Plasma glucose fasting

It has been proposed that the development of the complications of diabetes mellitus may be linked to oxidative stress and therefore might be attenuated by antioxidants such as vitamin E. Furthermore, it is discussed that glucose-induced vascular dysfunction in diabetes can be reduced by vitamin E treatment due to the inactivation of PKC. Cardiovascular complications are among the leading causes of death in diabetics. In addition, a postulated protective effect of vitamin E (antioxidants) on fasting plasma glucose in type 2 diabetic patients is also mentioned but could not be confirmed in a recently published triple-blind, placebo-controlled clinical trial [3]. To our knowledge, up to now no clinical intervention trials have tested directly whether vitamin E can ameliorate the complication of diabetes. 

Test method Fasting plasma glucose preferred... 

Any woman diagnosed with GDM should be retested at 6 weeks postpartum. If the fasting plasma glucose (FPG) level is normal, then reassessment for DM should occur every 3 years. Family planning for subsequent pregnancies should be discussed, and monitoring for the development of symptoms of DM should be undertaken. 

Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours. 

If initial presentation with Fasting Plasma Glucose (FPG) greater than or equal to 260 mg/dL (14.11 mmol/L) in a symptomatic patient, consider insulin or... 

A comprehensive plan includes ancillary monitoring of lipid profiles, fasting plasma glucose, thyroid function tests, hemoglobin/hematocrit, and electrolytes. 

The recommended screening test is a fasting plasma glucose (FPG). Normal FPG is less than 100 mg/dL (5.6 mmol/L). 

First-line therapy includes nutritional and exercise interventions for all women, and caloric restrictions for obese women. If nutritional intervention fails to achieve fasting plasma glucose levels less than or equal to 105 mg/dL, 1-hour post-prandial plasma glucose concentrations less than or equal to 155 mg/dL, or 2-hour postprandial levels less than or equal to 130 mg/dL, then therapy with recombinant human insulin should be instituted glyburide may be considered after 11 weeks of gestation. 

Weight should be monitored monthly for 3 months, then quarterly. Body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile should be monitored at the end of 3 months, then annually. The use of patient self-assessments are encouraged. 

R. A. Hegele, P. W. Connelly, S. W. Scherer, A. J. G. Hanley, S. B. Harris, L. C. Tsui, B. Zinman, Paraoxonase-2 Gene (PON2) G148 Variant Associated with Elevated Fasting Plasma Glucose in Noninsulin-Dependent Diabetes Mellitus , J. Clin. Endocrinol. Metab. 1997, 82, 3373 - 3377. 

Insulin For patients stabilized on insulin, continue the insulin dose upon initiation of rosiglitazone therapy. Dose rosiglitazone at 4 mg daily. Doses greater than 4 mg daily in combination with insulin are not currently indicated. It is recommended that the insulin dose be decreased 10% to 25% if the patient reports hypoglycemia or if fasting plasma glucose concentrations decrease to less than 100 mg/dL. 

In a placebo-controlled study in 116 patients who responded insufficiently to metformin 2.5 g/day, rosiglita-zone 2 or 4 mg bd was added for 26 weeks (14). HbAlc and fasting plasma glucose improved and hemoglobin fell. Edema was reported in 5.2% of the patients who took rosiglitazone and two patients withdrew because of headache. 

In a 6-month, multinational, open, parallel-group comparison of insulin detemir and protamine zinc insulin in 448 patients with type 1 diabetes, the two treatments produced comparable HbAlc concentrations and fasting plasma glucose concentrations with less within-subject variation in fasting blood glucose with insulin detemir (4). The risk of hypoglycemia was 22% lower with insulin detemir and 34% lower for nocturnal hypoglycemia. 

In 619 patients with type 1 diabetes treated with protamine zinc insulin and insulin lispro, randomized to once-daily insulin glargine or to once-daily or twice-daily protamine zinc insulin for 16 weeks in an open study, there was no difference in the frequency of hypoglycemic episodes, severe hypoglycemia, or HbAic (25). Fasting plasma glucose concentrations were lower with insulin glargine. 

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