Glucose infusion

If hypoglycemia develops in the setting of continued ketoacidosis, lower the insulin infusion and administer glucose infusions to maintain euglycemia. Do not stop the insulin infusion... 

Sibson, N. R., Mason, G. E, Shen, J. etal. In vivo 13C NMR measurement of neurotransmitter glutamate cycling, anaplerosis and TCA cycle flux in rat brain during [2-13C]glucose infusion. /. Neurochem. 76 975-978, 2001. 

Avoid prolonged fasting. Glucose infusion during acute episode... 

The above experiments strongly suggest to us that a linear relationship exists between serum or plasma insulin levels over a wide physiological range, and urinary calcium excretion. The calciuric response to arginine or glucose infusion does not occur if insulin secretion is prevented, as evidenced by the data obtained from animals made acutely insulinopenic by mannoheptulose, or more chronically diabetic by streptozotocin. 

Extent and duration of action of various types of insulin as indicated by the glucose infusion rates (mg/kg/min) required to maintain a constant glucose concentration. The durations of action shown are typical of an average dose of 0.2-0.3 U/kg. The durations of regular and NPH insulin increase considerably when... 

A composition based on diketopiperazine derivatives (3,6-bis (N-fumaryl-N-(n-butyl) amino-2, 5-diketopiperazine) has been investigated as a pulmonary drug delivery system, termed Technospheres (Pharmaceutical Discovery Corp., Elmsford, NY) (Pohl et al. 2000 Steiner et al. 2002). The diketopiperazine derivatives self-assemble into microparticles at low pH with a mean diameter of approximately 2 pm. During self-assembly, diketopiperazine derivatives microencapsulate peptides present in the solution. Insulin incorporated in diketopiperazine derivatives (TI) was administered to five healthy humans by the use of a capsule-based inhaler with a passive powder deagglomeration mechanism. Relative and absolute bioavailability of TI in the first 3 hours (0-180 min) were 26 12% and 15 5%, and for 6 hours (0-360 min) 16 8% and 16 6%, respectively (Steiner et al. 2002). The time to peak action for glucose infusion rates was shorter with both IV (14 6 min) injection and inhalation (39 36 min), as compared to SC administration (163 25 min). This rapid absorption of insulin would be beneficial for diabetic patients who need to rapidly affect their glucose levels. 

Whatever the site of the enzyme may be, Keston et al. have recently produced fairly conclusive evidence that glucose, which is reabsorbed by the kidney, is exposed to mutarotase at some stage of the process (117). Glucose infused into the renal artery spills into urine when the renal threshold is exceeded in the same anomeric form as that administered, whereas reabsorbed glucose in the renal vein is mutarotated. Hill has also shown that the anomer infused in excess is excreted in excess (73). 

A 23-year-old woman took chlorpropamide 5-10 g. She needed assisted respiration and cardiac pacing for bradycardia (probably due to blockade of potassium channels), fluid infusion, and forced diuresis for 3 days. Notwithstanding continuous glucose infusion and glucose boluses she relapsed into severe hypoglycemia with convulsions. Only on day 27 was her urine free of chlorpropamide and her blood glucose normal. 

Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction Study Group. Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. British Medical Journal 1997, 314, 1512. 

Fig. 9.7 Dose-response ofAERx iDMS inhaled and injected insulin. (A) Glucose infusion rates (GIR) over 10 h after administration of the different treatments. (B) Dose-response relationship of the AUC-GI Ro no h f°r inhaled insulin vertical bars indicate 95% confidence intervals. (Reproduced with permission from [64]).

Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study) effects on mortality at I year. J Am Coll Cardiol 1995 26 57-65. 

Pentamidine isethionate solution is incompatible and precipitates immediately with cephalosporin and cephalomycin injections when admixed with 5% glucose infusions.16... 

The stability of procainamide in glucose infusions may be improved by the addition of sodium bicarbonate. Patients receiving sodium chloride infusions of procainamide are prone to the risk of heart failure due to sodium load.121122 Quinidine gluconate is incompatible with intravenous infusion sets made of PVC due to drug loss by adsorption.123... 

Bleomycin sulfate should not be diluted in 5% glucose-infusion solutions. Loss of activity of bleomycin was reported with different packaging materials.205 Patients under treatment with bleomycin must avoid driving 206... 

Fig. 2.1 Examples of ultradian oscillations in human insulin secretion and blood glucose concentration (a) during continuous enteral nutrition and (b) during constant glucose infusion. Closer inspection shows that the glucose oscillations lead the insulin oscillations by a few minutes. Redrawn from [39, 40].

Fig. 2.2 Simulation of a mechanism-based model of ultradian insulin-glucose oscillations. Using independently determined parameters and nonlinear relations, the model displays self-sustained oscillations of the correct period with proper amplitudes and phase relationships. The model also responds correctly to a meal as well as to changes in the rate of glucose infusion.

Figure 2.2 presents the results obtained with our mechanism-based model of the ultradian insulin-glucose oscillations [9], Although clearly only a preliminary model of the phenomenon, the applied model passes all of the above tests. The model produces self-sustained oscillations of the correct period and proper amplitudes, and the model also responds correctly both to a meal and to changes in the rate of glucose infusion. The next step is to use the model to predict the outcome of experiments that have not previously been performed. To the extent that the model is successful in such predictions, the hypothesis underlying the model structure gains additional support. 

A first experiment to test the model predictions could be to replace the constant glucose infusion rate GIRq by a harmonically oscillating infusion rate [10] ... 

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