Glucose plasma

The dynamics of the plasma glucose concentration can be described by the simple equation  

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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. 

During exercise below 60% VO2 max, there is greater reliance on fuel sources from outside the muscle (plasma glucose and FFAs). Since exercise can be sustained for 3-5 hours at 50% VO2 max and over eight hours at or below 40%... 

There is a small fall in plasma glucose upon starvation, then little change as starvation progresses (Table 27-2 Figure 27-2). Plasma free fatty acids increase with onset of starvation but then plateau. There is an initial delay in ketone body production, but as starvation progresses the plasma concentration of ketone bodies increases markedly. 

In a recent placebo-controlled study, 2 month s vitamin E treatment in patients with type 1 diabetes resulted in a significant dose-dependent fall in glycosylated proteins independent of changes in plasma glucose (Ceriello et al., 1991). Dose-related falls in both labile and stable fractions of haemoglobin Al also occurred. 

When plasma glucose falls to <250 mg/dL, switch to D5W, D5W/half NS, or D5W/NS depending on plasma sodium concentration... 

When plasma glucose drops to 250 mg/dL, decrease insulin infusion rate and continue until acidosis is corrected (i.e., anion gap closes)... 

Maintain plasma glucose between 200 and 250 mg/dL during the first 6-10 h, then between 150 and 200 mg/dL... 

The combined effect of fluids and insulin should decrease plasma glucose by approx 100-200 mg/dL per hour... 

Total cholesterol greater than 240 mg/dL (6.22 mmol/L) High-density lipoprotein less than 40 mg/dL (1.04 mmol/L) Triglycerides greater than 200 mg/dL (2.26 mmol/L) Fasting blood serum or plasma glucose... 

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. 

Symptoms of diabetes plus a casual plasma glucose concentration greater than or equal to 200 mg/dL (11.1 mmol/L). Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss. 

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. 

Diabetes mellitus3 2-Hour Postload Plasma Glucose (Oral glucose tolerance test) Greater than or equal to 126 7.0... 

Preprandial plasma glucose Every 3 months until in goal then every 6 months 90-130 mg/dL (5.0-7.2 mmol/L)... 

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... 

Confirm diagnosis (T plasma glucose, positive serum ketones, metabolic acidosis). 

Replace fluids 2-3 L of 0.9% saline over first 1-3 hours (5—10 mLAkg per hour) subsequently, 0.45% saline at 1 50-300 mLAhour change to 5% glucose and 0.45% saline at 100-200 mLAhour when plasma glucose reaches 250 mg/dL (14 mmol/L). 

At present, antioxidants are extensively studied as supplements for the treatment diabetic patients. Several clinical trials have been carried out with vitamin E. In 1991, Ceriello et al. [136] showed that supplementation of vitamin E to insulin-requiring diabetic patients reduced protein glycosylation without changing plasma glucose, probably due to the inhibition of the Maillard reaction. Then, Paolisso et al. [137] found that vitamin E decreased glucose level and improved insulin action in noninsulin-dependent diabetic patients. Recently, Jain et al. [138] showed that vitamin E supplementation increased glutathione level and diminished lipid peroxidation and HbAi level in erythrocytes of type 1 diabetic children. Similarly, Skyrme-Jones et al. [139] demonstrated that vitamin E supplementation improved endothelial vasodilator function in type 1 diabetic children supposedly due to the suppression of LDL oxidation. Devaraj et al. [140] used the urinary F2-isoprostane test for the estimate of LDL oxidation in type 2 diabetics. They also found that LDL oxidation decreased after vitamin E supplementation to patients. 

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