaemia through their access to ext1d.com.au in the longitudinal part of the study, was examined. The main positive post-hoc exploratory findings were: that documented carbohydrate supplementation around exercise, and also insulin reductions documented around exercise (bolus insulin changes), were each associated with a reduction in hypoglycaemia events. Only the insulin reductions were significant on a correlative analysis. In addition, significantly advancing the timing of exercise to an earlier median time in the day may also have contributed to the lesser exercise-related hypoglycaemia observed. In contrast to these findings of documented behavioural changes, resistance exercise was not increased following access to ext1d.com.au. The research described in this thesis has contributed to scientific and clinical information about type 1 diabetes and exercise. It has reinforced that exercise is a predominant cause of hypoglycaemia in adults with type 1 diabetes, especially those who undertake exercise to the recommended levels and who have tight glycaemic control. It has provided increased evidence that an established online educational tool as a total package may help to reduce hypoglycaemia related to exercise in adults with type 1 diabetes, and it has, using CGMS technology, identified some of the behaviours that may have contributed to this finding. The research described herein has highlighted where the field could be further progressed namely which is through the identification of particular people with type 1 diabetes who may best benefit from educational interventions to safely and confidently undertake exercise to recommended levels.
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Kesselheim, Anne Lore. "Genetic and molecular studies in hyperinsulinemic hypoglycemia and congenital polycystic kidney disease (HIPKD)." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10057201/.
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Background: Hyperinsulinemic hypoglycemia (HI) and congenital polycystic kidney disease (PKD) are rare, genetically heterogeneous disorders. The co-occurrence (HIPKD) in 17 children from 11 unrelated families suggested a shared cause. Methods: We ascertained the clinical phenotype and performed genetic studies. The effect of the identified shared mutation was assessed in vitro. Results: All patients exhibited HI and enlarged polycystic kidneys. Whole genome linkage analysis in 5 informative families identified a single significant (LOD 6.5) locus on chromosome 16p13.2. A promoter mutation (c.-167G > T) in PMM2 was found in all patients, either homozygous or in trans with PMM2 coding mutations. Yet, typical systemic features of congenital disorder of glycosylation type 1a were absent and the diagnostic test of transferrin isoelectric focusing was normal. The promoter mutation showed decreased transcriptional activity in patient kidney cells and impaired binding of the transcription factor ZNF143. In silico analysis suggests an important role for ZNF143 for the formation of a chromatin loop including PMM2 that could affect tissue-specific transcription. In order to investigate this further in a chromatin conformation study a HIPKD cell model homozygous for the promoter mutation was generated with CRISPR-Cas9. Conclusions: We report a rare disease characterized by the combination of hyperinsulinemic hypoglycemia and polycystic kidney disease. Our findings extend the spectrum of genetic causes for both disorders, provide insights into gene regulation and implicate glycosylation in the disease etiology. The identified promoter mutation appears critical for tissue-specific regulation of PMM2 transcription, leading to an organ-specific phenotype and explaining PMM2 pleiotropy.
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Moriconi, Diego. "Efficacy of Lisosan G (fermented wheat) on post-prandial hypoglycemia after bariatric surgery." Doctoral thesis, Università di Siena, 2023. https://hdl.handle.net/11365/1227315.
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Introduction: post-bariatric hypoglycemia (PBH) is considered a chronic complication after bariatric
surgery that increase cardiovascular risk. Changes in gut microbiota and a dysregulated inflammatory
response to a glucose load seems to be the conditions favoring the development of PBH.
Lisosan G (LG) is a fermented powder obtained from whole grains (Triticum aestivum), rich in
polyphenols and flavonoids with antioxidant, anti-inflammatory and prebiotic properties.
Aims: The aims of the study were 1) to evaluate the effectiveness of using LG added to the diet in
reducing PBH events in patients undergoing RYGB, 2) investigate the mechanism by which LG acts
on the gut-pancreas axis.
Methods: Twenty patients self-reporting symptoms/signs of PBH, who had undergone gastric bypass
between 2015 and 2018, were enrolled. At baseline, patients underwent clinical examination, blood
test and 4-hour oral glucose load test (OGTT). After that, the patients were kept on a free diet with
15 days of continuous glucose monitoring (CGM). The CGM was then repeated for another 15 days,
adding LG to the same dietary regimen (5 g LG-powder, bid). At the end of the treatment period,
patients repeated the 4-hours OGTT and blood test. Plasma insulin and C-peptide were measured by
electrochemiluminescence on a Cobas e411 instrument. Plasma total glucose-like peptide-1 (GLP 1) concentrations were measured by ELISA (Millipore). Insulin sensitivity was assessed by the oral
glucose insulin sensitivity index (OGIS).
PBH was defined as a plasma glucose level of ≤ 60 mg/dl in presence of typical symptoms.
Results: a marked reduction in PBH episodes recorded by CGM was observed after LG
administration (6.5 [5-11] vs 2.5 [2-3], p= 0.009), as well as a reduction in the overall length of
hypoglycemia (410 [129-633] vs 39 [20-89], minutes, p=0.003). During OGTT, a marked increase in
the blood glucose nadir (44 ± 11 vs 56 ± 10, mg/dl, p= 0.038) was found after LG treatment.
Conversely, no difference were observed in fasting glycemia, in the time-to-nadir, as well as in the
blood glucose zenith nor the time-to-zenith. After treatment, the peak of GLP-1 was attenuated and
total GLP-1 AUC significantly decrease (7.6 ± 4.1 vs 6.5 ± 3.8, nmol/L*min, p= 0.043), as well as
potentiation factor ratio (1.5 ± 0.5 vs 0.8 ± 0.4, p= 0.038) and total insulin AUC (57±12 vs 49±9,
nmol/m2
, p= 0.041).
Conclusion: LG is effective on reducing frequency, overall duration and severity of PBH episodes.
The main mechanism by which LG acts appears to be the attenuation of GLP-1 peak and,
consequently, the second phase of insulin secretion in response to the glucose load. Further specific
studies are necessary to evaluate the effects of LG on the microbiota and inflammation to better
understand the mechanisms of action of this precious supplement.
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Cowan, Simone. "Anti-hypertensive drug use and the risk of serious hypoglycemia in patients with diabetes." Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30840.
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Recently, there have been conflicting reports on whether anti-hypertensive medications cause serious hypoglycemia in patients with diabetes. We assessed this association using a population-based approach.Utilizing the Saskatchewan Health databases, we conducted a case-control study nested within a cohort of 3639 patients with diabetes, newly prescribed angiotensin converting enzyme inhibitors (ACE-I) or dispensed other anti-hypertensive drugs during 1982 to 1987. There were 162 cases of hypoglycemia identified. All potential controls, matched to the case on entry date and at different eligible at-risk times, were selected (n = 8329).
After adjustment for confounders, current users of ACE-I and non-selective beta-blockers had a clinically important increased risk of hypoglycemia, RR 1.61 (95% CI: 0.99--2.60) and RR 1.81 (0.97--3.40), respectively. Current users of ACE-I for a duration of 120 days or greater had a 2-fold increased hypoglycemic risk, RR 2.06 (1.12--3.82).
The use of ACE-I and non-selective beta-blockers may be associated with serious hypoglycemia.
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Lam, Fred, and Ali Bokhari. "New Onset Hypoglycemia in Non-diabetic Adult Patients: Where Do We Go from Here?" Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/55.
Full textAbstract:
Background:
Hypoglycemia is a commonly encountered metabolic state in the patient population. It can be medically defined as a blood sugar <70mg/dL in a diabetic patient or <50mg/dL in a non-diabetic patient. It is less frequently seen in non-diabetics due to the body’s ability to autoregulate insulin administration. Common symptoms are sweating, tremors, palpitations, dizziness, drowsiness, and confusion. If left untreated, these symptoms can progress to seizures, arrythmias, or other complications that ultimately lead to death.
Objective:
To highlight the possible causes of hypoglycemia and the appropriate work-up for normally euglycemic patients.
Case Description:
We herein report a case of hypoglycemia in a 36-year-old female with Lupus related end-stage renal disease on hemodialysis via Ash-catheter who presented with peritonitis due to a defunct peritoneal dialysis catheter. The patient was found to be bacteremic; therefore both catheters were removed and antibiotics were started. Repeat blood cultures showed no growth for 48 hours, so the patient was held fasting at midnight for placement of a new catheter. On the day of surgery, she registered multiple blood sugar readings as low as 15mg/dL. Her symptoms were limited to drowsiness and shortness of breath. She was given four D50 boluses, glucagon IV, and a D5 drip that was adjusted to a D15 drip to stabilize her blood sugar. It was discovered that at an admission two months ago, the patient had a few readings in the 30s. She denied any recollection of this and claimed to have been asymptomatic. She also denied a history of low blood sugars and a diagnosis of diabetes. In surgery that day, the patient went into cardiac arrest on the operating table after being sedated. She was resuscitated after one round of chest compressions, and her catheter was placed. During the episodes of low blood sugar, specific labs were drawn for the work-up of hypoglycemia (glucose, insulin, C-peptide, proinsulin, beta-hydroxybutyrate, insulin antibodies, and sulfonylurea/meglitinide screen), but results yielded inconclusive values that prevented a diagnosis. The patient’s blood sugars became steady once her diet was restarted, and she was discharged in stable condition to a rehab facility after cautionary counseling was given.
Discussion:
This case highlights an optimal way to work-up a patient with new onset hypoglycemia, focusing on patient history and drawing the appropriate labs during hypoglycemic episodes. The specific labs listed above can be used to differentiate between various causes of hypoglycemia (exogenous insulin administration, an insulin secreting tumor [insulinoma], insulin antibodies, insufficient cortisol or glucagon levels, or improper sulfonylurea/meglitinide use) by comparing them to standards. If labs are unable to be obtained, a 72-Hour Fast can be conducted to create a controlled environment, and a Glucagon Tolerance Test can further explore if the cause of hypoglycemia is insulin related. The goal of all of this testing is to be able to identify and treat the underlying cause of the hypoglycemia and prevent future episodes and the complications that accompany it.
21
Dwyer, Trisha A. "Brain Hypometabolism and Seizures: The Dynamics of Hypoxia and Hypoglycemia in Brain Energy Homeostasis." University of Toledo Health Science Campus / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=mco1313737400.
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Shum, Kar Man Kathy. "Effects of antecedent hypoglycemia, antecedent hyperinsulinemia, and antecedent corticosterone on subsequent counterregulation in normal rats." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape2/PQDD_0021/MQ54188.pdf.
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Klöckener, Tim [Verfasser], and Jens [Akademischer Betreuer] Brüning. "Insulin regulates Energy Homeostasis and Hypoglycemia in the Ventromedial Hypothalamus / Tim Klöckener. Gutachter: Jens Brüning." Köln : Universitäts- und Stadtbibliothek Köln, 2012. http://d-nb.info/103837989X/34.
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Liang, Lei [Verfasser]. "Human KCNQ1 mutations cause neonatal diabetes and hyperinsulinemic hypoglycemia : clinical and functional characterization / Lei Liang." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1119803284/34.
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Chaverneff, Florence. "CK2 Contributes to the Synergistic Effects of BMP7 and BDNF on Smad 1/5/8 Phosphorylation in Septal Neurons." Scholarly Repository, 2008. http://scholarlyrepository.miami.edu/oa_dissertations/352.
Full textAbstract:
The combination of bone morphogenetic protein 7 (BMP7) and neurotrophins (e.g. brain-derived neurotrophic factor, BDNF) protects septal neurons during hypoglycemic stress. I investigated the signaling mechanisms underlying this synergistic protection. BMP7 (5 nM) increased phosphorylation and nuclear translocation of BMP-responsive Smads 1/5/8 within 30 min in cultures of rat embryonic septal neurons. BDNF (100 ng/ml) enhanced the BMP7-induced increase in phospho-Smad levels in both nucleus and cytoplasm; this effect was more pronounced after a hypoglycemic stress. BDNF increased both Akt and Erk phosphorylation, but pharmacological blockade of these kinase pathways (with wortmannin and U0126, respectively) did not reduce the Smad phosphorylation produced by the BMP7+BDNF combination. Inhibitors of casein kinase II (CK2) activity reduced the (BMP7 + BDNF)-induced Smad phosphorylation, and this trophic factor combination increased CK2 activity in hypoglycemic cultures. These findings suggest that BDNF can increase BMP-dependent Smad phosphorylation via a mechanism requiring CK2. Preliminary results indicate that a cytoplasmic component robustly inhibits CK2. Protection of septal cholinergic neurons during a hypoglycemic stress is inhibited by a CK2 inhibitor and by a Phosphatidylinositol 3-kinase inhibitor, indicating that increases in CK2 activity and in Smad phosphorylation are only part on the protective mechanisms.
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Oberlin, Douglas J. "Neither recurrent hypoglycemia nor chronic aerobic training alter the content of MCTs in the ventromedial hypothalamus." Thesis, The University of North Carolina at Greensboro, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10154649.
Full textAbstract:
Many individuals with diabetes use medications or exercise to control blood glucose concentrations, which can lead to episodes of hypoglycemia. Although chronic hyperglycemia leads to many diabetic complications, hypoglycemia is an acute threat to the health of individuals, and can lead to myocardial ischemia and arrhythmias, as well as increasing inflammation, oxidative stress, and thrombotic and fibrinolytic processes. Either antecedent exercise or antecedent hypoglycemia lead to a blunted counter-regulatory response to a subsequent hypoglycemia episode. Acute exercise has been shown to increase monocarboxylate transport proteins (MCTs) in the ventromedial hypothalamus (VMH) of the brain, which is involved in regulating the counter-regulatory response to restore euglycemia. The MCTs shuttle lactate in and out of cells, however when is lactate infused into the VMH has been shown to interfere with the counter-regulatory response. Additionally, antecedent recurrent hypoglycemia has been shown to increase lactate transport in the brain. Therefore, the current studies investigated what effect exercise training or recurrent antecedent hypoglycemia had on MCT proteins in the VMH. Adult male Sprague-Dawley rats were used for both studies, randomized to receive either 6-7 weeks of aerobic training, sedentary behavior, 3 days of insulin induced hypoglycemia, or 3 days of saline injection. The increases in cytochrome c oxidase activity among the aerobically trained group showed that training adaptations occurred, however, there were no significant differences in MCT proteins within the VMH between the trained versus sedentary rats. While each of the 3 days of hypoglycemia or saline injection showed differences in 30 minute post-injection glucose concentrations, no significant differences in MCTs were observed in the VMH between the 2 groups on day 4.
27
Dobriansky, V. V. "Risk factors for recurrent hypoglycemia in patients with type II diabetes mellitus in the prehospital stage." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19824.
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Ritrosky, Zulay. "Prevalence of and Risk Factors for Intraoperative Non-Euglycemia Events in Premature Neonates <2500 Grams." Doctoral diss., University of Central Florida, 2010. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2195.
Full textAbstract:
This study examined the rates and risks of premature neonates <2500grams developing intraoperative non-euglycemia events (IONEE). A retrospective chart review of 26 premature neonates <2500 grams who underwent surgical procedures between January 1 and December 31, 2009 was conducted. Statistical analysis was done using Chi square and t-tests. Ten of the 26 subjects (38%) experienced an IONEE. Hyperglycemia was the primary IONEE that was noted in the neonates. (Mean: 143.19; sd: 56.041) Length of surgery was significantly longer in those premature neonates with IONEE than those with euglycemia (71.7 0± 27.03 vs. 45.62 ± 17.98 minutes). All IONEE subjects received general anesthesia (n=10) while none of those with only intravenous anesthesia had an IONEE (X2 (1) = 4.875, p=.027). Subjects with IONEE had a higher mean preoperative glucose level (127.11 gm/dL ± 31.66) than those who did not experienced IONEE (86.36 gm/dL ± 29.39; t(21) = 3.151, p=.005). A higher proportion of subjects who developed IONEE had the capillary heel (60%) as opposed to an arterial (40%) site for blood collection (X2 (1) = 6.518, p =.001). Also, subjects free of preoperative pulmonary complications were more prone to develop IONEE (X2 (1)= 8.60, p = .003). The presence of IONEE was associated with development of metabolic acidosis (X2 (1)= 5.426, p=.020) and lower postoperative pH values (7.19 ± 0.20 vs. 7.35 ± 0.11). Anesthesia providers need to establish intraoperative guidelines for the monitoring and treatment of IONEE to protect these premature neonates from having complications such as developmental delay.D.N.P.
School of Nursing
Other
Nursing Practice DNP
29
Zuzarte, Ian. "A principal component regression analysis for detection of the onset of nocturnal hypoglycemia in Type I diabetic patients." Akron, OH : University of Akron, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=akron1226955083.
Full textAbstract:
Thesis (M.S.)--University of Akron, Dept. of Biomedical Engineering, 2008."December, 2008." Title from electronic thesis title page (viewed 12/12/2009) Advisor, Dale H. Mugler; Committee members, Daniel B. Sheffer, Bruce C. Taylor; Department Chair, Daniel B. Sheffer; Dean of the College, George K. Haritos; Dean of the Graduate School, George R. Newkome. Includes bibliographical references.
30
McMahon, Sarah Kate. "Glucose requirements to maintain euglycaemia during and following moderate intensity afternoon exercise in adolescents with type 1 diabetes mellitus : an insight to the risk of exercise-associated hypoglycaemia." University of Western Australia. School of Paediatrics and Child Health, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0084.
Full textAbstract:
Exercise has a wide range of benefits for patients with type 1 diabetes, including improvements in body composition, cardiovascular risk profile and glycaemic control. Unfortunately, exercise also increases the risk of hypoglycaemia in children with type 1 diabetes, both at the time of exercise and for many hours afterwards. The availability of clear, evidence-based guidelines regarding appropriate adjustments in carbohydrate intake or insulin doses may help to prevent this exercise associated hypoglycaemia. However, current guidelines regarding exercise in children with type 1 diabetes rely heavily on adult literature or the consensus of experts. Therefore, further studies are needed in young people with diabetes to document the metabolic responses during and following exercise. In particular, the mechanisms underlying hypoglycaemia occurring many hours after exercise require further exploration. In addition, as children often exercise in the afternoon, studies performed at this time of the day are more likely to be transferrable to a real life situation. For this reason, we studied adolescents with type 1 diabetes to investigate physiological responses to exercise, focusing on afternoon activity and employing a novel variation of the euglycaemic insulin clamp technique. The core experiments involved studying diabetic adolescents on two occasions in a counterbalanced, paired design during and after afternoon exercise. Insulin was infused at a constant rate based on the subjects' usual daily insulin dose and glucose was infused to maintain euglycaemia. At 1600 hrs subjects either exercised at a moderate intensity (95% of their lactate threshold) for 45 minutes on a cycle ergometer (exercise study), or sat on the ergometer without exercising (rest study). Using this experimental design, it was found that glucose infusion rates (GIR) to maintain euglycaemia were elevated during and shortly following exercise and again from 7-11 hours after exercise compared with the rest study. Counterregulatory hormone levels were similar between the exercise and rest studies except for peaks in noradrenaline, cortisol and growth hormone levels at the end of exercise. Glucagon and adrenaline levels did not increase with exercise. The observed biphasic increase in glucose requirements paralleled the observed clinical risk of hypoglycaemia immediately during exercise and the delayed risk of hypoglycaemia which often occurs overnight.
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Medford, Cynthia D. "In vitro simulation experiments for the implementation of a nocturnal hypoglycemic alarm based on near-infrared spectroscopy." Ohio : Ohio University, 2004. http://www.ohiolink.edu/etd/view.cgi?ohiou1108144876.
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Zuzarte, Ian Jeromino. "A Principal Component Regression Analysis for Detection of the Onset of Nocturnal Hypoglycemia in Type 1 Diabetic Patients." University of Akron / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=akron1226955083.
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Bouchghoul, Hanane. "Déterminants de l’hypoglycémie néonatale et maternelle chez les femmes ayant un diabète gestationnel traité par glyburide Hypoglycemia and glycemic control with glyburide in women with gestational diabetes and genetic variants of cytochrome P450 2C9 and/or OATP1B3 Transplacental transfer of glyburide in women with gestational diabetes and neonatal hypoglycemia risk Assessment of risk of hypoglycemia by anthropometric measurements in neonates of mothers with treated gestational diabetes." Thesis, université Paris-Saclay, 2021. http://www.theses.fr/2021UPASR008.
Full textAbstract:
Le diabète gestationnel (DG), dont la prévalence était de 10,8% en 2016 en France, est associée à une morbidité maternelle et néonatale. Actuellement, le traitement de référence est l’insulinothérapie. Le glyburide est efficace notamment sur le contrôle de l’équilibre glycémique par rapport à l'insuline. Cependant, il serait associé à une augmentation du risque d’hypoglycémie maternelle et néonatale en comparaison à l’insulinothérapie.L’objectif général de cette thèse était de mieux comprendre les déterminants de l’hypoglycémie maternelle et de l’hypoglycémie néonatale à partir d’analyses ancillaires et secondaires issues de l’essai randomisé national INDAO, publié en 2018.Les objectifs spécifiques étaient d’étudier 1-le passage transplacentaire de glyburide à l'accouchement, 2-l'association entre les mesures anthropométriques néonatales (rapport poids-taille (RPT) et poids de naissance) et l'hypoglycémie néonatale chez les femmes bénéficiant d’un traitement médicamenteux du DG, 3-l'association entre l’hypoglycémie maternelle et les variants à fonction diminuée CYP2C9*2 et les variants perte de fonction CYP2C9*3 et OATP1B3*4, puis l'association entre la dose quotidienne de glyburide et les porteurs de variants perte et diminution de fonction.Nous avons montré qu’il existait un passage placentaire du glyburide avec un rapport de la concentration de glyburide fœtus/mère de 0,62 (IC 95% : 0,50-0,74). Le risque d'hypoglycémie néonatale augmentait de manière significative avec l’augmentation de la concentration de glyburide dans le cordon ombilical, indépendamment de la macrosomie néonatale. Ensuite, nous avons montré que le risque accru d'hypoglycémie néonatale est associé de manière indépendante à des valeurs extrêmes du RPT, pour un faible Z-score du RPT (inférieur à -1,28), et un Z-score du RPT élevé (supérieur à 1,28), indépendamment du traitement maternel. Enfin, nous avons constaté un taux augmenté d'hypoglycémie maternelle au début du traitement par glyburide dans le groupe variant comprenant les porteuses de l’allèle CYP2C9*3 et/ou d'OATP1B*4 à l’état homozygote, associé à une augmentation moindre de la dose de glyburide et à une dose plus faible de glyburide atteinte en fin de traitement.Ces travaux apportent de nouvelles connaissances concernant le mécanisme d’action du glyburide chez les femmes enceintes, permettant une meilleure utilisation dans le traitement du DG. Demeurent cependant pour l’enfant les conséquences potentielles à long terme de l’exposition prolongée in utero au glyburideGestational diabetes (GD), whose prevalence in France was 10.8% in 2016, is associated with maternal and neonatal morbidity. Currently, the reference treatment is insulin therapy. Glyburide is effective, particularly in achieving glycemic control, compared with insulin. However, according to some studies, it is associated with an increased risk of maternal and neonatal hypoglycemia compared to insulin therapy.The main objective of this thesis was to better understand the determinants of maternal hypoglycemia and neonatal hypoglycemia based on ancillary and secondary analyses from the national randomized INDAO trial, published in 2018. The specific objectives were to investigate 1-the transplacental transfer of glyburide at delivery, 2-the association between neonatal anthropometric measures (weight-for-length ratio [WLR] and birth weight) and neonatal hypoglycemia in women receiving drug therapy for GD, 3-the association between maternal hypoglycemia and CYP2C9*2 reduced-function variants and CYP2C9*3 and OATP1B3*4 loss-of-function variants, and then in a second step to investigate the association between daily glyburide dose and carriers of loss-of-function and reduced-function variants.First, we showed that there was a placental transfer of glyburide with a fetal/maternal glyburide concentration ratio of 0.62 (95% CI 0.50-0.74). The risk of neonatal hypoglycemia increased significantly with increasing umbilical cord blood glyburide concentration, regardless of neonatal macrosomia. Second, we showed that the increased risk of neonatal hypoglycemia was independently associated with extreme values of WLR, for a low WLR Z-score (less than -1.28) and a high WLR Z-score (greater than 1.28), regardless of maternal treatment. Finally, we found an increased rate of maternal hypoglycemia at the beginning of glyburide treatment in the variant group including carriers of the CYP2C9*3 and/or OATP1B*4 allele in a homozygous state, associated with a smaller glyburide dose increment and a lower glyburide dose reached at the end of treatment.This thesis work provides new insights into the mechanism of action of glyburide in pregnant women, allowing for better use in the treatment of GD. However, the potential long-term consequences for the child of prolonged in utero exposure to glyburide remain
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Kariuki, Anastacia Wanjiku. "The prevalence and nutritional causes of hypoglycaemia in patients with end-stage renal failure (ESRF) on maintenance haemodialysis (MHD) at Kenyatta National Hospital Nairobi, Kenya." Thesis, Link to the online version, 2008. http://hdl.handle.net/10019/1444.
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Eriksson, Björn. "Risker med att patienter som behandlats prehospitalt för hypoglykemi kvarstannar i hemmet." Thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-23851.
Full textAbstract:
Att som ambulanssjuksköterska behandla patienter med hypoglykemi i hemmet är en vanlig åtgärd, i relation till den ökade belastningen på akutmottagningarna är det viktigt att kunna identifiera vilka patienter som behöver transporteras in till sjukhus. De flesta av patienterna vill stanna kvar i hemmet efter behandling, att vara medveten om vilka potentiella risker som finns om patienten stannar kvar hemma kan göra att det är lättare att bedöma vilken patient som bör åka med till sjukhus. Syftet med denna studie är att belysa riskerna med att patienter som behandlas för hypoglykemi kvarstannar i hemmet. Studien genomfördes i form av en litteraturstudie. Sökningar gjordes i databaserna PubMed samt Cinahl. Dessa sökningar resulterade i fyra artiklar som inkluderades i resultatet. Under analysen av artiklarna framkom två problemområden, risk för återkommande hypoglykemi samt bristande uppföljning. För att kunna identifiera de patienterna som har ökad risk för återkommande hypoglykemi krävs en adekvat bedömning av sjuksköterskan samt att det finns beslutsstöd till hjälp. Bristande uppföljning av patienterna är det andra problemområdet, där krävs ett förbättrat samarbete mellan ambulans, sjukhus samt primärvård för att kunna förbättra uppföljningen, analysen visade på att även om risken för återkommande hypoglykemi inom 48 timmar är låg, så har många av patienterna upprepade hypoglykemi episoder sett ur ett längre perspektiv vilket understryker vikten av uppföljning. Där kan ambulanssjuksköterskan vara den som initierar uppföljningen, det är dock viktigt att beslutet tas i samråd med patienten.That as an ambulance nurse treating patients with hypoglycemia in the home is a common practice, in relation to the increased burden on emergency departments, it is important to identify which patients need to be transported to the hospital. Most patients want to stay at home after treatment, to be aware of the potential risks that exist if the patient stays at home can make it easier to determine which patient should go to the hospital. The purpose of this study is to highlight the risks of patients being treated for hypoglycemia remains in the home. The study was conducted in the form of a literature review. Searches were made in the PubMed and Cinahl. These searches resulted in four articles that were included in the results. During the analysis of the articles revealed two problem areas, the risk of recurrent hypoglycemia and inadequate follow-up. In order to identify those patients who are at increased risk for recurrent hypoglycemia requires an adequate assessment of the nurse and that there are decision supportto help. Lack of follow-up of patients is the second problem area, which require improved cooperation between ambulance, hospital and primary care to improve monitoring, analysis showed that although the risk of recurrent hypoglycemia within 48 hours is low, so many of the patients repeated hypoglycemic episodes from a longer perspective, which emphasizes the importance of follow-up. There, ambulance nurse to be the initiating follow-up, it is important that the decision taken in consultation with the patient.
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Metcalf, Kristen Marie. "Effects of moderate to vigorous-intensity physical activity on nocturnal and next day hypoglycemia in adolescents with Type 1 Diabetes." Thesis, University of Iowa, 2013. https://ir.uiowa.edu/etd/2580.
Full textAbstract:
Physical activity (PA) provides many benefits to adolescents with Type 1 Diabetes (T1D); however, adolescents with T1D tend to have lower fitness and PA levels. One reason adolescents with T1D engage in less PA is due to a fear of hypoglycemia. Most studies examining PA in relation to glycemic control measure PA through self-report, thus introducing bias. The purpose of this study was to objectively monitor PA and glucose in adolescents with T1D to examine the temporal associations between moderate and vigorous intensity physical activity (MVPA) and hypoglycemia.
Twenty participants (14 to 19 yr, n=10 females and 10 males) with a T1D diagnosis for at least 1 year were recruited. Participant fitness was evaluated via indirect calorimetry during a maximal treadmill exercise test, and body composition was measured using air displacement plethysmography. An accelerometer (GENEActiv, Activinsights Ltd, Kimbolton, UK) was worn on the wrist continuously for 7 days and the waveform data used to estimate MVPA in min/d. Blood glucose values were simultaneously tracked using continuous glucose monitoring (DexCom SEVEN PLUS, San Diego, CA). After controlling for gender, % body fat (%BF), and fitness, the likelihood of hypoglycemia (¡Ü 70 mg/dl) at nighttime or the next day due to MVPA was examined using logistic regression.
Participants were of avg fitness (females: 43.9 ml/kg/min; males: 49.8 ml/kg/min) and fatness (females: 26.2%; males: 19.2%), and 63.2% of participants met the US federal guidelines of accumulating 60 min/d of MVPA. Hypoglycemia was 22% more likely in those who had 30 min/d more MVPA than those with less (95% CI: 1.03, 1.45; p =0.022).
The results indicate that participating in MVPA increases the risk of hypoglycemia during the night time and the following day. The relationship is independent of gender, %BF and fitness. While promoting PA as a healthy behavior, it is important to educate adolescents with T1D on prevention of hypoglycemia following PA.
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Maltez, José Carlos. "Quantitative EEG analysis : temporal variability and clinical applications /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-522-4/.
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Yngen, Marianne. "Platelet function in diabetes mellitus : relationships to hyperglycaemia, antidiabetic treatment and microangiopathy /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-062-1/.
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Liu, Xu-Jing. "Effects of maternal dietary carbohydrate on phosphoenolpyruvate carboxykinase development in the fetus and neonate." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23282.
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The effect of maternal dietary glucose on perinatal phosphoenolpyruvate carboxykinase (PEPCK) gene expression was investigated in this study. Pregnant rats were fed isoclaoric diets containing graded levels of glucose (0%, 12%, 24% and 60%) from gestation day 2 to lactation day 15. The developmental profiles of PEPCK gene expression in fetal and neonatal liver and kidney were analyzed by northern blot. In the liver, feeding glucose free and glucose restriction (12% and 24%) diets precociously induced PEPCK gene expression at day 21 of gestation. In the kidney, PEPCK mRNA (2.8 kb) was detected at birth in the glucose free group, 12-16 hours postnatally in control group; it was not visualized until day 3 in the 12% and 24% glucose restriction groups. In our study, two species of RNA (1.8 kb and 2.8 kb) were hybridized with PEPCK cDNA probes, and there was a relationship between maternal dietary glucose levels and the 1.8 kb RNA fragment in the kidney.
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Dahlberg, Råger, and Ewa Spets. "Erfarenheter och upplevelser av hypoglykemi hos vuxna med diabetes mellitus : En kvalitativ intervjustudie." Thesis, Högskolan Dalarna, Omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:du-20858.
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Bakgrund: Omkring en tredjedel av personer med diabetessjukdom drabbas någon gång av hypoglykemi med medvetslöshet som följd. Upplevelsen av hypoglykemi var obehaglig och försökte undvikas vilket ofta resulterade i högre plasmaglukosvärden. Omvårdnaden kunde innebära att hjälpa personer att hantera obehagliga upplevelser av hypoglykemi i det dagliga livet. Syfte: Att beskriva vuxnas erfarenheter och upplevelser av hypoglykemi vid diabetes mellitus, samt vilka konsekvenser hypoglykemi leder till i det dagliga livet. Metod: Denna studie har genomförts med en kvalitativ innehållsanalys med induktiv ansats. Studien har genomförts som en sekundäranalys av semistrukturerade intervjuer. Antalet informanter var totalt 29 varav 15 med diabetes typ 1 och 14 med diabetes typ 2. Resultat: Temat som framkom var Hypoglykemi är ständigt närvarande och gestaltar sig olika med följande kategorier: Symtom av hypoglykemi kunde komma som en blixt från en klar himmel, Kunskapen kom genom livets erfarenheter, Träning och motion idag – konsekvenser i morgon, Egenvård kunde upplevas som att inte vara fri, Omgivningens stöd – en trygghet vid sjukdom. Konklusion: Förekomsten av hypoglykemi var vanligt och upplevdes som obehagligt och orsakade rädsla. Underbehandling sågs som en konsekvens. Bättre stöd, hjälp och information från specialistsjuksköterskor efterfrågades. Kunskap och information, även till anhöriga, ansågs viktigt för att minska rädsla och obehag av hypoglykemi.Background: Approximately one third of people with diabetes suffer episodes of hypoglycaemia with a loss of consciousness as a result. The incidence of hypoglycaemia is unpleasant and patients attempt to avoid this event, which often results in higher plasmaglucose values. Dedicated nursing care involves helping people to cope with unpleasant experiences of hypoglycaemia in daily life. Aim: To describe adults' experiences of hypoglycaemia in diabetes mellitus, and the consequences hypoglycaemia leads to daily life. Method: This study was conducted with a qualitative content analysis with an inductive approach. The study was conducted as a secondary analysis of semi-structured interwievs. The number of study participants were a total of 29 of which 15 with Type 1 diabetes and 14 with Type 2 diabetes. Results: The theme that emerged was: Hypoglycaemia is an ever present risk and is shaped differently with the following categories. Symptoms of hypoglycaemia could come as a bolt from the blue. Knowledge comes from life experiences. Training and exercise today - often have consequences tomorrow for patients. Self management could be perceived as a feeling of not being free. Family support – could mean security in illness. Conclusion: The incidence of hypoglycaemia is a common event and is perceived as unpleasant and unsafe event and causing fear in people suffering from diabetes. Undertreatment was seen as a consequence. Better support, help and information from the specialist nurses were needed. Knowledge and information, even to family members, was considered important to reduce the fear and discomfort of hypoglycaemia.
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Blank, Maja, and Lina Johansson. "Fysisk aktivitet hos personer med diabetes typ 1 : Upplevelser och erfarenheter av information och stöd - en kvalitativ studie." Thesis, Uppsala universitet, Åsenlöf: Fysioterapi, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-411490.
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Bakgrund: Fysisk aktivitet vid diabetes typ 1 är viktig. Den kan förbättra blodsockerkontrollen över tid. Det har uttryckts ett behov av vidare studier för att undersöka vilket stöd diabetiker får från sjukvården gällande fysisk aktivitet. Det behöver även undersökas om personer med diabetes upplever rädsla för att vara fysiskt aktiva på grund av risken för hypoglykemi. Syfte: Syftet med denna kvalitativa studie är att via intervjuer undersöka vilket stöd individer med nydiagnostiserad diabetes typ 1 upplever att de får från sjukvården gällande fysisk aktivitet. Studien ska även belysa vilka erfarenheter patienter med diabetes typ 1 har gällande rädsla kopplad till fysisk aktivitet samt vad de anser skulle kunna minska den rädslan. Metod: I studien användes en kvalitativ deskriptiv design och datainsamlingen genomfördes med fem semistrukturerade intervjuer. Databearbetningen gjordes med kvalitativ innehållsanalys. Resultat: Upplevelserna av råden från sjukvården gällande fysisk aktivitet skiljde sig mellan de intervjuade. För dem som haft diabetes kortast tid framstod råden som bra men generella, medan de som levt med sin diabetes en längre tid tyckte att råden var mer individanpassade. Mer individanpassade råd önskades. Ingen av de intervjuade uttryckte specifik rädsla för att vara fysiskt aktiv. Konklusion: Råden diabetiker får från sjukvården är bra men otillräckliga. I framtiden skulle det behövas mer stöd kring fysisk aktivitet i form av träningsspecifika råd och uppmuntran.Background: For people diagnosed with type 1 diabetes physical activity is important. It can improve glucose control over time. A need for further research about the support diabetics receive from healthcare professionals regarding physical activity has been expressed. There is also a need for investigating if diabetics experience fear of being physically active due to the risk of hypoglycemia. Purpose: The purpose of this qualitative study is to explore, through interviews, what support individuals with newly diagnosed type 1 diabetes receive from healthcare professionals regarding physical activity, and how they experience this support. The study will also illustrate what experiences people with type 1 diabetes have regarding fear of being physically active as well as what they believe can reduce that potential fear. Method: The study used a qualitative descriptive design, and data collection was conducted through five semi-structured interviews. Qualitative content analysis was used to process the data. Results: The interviewees’ experiences of the advice from healthcare professionals regarding physical activity was inconsistent. For those who have lived with diabetes for a shorter period of time, the advice was considered good but quite general. Those who have lived with their diabetes for a longer period of time thought that the advice was more individualized. More individualised advice was requested. None of the interviewees expressed specific fear of being physically active. Conclusion: The advice diabetics receives from healthcare professionals is considered good but insufficient. In the future more support will be needed regarding physical activity in the form of exercise-specific advice and encouragement.
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Campbell, Teresa B. S. "ACACB encoding mitochondrial enzyme for carboxylation of acetyl-CoA is a novel disease-causing gene for congenital hyperinsulinemia." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1592171025208869.
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Verdenhalven, Moritz [Verfasser], and Adriana del [Akademischer Betreuer] Rey. "Metabolic changes in the brain as consequence of IL-1-induced hypoglycemia: involvement of MyD88 / Moritz Verdenhalven. Betreuer: Adriana del Rey." Marburg : Philipps-Universität Marburg, 2015. http://d-nb.info/1076865771/34.
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Sarem, Zeinab [Verfasser], and Florian J. [Akademischer Betreuer] Schweigert. "Regulation of IGF-1 bioactivity by dietary hormones, impact of glucagon and insulin-induced hypoglycemia / Zeinab Sarem ; Betreuer: Florian J. Schweigert." Potsdam : Universität Potsdam, 2015. http://d-nb.info/1218399732/34.
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Saugur, Anusooya. "Management of type 2 diabetes mellitus : a pharmacoepidemiological review." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/1635.
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Type 2 diabetes mellitus (DM) is a progressive disease characterised by hyperglycaemia caused by defects in insulin secretion and insulin action. In early stages of type 2 DM, dietary and lifestyle changes are often sufficient to control blood glucose levels. However, over time, many patients experience β cell dysfunction and require insulin therapy, either alone or in combination with oral agents. There are guidelines available to structure the management of this disease state, including both the use of oral hypoglycaemic agents and or insulin. Besides health complications, there are economic burdens associated with the management of type 2 diabetes mellitus. The aim of this study was to determine the management of type 2 DM in a South African sample group of patients drawn from a large medical aid database. The objectives of the study were: to establish the prevalence of type 2 DM relative to age, examine the nature of chronic comorbid disease states, establish trends in the prescribing of insulin relative to other oral hypoglycaemic agents, investigate cost implications, and determine trends in the use of blood and urine monitoring materials by patients. The study was quantitative and retrospective and descriptive statistics were used in the analysis. DM was found to be most prevalent amongst patients between 50 and 59 years old. Results also demonstrated that 83% of DM patients also suffered from other chronic comorbid diseases, with cardiovascular diseases, especially hypertension and hypercholesterolaemia being the most prominent. This study also revealed that DM is predominantly managed with oral hypoglycaemic agents. Changes in drug prescribing, for chronic disease states such as DM may have medical, social and economic implications both for individual patients and for society and it is envisaged that the results of this study can be used to influence future management of DM. Keywords: Pharmacoepidemiology, management, type 2 diabetes mellitus
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Bulsara, Mahesh K. "Epidemiology of severe hypoglycaemia in children and adolescents with type 1 diabetes." Telethon Institute for Child Health Research, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0226.
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[Truncated abstract] Type 1 Diabetes is emerging as a significant public health problem faced by nearly every country in the world. It has major economic and social implications with considerable burden of illness. Approximately 140,000 Australians have been diagnosed with T1DM with an annual increase in incidence rate of 3% per year, comparable to the overall global increase. The management of T1DM requires insulin therapy which places considerable burden on the patient and their carers. Coping with daily insulin injections, dietary changes, modification of physical activity and vigilant monitoring of blood glucose levels, will impact on patient?s quality of life. The optimum goal for the treatment of type 1 diabetes is to safely achieve near-normal glycaemia and failure to maintain this goal accelerates the progression of the devastating long term complications of diabetes. Unfortunately attempts to achieve near normal glycaemia are limited by the risk of excessive lowering of blood glucose levels and hypoglycaemia remains a major barrier to strict glucose control of diabetes. In general this thesis focuses on two fundamental issues related to the epidemiology of severe hypoglycaemia. Namely, methodological consideration when analysing prospective observational data and application of the most robust methodology. A prospective open cohort study of the Princess Margaret Hospital diabetes clinic established in 1992, with 99% case ascertainment was used. This hospital is the only paediatric referral centre for type 1 diabetes and every child diagnosed in the state of Western Australia is treated at this centre. ... The results of this study showed that severe hypoglycaemia remains a major problem and recent approaches to therapy may be allowing a degree of improved control without the expected increased risk of severe hypoglycaemia. The study in chapter 7 investigates genetic risk factors related to severe hypoglycaemia. A significant relationship where the presence of the iv deletion (D) allele of the angiotensin-converting enzyme (ACE) increases risk of severe hypoglycaemia has been reported. This study concludes that the presence of D allele of the ACE gene does not predict a significantly higher risk of severe hypoglycaemia. In an attempt to optimize glycemic control, patients may suffer multiple episodes of severe hypoglycaemia which can adversely affect quality of life as well as educational and intellectual disadvantage. The study in chapter 8 investigates the factors related to recurrent severe hypoglycaemia. A rigorous and informative time-to-event approach is used to account for within child correlation, staggered enrolment and timevarying covariates. This allows important risk factors to change over time. Preschool children have an increased risk of experiencing recurrent severe hypoglycaemia. The findings of this thesis highlights the importance of selecting appropriate analytical methodology to identify risk factors associated with severe hypoglycaemia and also to dismiss factors that had previously been thought to be important. This will help in formulating management plans in order to limit the impact of severe hypoglycaemia.
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Louey, Samantha 1977. "The effects of intrauterine growth restriction on postnatal growth, arterial pressure and the vasculature." Monash University, Dept. of Physiology, 2003. http://arrow.monash.edu.au/hdl/1959.1/7939.
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Banin, Marcia Regina. "Caracteristicas clinicas, antropometricas e laboratoriais de pacientes com glicogenose." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313374.
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Orientador: Gabriel HesselDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Racional - As doenças de depósito de glicogênio compreendem um grupo de doenças geneticamente determinadas e classificadas em 11 tipos, de acordo com as deficiências enzimáticas identificadas. Há pouca informação sobre a evolução dessas doenças. Objetivos - Descrever as características clínicas e laboratoriais, na admissão e evolução, de pacientes com doença de depósito de glicogênio. Pacientes e métodos ¿ Participaram do estudo 22 pacientes com diagnóstico de glicogenose hepática, sendo 11 (50%) do sexo feminino. O estudo foi descritivo e longitudinal. A ficha de coleta de dados constituiu-se de informações iniciais de: quadro clínico, peso, estatura, índice de massa corporal (IMC) e resultados dos exames laboratoriais (hemograma, enzimas hepáticas, colesterol total e frações, triglicérides, glicemia, ácido úrico, uréia e creatinina). Selecionou-se os momentos 1 (admissão), 3 (12 meses de evolução) e 7 (36 meses de evolução) para coleta dos seguintes dados: peso, estatura, IMC, ácido úrico, glicemia, colesterol e triglicérides. Também, foram comparados os resultados de antropometria e exames bioquímicos dos pacientes em dois momentos: admissão e última consulta. Para as variáveis peso e estatura, calculou-se o Z escore sendo considerado déficit quando o valor se situava abaixo do segundo desvio padrão. A velocidade de crescimento foi calculada a partir da 2ª e 1ª consulta (V1) e a partir da última e penúltima consulta (V2). A taxa de aderência foi determinada pela porcentagem de absenteísmo das consultas da seguinte forma: boa: se absenteísmo menor que 20%; regular: se absenteísmo entre 20% e 40% e ruim: se absenteísmo maior que 40%. Utilizou-se como teste estatístico a análise de variância e os testes de Kruskal-Wallis, Mann-Whintney e Wilcoxon, sendo o nível de significância adotado de 5%. Resultados - A média da idade de início dos sintomas foi de 10,7 meses e do diagnóstico de 28,18 meses. O tempo médio de seguimento foi de 105 meses. As manifestações clínicas iniciais mais freqüentes foram: hepatomegalia em 21 (95%), abdômen protuberante em 19 (86%), face de boneca em 14 (64%), diarréia em 10 (45%) e história de hipoglicemia em 8(36%). Nos exames laboratoriais, observou-se, na maioria dos casos, aumento das enzimas hepáticas, hipercolesterolemia, hipertrigliceridemia e hipoglicemia. Na admissão, o déficit de peso/idade foi de 26% (5/19) e de estatura/idade foi de 35% (7/20). Não houve diferença estatística na comparação do Z escore de peso/idade, estatura/idade, índice de massa corporal e exames laboratoriais na admissão, com 12 e 36 meses. Entre a admissão e a última consulta, observou-se diferença significativa no índice de massa corporal, enzimas hepáticas, glicemia e triglicérides, o que não aconteceu com Z escore de peso/idade, estatura/idade e os exames de ácido úrico e colesterol. A taxa de aderência foi considerada boa em 64% dos pacientes. Na comparação da velocidade de crescimento, observou-se tendência de aumento comparando V1 com V2. Conclusões ¿ Houve demora no encaminhamento ao centro de referência para o diagnóstico das glicogenoses. As manifestações clínicas mais freqüentes foram abdômen protuberante e hepatomegalia e as alterações laboratoriais mais significativas foram a elevação dos triglicérides, colesterol e diminuição da glicemia. Na evolução, não houve diferença nos parâmetros antropométricos, mas uma tendência de melhora de velocidade de crescimento. O tratamento melhorou o desarranjo metabólico
Abstract: Background ¿ Glycogen storage diseases comprise a group of genetic diseases determined and classified into 11 types, according to the identified enzymatic deficiency. There is little information regarding the disease evolution. Aim ¿ Describe clinical and laboratorial characteristics in the admission and evolution of patients with glycogen storage disease. Patients and methods ¿ Twenty-two patients with hepatic glycogen diagnosis participated in the study, 11 (50%) of which were female. The study was descriptive and longitudinal. The collected data file consisted of admission information: clinical features, weight, height, body mass index (BMI) and laboratorial exam results: hemogram, hepatic enzymes, total cholesterol and fractions, triglycerides, glycemia, uric acid, urea and creatin. Afterwards, the following phases were selected: 1 (admission), 3 (12 months of evolution) and 7 (36 months of evolution) for the weight, height, BMI and laboratorial tests: uric acid, glycemia, total cholesterol and triglycerides. The antropometric data, hepatic enzymes and mentioned tests were compared during 2 moments: admission and last appointment of each patient. The score Z was utilized to evaluate the weight and height of patients, considered if the standard deviation was under 2. The growth velocity was calculated among the second and first consult and the last and the penultimate consult. The adherence percentage was determined by the appointment absence percentage: Good: absenteeism minor 20%; regular: absenteeism major 20% and minor 40%; bad: absenteeism major 40%. The statistical tests applied were ANOVA, Kruskal-Wallis, Mann-Whintney, and Wilcoxon. The significance level was 5%. Results - The mean time during the first symptoms was 10,73 months and the mean time up to diagnosis was 28,18 months. The mean time of follow-up was 105 months. The most frequent initial clinical manifestations were: hepatomegaly in 21 (95%), protuberant abdomen in 19 (86%), doll face in 14 (64%), diarrhea in 10 (45%) and history hypoglycemia in 8 (36%). In the admission the deficit of the weight to age was 26% (5/19) and height to age was 35% (7/20), In the initial biochemical tests showed elevation of hepatic enzymes, hypercholesterolemia, hypertriglyceridemia, hypoglycemia. There was no statistical difference among the score Z weight to age, score Z height to age, body mass index and laboratorial tests of admission within 12 and 36 months. Significant differences were observed in BMI, hepatic enzymes, glycemia and triglycerides between the first and the last appointments, opposing to the score Z weight to age, score Z height to age, uric acid and cholesterol exam results. In the comparison of the growth velocity there was elevation tendency between the V1 and V2. There was difference significative of the growth velocity among the first and second versus the penultimate and the last consult. The adherence percentage was considered good in 64%. Conclusions - The patients delayed in seeking the reference center for glycogenosis early diagnosis. The most frequent clinical manifestations were protuberant abdomen, hepatomegaly, elevation of triglycerides and cholesterol, and glycemia reduction. In the evolution, there wasn¿t difference statistic in the antropometric parameters, but there was improvement tendency on the growth velocity. The treatment has improved the metabolic derangement
Mestrado
Saude da Criança e do Adolescente
Mestre em Saude da Criança e do Adolescente
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ALEIXO, Grazielle Anahy de Sousa. "Comparação da glicemia em cães utilizando o glicosímetro portátil e o método de referência laboratorial." Universidade Federal Rural de Pernambuco, 2006. http://www.tede2.ufrpe.br:8080/tede2/handle/tede2/5673.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The increase or decrease in the glucose concentration in the blood is a common endocrine alteration in human beings and animals that can cause serious consequences to their health condition. Dosing the glucose of patient with hypo or hyperglycemia allows the same ones to receive appropriate treatment, propitiating a better life quality. The present work had as object to determine the glycemic values of dogs using a portable glucometer (Accu-Chek® Advantage / Roche) projected for human patients, and to compare the results obtained with that equipment to those acquired with the enzymatic-colorimeter (GOD-POD) according to Trinder laboratorial method, since it is considered a standard technique. Once proving that exists a good correlation among the results obtained with the two methods, it becomes possible for the Veterinary Doctors to use the glucometer in their routine with the intention of diagnosing alteration in their patients' glycemia and nevertheless, obtain important information that will help to govern the therapeutic conducts in animals with diseases such as Diabetes mellitus. Another purpose of this work was to describe which factors can alter the precision of the results obtained with the portable glucometer. For the development of the research 53 animals of the canine species, of varied age, sex, weight and breed, assisted at the Veterinary Hospital of the Department of Veterinary Medicine (DMV) of the Rural Federal University of Pernambuco (UFRPE) were used). In 17 patients it was observed factors of risks that could alter the precision of the results in the glucometer, such as low hematocrit, inadequate soak of the test strip, a part of the sample was over the reagent strip or still, the accomplishment of the test passed the 15 seconds recommended by the manufacturer of the equipment, and as consequence, only 36 animals were considered eligible for the study of the evaluation of the portable glucometer in relation to the laboratorial method. It was concluded that the glucose dosage in dogs using the portable glucometer Accu-Chek® Advantage can be considered clinically useful, because the differences obtained among the methods are inside of the margin established by the regulators entities of the area.
O aumento ou a diminuição da taxa de glicose no sangue é uma alteração endócrina comum em seres humanos e animais, e que pode ocasionar graves conseqüências ao estado de saúde dos mesmos. Dosar a glicose sangüínea de pacientes portadores de hipo ou hiperglicemia permite que eles recebam adequado tratamento, propiciando uma melhor qualidade de vida. O presente trabalho teve como objetivo determinar os valores glicêmicos em cães utilizando um glicosímetro portátil (Accu-Chek® Advantage / Roche Diagnóstica Brasil Ltda.) projetado para pacientes humanos, e comparar os resultados obtidos com esse equipamento àqueles conseguidos com o método laboratorial enzimático-colorimétrico (GOD-POD) segundo Trinder, que é considerado uma técnica padrão. Uma vez comprovada que existe uma boa correlação entre os dois métodos, torna-se possível para os Médicos Veterinários utilizarem o glicosímetro na sua rotina com o intuito de diagnosticar alterações na glicemia de seus pacientes e, ainda assim, obterem informações importantes que vão ajudar a reger as condutas terapêuticas em animUma outra finalidade deste trabalho foi descrever quais fatores de risco podem alterar a precisão dos resultados obtidos com o glicosímetro portátil. Para o desenvolvimento da pesquisa foram utilizados 53 animais da espécie canina, de idades, sexos, pesos e raças variadas, atendidos no Hospital Veterinário do Departamento de Medicina Veterinária (DMV) da Universidade Federal Rural de Pernambuco (UFRPE). Em 17 pacientes foram observados fatores que poderiam alterar a precisão dos resultados no glicosímetro, como baixo hematócrito, embebição inadequada da tira teste, uma parte da amostra ficou por cima da tira reagente ou ainda, a realização do teste ultrapassou os 15 segundos recomendados pelo fabricante do equipamento e, como conseqüência, apenas 36 animais foram considerados elegíveis para o estudo da avaliação do glicosímetro portátil em relação ao método laboratorial. Concluiu-se que a dosagem de glicose em cães utilizando o glicosímetro portátil Accu-Chek® Advantage pode ser considerada clinicamente útil, pois as diferenças obtidas entre os métodos estão dentro da margem estabelecida pelos órgãos reguladores da área.
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Santos, Joana Cuba Macedo dos. "Insulinoma em furões." Master's thesis, Universidade de Lisboa. Faculdade de Medicina Veterinária, 2016. http://hdl.handle.net/10400.5/11732.
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Dissertação de Mestrado Integrado em Medicina Veterináriajoana.cmds@gmail.com
Os primeiros casos de insulinoma no furão (Mustela putorius furo) aparecem documentados na literatura nos anos 80, sendo hoje em dia uma das neoplasias mais diagnosticadas nesta espécie. A neoplasia das células Beta dos ilhéus pancreáticos, mais frequentemente designada por insulinoma, produz os seus efeitos através da hipersecreção de insulina e é a hipoglicémia resultante que acaba por se traduzir numa variedade de sinais clínicos. Este estudo descreve a apresentação clínica, o diagnóstico, as opções terapêuticas e o prognóstico do insulinoma, dada a relevância clínica desta patologia no furão doméstico. Foram seguidos 10 casos durante o período de estágio curricular, que pretendem ser um reflexo daquilo que pode ser encontrado na prática clínica. Os sinais clínicos predominantes na amostra foram a perda de peso, apatia, vómito e ptialismo (n=7), sendo a apresentação crónica, com desenvolvimento lento de sinais ao longo de semanas ou meses, a mais observada (n=6). O diagnóstico foi obtido presuntivamente na maior parte dos casos, pois a confirmação histopatológica só foi possível em 3 animais. A determinação da concentração da glucose sanguínea com o glucómetro e a ecografia abdominal foram os exames complementares que se revelaram mais valiosos para o diagnóstico. A maioria dos furões (n=8) recebeu um tratamento combinado, médico e cirúrgico. O tratamento médico consistiu sobretudo na administração de glucocorticoides (prednisona) com adição de diazóxido, e o tratamento cirúrgico baseou-se na execução de pancreatectomia parcial. Quatro animais tornaram-se euglicémicos imediatamente após a pancreatectomia, outros quatro passaram para um estado hiperglicémico com necessidade de insulinoterapia e um permaneceu hipoglicémico. Nos animais que demonstraram recidiva de sinais clínicos durante o período de seguimento (n=7), o tempo até recidiva foi, em média, de 181 dias. A eutanásia foi por duas vezes o último recurso, por agravamento do quadro de insulinoma. Por fim, e uma vez que o comportamento biológico do insulinoma no furão difere do de outras espécies, foram também discutidos alguns aspetos comparativamente ao insulinoma no cão.
ABSTRACT - Insulinoma in ferrets - The first reports of insulinoma in ferrets (Mustela putorius furo) began appearing in the literature in the 1980s, and this is now one of the most common neoplastic disease diagnosed in this species. Pancreatic islet beta cell tumors, more commonly known as insulinomas, oversecrete insulin which results in hypoglycemia, causing the wide variety of clinical signs present in this condition. This study describes the clinical presentation, diagnosis, treatment options and prognosis of insulinoma, given the clinical relevance of this condition in the ferret. Ten cases were observed during the curricular internship, and their purpose is to mirror what can be found in a clinical environment on a daily basis. The most common clinical signs were weight loss, apathy, vomiting and ptyalism (n=7), with a chronic onset over the course of weeks or months (n=6). A tentative diagnosis was made in most cases, because histological confirmation was possible in only 3 cases. Measurement of blood glucose concentration with a portable blood glucose meter and abdominal ultrasonography appeared to be the most valuable diagnostic procedures. Most ferrets (n=8) were treated medically and surgically. Medical management consisted of glucocorticoids administration (prednisone) combined with diazoxide, and partial pancreatectomy was performed as surgical therapy. Four pacients became euglycemic in the immediate postoperative period, four others developed postoperative hyperglycemia and required insulin injections, and one remained hypoglycemic. The mean disease-free interval was 181 days, in those cases where recurrence of clinical signs was observed during the follow-up period (n=7). Two ferrets were euthanized due to worsening of the disease. Finally, and once the biological behavior of insulinoma in ferrets is different than that in other species, some comparative aspects of the canine insulinoma were also briefly discussed.