Fasting blood glucose concentration

Insulin detemir has been compared with protamine zinc insulin in 59 patients with type 1 diabetes (3). All used insulin detemir for 6 weeks and protamine zinc insulin for 6 weeks in a randomized order. About 2.35 times higher doses of detemir were necessary than protamine zinc insulin. Fasting blood glucose concentrations were lower at the end of the detemir period and there were fewer attacks of hypoglycemia. 

A 37-year old man with a dilated cardiomyopathy was given furosemide, spironolactone, and candesartan. After 1 year carvedilol was introduced in a maintenance dose of 10 mg/day. HbAic was 5.1% at the beginning of carvedilol treatment. After 9 months of treatment, he started to feel extremely thirsty and lost 10 kg in 3 months. No viral infections or pancreatitis were detected. The HbAic concentration increased to 17%, the blood glucose concentration was 31 mmol/1 (557 mg/dl). Furosemide was withdrawn and the blood glucose concentration fell within a week to 8.9 mmol/1 (160 mg/dl). Carvedilol was then replaced by metopro-lol and after 2 further weeks the fasting blood glucose concentration fell to 5.9 mmol/1 (106 mg/dl). The patient was stable thereafter. 

Ritzel RA, Butler AE, Rizza RA, Veldhuis JD, Butler PC. Relationship between beta-cell mass and fasting blood glucose concentration in humans. Diabetes Care 2006 29 717-718. 

As the pancreatic exhaustion continues, insulin response becomes insufficient and the absolute amount of insulin decreases. Basal blood glucose begins to rise. Once the fasting blood glucose concentration exceeds 120 mg/100 ml there is a further progressive decline in reactive insulin release in response to glucose. Basal insulin, however, still remains elevated. Finally, the early and late phases of insulin secretion disappear, and a decrease in the absolute amount of insulin is noted. 

At this early stage, hypocaloric diet and weight loss is the primary and most important therapy for reducing basal hyperinsulinaemia and insulin resistance and improving fasting blood glucose concentration. 

Whereas most studies have focused on fhe effects of NA on lipid metabohsm, the action of NA on carbohydrate metabohsm is less well understood. After acute NA administration, glucose concentrations have been reported to decrease [435], rise [436] or remain unaltered [437] in rats and humans. Results of glucose tolerance tests after acute NA intake have also been inconsistent [438, 439]. Chronic administration of NA has consistenfly resulted in deterioration of glucose tolerance and elevation of fasting blood glucose concentrations in normal humans [439-441] and impairment of glycemic control in NIDDM patients [440]. These effects are contrary to expectations based on the glucose-FA cycle of Randle and coworkers [38, 39]. If reduction of hpolysis and NEFA availability reduces oxidation... 

Niacin has also been trialled in combination with a statin and its safety compared with a statin alone [64 ]. Flushing occurred in 67% of patients and was the most common treatment-related adverse effect 21% of patients stopped taking niacin for a variety of symptoms and the incidence of adverse effects apart from flushing was 85%. There were three cases of chest pain, which were regarded as serious adverse events. Gastrointestinal discomfort was not uncommon. Fasting blood glucose concentrations rose by 7.7% over the 12 weeks of the study. In contrast in another study there was improved whole-body insulin sensitivity in an open study over 6 months [65 ]. 

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