Hyperglycaemia

The possible role of hyperglycaemia in relation to the anti-inflammatory activity of catecholamines has already been discussed. There is a considerable amount of additional evidence that under certain conditions hyperglycaemia produces anti-inflammatory effects. 

Thus it seems that hyperglycaemia can inhibit inflammatory reactions in which hypersensitivity or anaphylactoid-type states are involved, but not, apparently, inflammation produced compound 48/80 or bradykinin . The inhibition of granulation tissue by hyperglycaemia also cannot be explained by the Adamkiewicz hypothesis. That hyperglycaemia can affect certain types of inflammation is not in question, but its role and its limitations have yet to be clarified. 

On the basis of this evidence, it is, therefore, conceivable that some compounds which possess experimental anti-inflammatory activity, may owe this to their ability to elevate blood-glucose. This mode of action does not apply to many anti-inflammatory compounds, and at least one, acetylsalicylic acid, produces hypoglycaemia . 

Chevreul named the other major principles he found in animal fat fatty acids , and showed that they occurred in the proportions of three fatty acids to each glycerol. When separated from the glycerol, fatty acids dissolve in alcohol and, by repeated extraction and precipitation with salts, could be purified sufficiently to form crystals. 

The term lipid includes all compounds that release fatty acids on digestion, so that this definition is more extensive than that of fat. Compounds which are insoluble in water, soluble in organic solvents but not derived from fatty acids have been termed non-saponifiable lipids. They include steroids, terpenes and ubiquinone. 

Fats are solid triacylglycerols, oils are liquid triacylglycerols it is the fatty acid composition of the triacylglycerol that determines its physical properties. Triacylglycerols with a high proportion of unsaturated fatty acids have lower melting points than those rich in sam-rated fatty acids, so the former are oils - that is, they are liquid at room temperature. The unsaturated fatty acids are identified by the number of carbon atoms and the position of the double bonds (see below). 

Fats in the diet are an important source of energy not only for immediate use but particularly for storage. Unfortunately, ingestion of too much fat and hence too much energy contributes to obesity, which is now amajor problem in developed countries and of much concern. Two early findings and two recent ones illustrate the importance of fat metabolism  

These topics are discussed in Chapters 11, 14 and 22. Discussion in this chapter focuses primarily on the metabolism of fats that are fuels and that provide energy for various tissues under different conditions, many of which are common in everyday life. It also provides basic knowledge for the discussion in Chapters 11, 14 and 22. 

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Type 2 diabetes is a heterogeneous and progressive endocrine disorder associated with insulin resistance (impaired insulin action) and defective function of the insulin-secreting (3-cells in the pancreatic islets of Langerhans. These endocrine disorders give rise to widespread metabolic disturbances epitomised by hyperglycaemia. The present classes of antidiabetic agents other than insulin act to either increase insulin secretion, improve insulin action, slow the rate of intestinal... 

PPARy is strongly expressed in adipocytes, and stimulation by TZDs promotes adipogenesis, predominantly in preadipocytes from subcutaneous depots. Increased transcription of transporters and enzymes involved in fatty acid uptake and lipogenesis increases the deposition of lipid in these adipocytes (Table 2). This appears to facilitate a reduction in hyperglycaemia by reducing circulating concentrations of non-esterified... 

Nathan DM, Buse JB, Davidson MB et al (2006) Management of hyperglycaemia in type 2 diabetes a consensus algorithm for the initiation and adjustment of therapy. Diabetologia 49 1711-1721... 

Diabetes mellitus is defined as hyperglycaemia (fasting > 7 mM and/or 2 h postprandial >11.1 mM) due to absolute or relative lack of insulin. The most common forms are type 1 diabetes (prevalence 0.25%), with absolute lack of insulin, and type 2 diabetes (prevalence 4-6%) which is due to the combination of insulin resistance and insufficient insulin secretion. 

Obesity and hyperglycemia 2. 2-AG levels are elevated in mouse adipocytes and epididymal of mice with DIO. AEA and 2-AG levels are elevated in rat insulinoma p-cells, in pancreas of mice with DIO, and in obese women. Patients with obesity or hyperglycaemia caused by type 2 diabetes exhibit elevated levels of 2-AG or of both endocannabinoids in visceral fat or blood, respectively. AEA levels are elevated in the liver of DIO mice 2. CB1 antagonists... 

Gray CS, Taylor R, French JM, Alberti KG, Venables GS, James OF, Shaw DA, Cartlidge NE, Bates D. The prognostic value of stress hyperglycaemia and previously unrecognized diabetes in acute stroke. Diabet Med 1987 4 237-240. 

A relationship between polyol pathway activity and reduction in endothelium-dependent relaxation in aorta from chronic STZ-diabetic rats has recently been reported (Cameron and Cotter, 1992). In agreement with several previous studies (Oyama et al., 1986 Kamata et al., 1989), endothelial-dependent relaxation was defective in the diabetic rats but the deficit was prevented by prior treatment with an AR inhibitor. The mechanism underlying the defect has been speculated to be due to decreased production of endothelium-derived relaxing factor (EDRF) or nitric oxide, NO (Hattori et al., 1991). It has been speculated that these vascular abnormalities may lead to diminished blood flow in susceptible tissues and contribute to the development of some diabetic complications. NO is synthesized from the amino-acid L-arginine by a calcium-dependent NO synthase, which requires NADPH as a cofactor. Competition for NADPH from the polyol pathway would take place during times of sustained hyperglycaemia and... 

The only common side effect associated with IFN-y is the characteristic flu-like symptoms. However, in rare instances and at high doses, adverse clinical reactions have been noted. These have included heart failure, central nervous system complications (confusion disorientation, Parkinsonian-like symptoms), metabolic complications (e.g. hyperglycaemia), and various other symptoms. 

Q87 Urinalysis for glucose monitoring is a good indicator of hypogly-caemia or hyperglycaemia. Blood glucose concentrations should be maintained at a constant level. 

Dysuria refers to difficult or painful urination. Dysuria generally indicates urinary tract infections. Symptoms of hyperglycaemia include polyuria (excretion of abnormally large quantity of urine), polydipsia (excessive thirst), visual disturbances, ketonuria and weakness. 

Clozapine is an atypical antipsychotic that is usually used in patients who are inadequately controlled with other antipsychotics. The reason is that clozapine is associated with a risk of potentially fatal agranulocytosis. As with other atypicals, side-effects of clozapine include occurrence of hyperglycaemia and diabetes. 

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