Blood glucose concentrations reducing

When a-glucosidase activity is inhibited, carbohydrate digestion is prolonged and takes place further along the intestinal tract. This in turn delays and spreads the period of glucose absorption, which reduces the extent of the postprandial rise in blood glucose concentrations. The effectiveness of a-glucosidase inhibitors is dq en-dent on the consumption of a meal rich in complex carbohydrate. 

Figure 13.27 A possible mechanism by which a low blood glucose level could give rise to central fatigue. A low blood glucose level reduces the rate of glucose utilisation in the brain which decreases the ATP/ADP concentration ratio in the presunaptic neurone. This reduces the energy available for synthesis of neurotransmitters, packaging of neurotransmitter molecules into vesicles and exocytosis of neurotransmitter into synaptic cleft. This decreases electrical activity in postsynaptic neurones and hence in the motor pathway.

Avandia contains rosiglitazone, which is a thiazolidinedione that is used as oral antidiabetic therapy. Thiazolidinediones reduce peripheral insulin resistance, resulting in reductions in blood-glucose concentrations. Inadequate response to oral antidiabetic therapy indicates failing insulin release and the impact of the introduction of rosiglitazone is of limited benefit on patient outcomes. Insulin should be considered. 

Delays gastric emptying Generates sensation of fullness Reduces postprandial blood glucose concentration... 

This subject has been reviewed in relation to combined oral therapy. In a systematic review of 63 studies with a duration of at least 3 months and involving at least 10 patients at the end of the study, and in which HbAlc was reported, five different classes of oral drugs were almost equally effective in lowering blood glucose concentrations (13). HbAic was reduced by about 1-2% in all cases. Combination therapy gave additive effects. However, long-term vascular risk reduction was demonstrated only with sulfonylureas and metformin. 

Frequent addition of isophane to a regimen of insulin aspart is unnecessary, as has been shown in a multicenter, multinational, randomized, open study in 368 patients followed for 64 weeks (10). Frequent addition of isophane up to four times daily to insulin aspart did not improve HbAic or change the number of episodes of hypoglycemia compared with regular insulin combined with isophane. Only postprandial blood glucose concentrations were reduced. 

During Ramadan, insulin lispro reduced the number of attacks of hypoglycemia and reduced postprandial blood glucose (4). It also reduced post-snack raised blood glucose concentrations when sugar-rich snacks were used (5). 

The UK Prospective Diabetes Study (3) has shown that timely treatment, by reducing blood glucose concentrations before subjective complaints develop, reduces secondary complications in type 2 diabetes mellitus. 

In 48 patients with type 2 diabetes on diet, gatifloxacin reduced blood glucose concentration by 1.1 mmol/1 (20 mg/dl) (178). In Japan gatifloxacin is contraindicated in patients with diabetes. Low blood glucose concentrations were reported in 75 patients, 58 of who had diabetes (177). 

Cortisol and aldosterone concentrations were reduced by etomidate in adults (403,404), but the clinical relevance was minimal after a single bolus (405). A reduction in cortisol was reported 2 hours after delivery in 40 infants whose mothers received etomidate for cesarean section. There were also nine cases of severe to moderate hypoglycemia in this study, but the changes in blood glucose concentration were not significantly different from those in controls (406). 

Maier JS, Walker S A, Fantini S,FranceschiniMA, GrattonE. Possible correlation between blood glucose concentration and the reduced scattering coefficient of tissues in the near-infrared. Optics Letters 1994, 19, 2062-2064. 

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