Abstract Page
Impact of Anticholinergics on Insulin Response to Oral Glucose Load in Patients with Impaired Glucose Tolerance
Background/Objective(s): Postprandial insulin secretion is determined by rate of glucose absorption, rate of gastric emptying, and the rate of insulin-driven metabolism via ‘incretins’. Preliminary data in healthy individuals have indicated a cholinergic basis to incretin-effect however no data exists in patient with impaired glucose tolerance (IGT). We aimed study insulin responses in IGT subjects and healthy controls during 75 g oral glucose tolerance test (OGTT), using an oral anticholinergic hyoscine butyl-bromide (HBB). HBB has high affinity for muscarinic receptors of GI tract smooth muscles and has strong
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Following screening of 25 subjects, 10 impaired glucose tolerance (IGT) patients met study requirements. 10 age, gender and weight match healthy subjects were selected as comparator. In females, all tests were performed within 10 d of the anticipated onset of menses. Baseline characteristics of study participants have been described in Table 1.0.
Samples size of this study was chosen on the basis of practical considerations rather than statistical estimation. However, according to our experience, the calculated sample size will most likely allow to detect large differences (if any) in parameters (> 50%) between the treatments groups.
Protocol & Sampling
The study was conducted as randomized, open label, parallel-group trial. Subjects (n= 20) were asked to avoid any strenuous exercise and maintain their customary dietary intake for 48 h prior to testing days. After an 8h overnight fasting, all tests began after cannulation of the cubital vein kept patent by slow infusion of isotonic saline. They underwent an OGTT (glucose 75 g; t =0 min) with and without pretreatment with HBB (20 mg PO single dose; at t = -30 min) three days apart. Serial blood samples were collected at 0, 30, 60, 90 & 120 min for PG and insulin estimation. Changes in vital signs were monitored throughout test procedure, on both test days.
Blood samples were then collected in glass tubes and
The blood glucose level has very limited range for humans to survive and stay healthy. Generally, people are able to remove excess glucose rapidly from the body but this is not the case when they are diagnosed with diabetes and insulin resistant situations. The lack of insulin resistance can also lead to a decrease in glycogen synthesis and storage as it usually converts glucose to energy for cell’s use (Jensen & et al. 2011). When insulin is produced under insulin resistance, the cells are incapable of using them effectively which then leads to high blood sugar level as ketones and ketoacids are produced as an alternative energy source for the body. The rise of ketoacid causes the blood pH acidic and the patient may also be diagnosed with ketoacidosis (Newton & Raskin 2004). There would also be less intake of lipid and more of stored triglycerides as the lipids are effected by the insulin. As the glucose levels increase, the muscle glucose uptake will decrease while the liver glucose production and blood fatty acid concentration will also increase within the body (Lichtenstein & Schwab 2000). Excess glucose within the blood are converted to fat which can lead to Diabetic Dyslipidaemia and furthermore to obesity, hypertension and
Plasma insulin/glucagon concentration differed significantly. Insulin levels were at their lowest during the fasting time period at about 68 while
By 1968, more than half of the American people relied on television as their principal source of news. What they saw informed, engrossed, and unsettled them. CBS Evening News anchor Harry Reasoner referred to it as “horrors and failures.” The Vietnam War dominated the network newscast as it never had before. Suddenly the war was everywhere. The impact on the American public would indeed be great. It set off a critical reaction to the war within the American media and gave greater credence to arguments against the war that a vocal protest movement had been voicing for some time. The media coverage of the Tet Offensive had a great influence on the eventual outcome of the fighting and its aftermath. Clarence Wyatt, author of Paper
There are many classes of medication which help control normal levels of glucose in the body. These medications work in different ways; sulfonylureas and meglitinides increase insulin production in different pathways, Thiazolidinediones increase insulin sensitivity by increasing the number of cells, Incretin mimetics increase insulin production as well as delay gastric emptying, Dipeptidyl Peptidase works in the gut, releasing incretin resulting in a prolonged secretion of insulin and Sodium glucose cotransporter reduces reabsorption of glucose and excreting excess glucose out of the urine (Demler & Rhoads, 2018).
Many randomised controlled trials involve large sample sizes because many treatments have relatively small effects. The size of the expected effect of the intervention is the main determinant of the sample size necessary to conduct a successful randomized controlled trial. Obtaining statistically significant differences between two samples is easy if large differences are expected. However, the smaller the expected effect of the intervention, the larger the sample size needed to be able to conclude, with enough power, that the differences are unlikely to be due to chance
A descriptive statistic, including frequency, means and standard deviation were used to summarize BG results. Repeated measures model were used to evaluate differences in glucose measurements by the time-lapse
The Tet Offensive played a key role triggering a wave of peak anti-war movements after that. Moreover, after that event, American media “took an increasingly unfavorable view of U.S. public policy” . It was remarkable that in the evening broadcast on February 27, 1968, Walter Cronkite ‘broke the rule’ by giving such comment on CBS evening news: “To say that we are closer to victory today is to believe in the face of the evidence, the optimists we have been wrong in the past. To suggest we are on the edge of defeat is to yield to unreasonable pessimism. To say that we are mired in stalemate seems the only realistic, yet unsatisfactory, conclusion.” At the same time, General Westmoreland was reported to have requested more than 260,000 additional troops by the New York Times. All of these events became a catalyst to a public protest.
In the prescence of inadequate insulin action, a second problem manifest
Diabetes mellitus is a disease characterized by the body’s inability to metabolize glucose. Glucose is the body’s main source of fuel for energy. Too much or too little of it can cause some serious complications in the body. Normal glucose level in the blood should be between 70-120mg/dl. An increased level of more than 250 mg/dl is called hyperglycemia. Signs and symptoms “include the three ‘polys’: polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger)” (Rosdahl, 2012). Other signs and symptoms may include
The thiazolidinediones are a unique class of agents that improve the third parameter, and are therefore also called as the “Insulin sensitizers”.
Blood samples were obtained after a 12 hour fast for assessment of various phenotypes including glucose, insulin, triglycerides, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and very low density lipoprotein cholesterol. In addition, participants ≥ 12 years of age (n=641) underwent a 2 hour oral glucose tolerance test (2hOGTT) where a solution containing 1.75g/kg dextrose (up to 75 g) was ingested and venous blood
Treatments that elevate insulin in the blood independent of the ambient glucose unavoidably bring danger of recurring hypoglycemia. Episodes of hypoglycemia are traumatic, because of the modification in human brain
Before blood continues to the heart, it must first travel through the liver to metabolize the substances from the GI tract. The carbohydrates that are in the food processing through the GI tract that is then transported to the liver is where it creates, stores, and releases glucose. At this point, the liver helps maintain a normal glucose levels within the blood flowing through the hepatic system. If sugar levels (glucose) were to start getting too high, the pancreas will start producing insulin to help the liver maintain the glucose levels. The drugs that the GI tract absorbs usually loses their potency before it reaches circulation of the blood because the liver processes and metabolizes them. At rest the liver consumes about 20% of total body
This study used a large effect size in their sample size calculation. They calculated the required total sample size for an analysis of variance (ANOVA) with an alpha value of 0.05 and power at 80% to be 66, or 22 participants in each group. The actual sample size for this study is 72, or 24 participants per
There are two types of diabetes, type 1 and type 2. Insulin management is needed for type 1 diabetes, because it is an autoimmune disease. Diabetes Mellitus type 2 is controlled by a strict diet. If the diet is not followed, then hypoglycemic proxies and insulin may be necessary to control a steady blood sugar level (Burden M, 2003). The main symptoms of diabetes common in type 1 are, lethargy, stupor, weight loss, breath which smells like acetone, kussmaul breathing (hyperventilation), nausea, vomiting, and abdominal pain. Signs and symptoms that associate with both diabetes type 1 and 2 are, polydipsia, polyphagia, blurred vision, polyuria, and glycosuria. A diagnostic test which supports the signs and symptoms of diabetes is the fasting plasma glucose. This test diagnoses diabetes primarily during pregnancy. Diabetes is confirmed with a level of greater than 126 mg/dl. The patient must remain NPO for at least 8 hours with the exception of water. An oral glucose tolerance test or glucose challenge test is when a patient drinks a beverage containing glucose. The levels being greater