DIABETES – DAMAGES AND TREATMENTS Edited by Everlon Cid Rigobelo Diabetes – Damages and Treatments Edited by Everlon Cid Rigobelo Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Alenka Urbancic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright karamysh, 2011. Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Diabetes – Damages and Treatments, Edited by Everlon Cid Rigobelo p. cm. ISBN 978-953-307-652-2 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Section A 1 Chapter 1 Management Approach to Hypoglycemia 3 Miriam Ciljakova, Milos Jesenak, Miroslava Brndiarova and Peter Banovcin Chapter 2 Hypoglycemia in Children Attending the Critical Care Medicine in Developing Countries 27 Mohammod Jobayer Chisti, Tahmeed Ahmed, Hasan Ashraf, Abu Syeed Golam Faruque, Sayeeda Huq and Md Iqbal Hossain Part 2 Section B 47 Chapter 3 Brittle Diabetes: A Contemporary Review of the Myth and Its Realization 49 Christina Voulgari and Nicholas Tentolouris Chapter 4 Hypoglycemia in Critically Ill Patients 77 Cornelia Hoedemaekers and Johannes van der Hoeven Part 3 Section C 93 Chapter 5 Inflammation and Hypoglycemia: The Lipid Connection 95 Oren Tirosh Chapter 6 Postprandial Hypoglycemia 117 Mubeen Khan and Udaya M. Kabadi Chapter 7 The Role of the Pituitary-Growth Hormone-IGF Axis in Glucose Homeostasis 127 Stephen F. Kemp VI Contents Chapter 8 Molecular Mechanism Underlying the Intra-Islet Regulation of Glucagon Secretion 139 Dan Kawamori and Rohit N. Kulkarni Part 4 Section D 159 Chapter 9 Insulin Therapy and Hypoglycemia - Present and Future 161 Simona Cernea, Ron Nagar, Gabriel Bitton and Itamar Raz Chapter 10 Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry 183 Susan S. Braithwaite, Lisa Clark, Lydia Dacenko-Grawe, Radha Devi, Josefina Diaz, Mehran Javadi and Harley Salinas Chapter 11 Hypoglycemia Prevention in Closed-Loop Artificial Pancreas for Patients with Type 1 Diabetes 207 Amjad Abu-Rmileh and Winston Garcia-Gabin Chapter 12 Glucose Homeostasis – Mechanism and Defects 227 Leszek Szablewski Part 5 Section E 257 Chapter 13 Neurologic Manifestations of Hypoglycemia 259 William P. Neil and Thomas M. Hemmen Chapter 14 Hypoglycemia Associated with Type B Insulin Resistance 275 Hiroyuki Tamemoto, Shin-ichi Tominaga Hideo Toyoshima, San-e’ Ishikawa and Masanobu Kawakami Part 6 Section F 287 Chapter 15 Role of Incretin, Incretin Analogues and Dipeptidyl Peptidase 4 Inhibitors in the Pathogenesis and Treatment of Diabetes Mellitus 289 Athanasia K. Papazafiropoulou, Marina S. Kardara and Stavros I. Pappas Chapter 16 Zinc Translocation Causes Hypoglycemia-Induced Neuron Death 301 Sang Won Suh Chapter 17 Congenital Hyperinsulinism 321 Xinhua Xiao and Si Chen Chapter 18 Diabetes Control and Hypoglycemia 333 Paul Norwood and Alex Fogel Preface Over the last few decades the prevalence of diabetes has dramatically grown in most regions of the world. In 2010, 285 million people were diagnosed with diabetes and it is estimated that the number will increase to 438 million in 2030. Hypoglycemia is a disorder where the glucose serum concentration is usually low. The organism usually keeps the glucose serum concentration in a range of 70 to 110 mL/dL of blood. In hypoglycemia the glucose concentration remains normally lower than 50 mL/dL of blood. This book comprehensively reviews and compiles information on hypoglycemia in 18 chapters which cover occurrence, damages, treatments and preventions, and relevant discussions about the occurrence of hypoglycemia in neonates, drug-induced and caused by infections in animals. This book is written by authors from America, Europe, Asia and Africa, yet, the editor has tried arrange the book chapters in a issue order to make it easier for the readers to find what they need. However, the reader can still find differ approaches on the same issue in same Section. Section A, which includes chapters 1-2, mainly describes the management approach and Hypoglycemia in children. It includes some treatment methods and their applications. Section B, which includes chapters 3-4, includes a contemporary review about Brittle Diabetes and Hypoglycemia in Critically III patients. It shows the great suffering of people that are affected by this specific disorder. Section C, which includes chapters 5-8, covers the issues related with hypoglycemia’s physiology. Section D, which includes chapters 9 -12, deals with preventions of hypoglycemia and glucose homeostasis. Section E, which includes chapters 13-14, covers hypoglycemia associated with tumors and with type B insulin resistant and also several neurologic manifestations. Section F, which includes chapters 15-18, describes the role of incretin, zinc translocation, hyperinsulinaemic-hypoglycaemia and diabetes control. X Preface Hopefully this book will be of help to many scientists, doctors, pharmacists, chemicals and other experts in variety of disciplines, both academic and industrial. In addition to supporting research and development, this book should also be suitable for teaching. Finally, I would like to thank my daughter Maria Eduarda and my wife Fernanda for their patience. I extend my apologies for many hours spent on the preparation of my chapter and the editing of this book, which kept me away from them. Prof. Dr. Everlon Cid Rigobelo Laboratory of Microbiology & Hygiene, Campus Experimental de Dracena Animal Science Faculty Dracena Brazil [...]... ketones (aminoacetate and hydroxybutyrate acids), lactate, free fatty acids, ammonia level, and 4 Diabetes – Damages and Treatments hormones: insulin, C-peptide, cortisol, growth hormone at the time of low blood glucose level Hypothyroidism ought to be excluded in all patients with low blood glucose level If hypoglycemia was less than 2,8 mmol/l (50 mg/dl), repeated sampling and measurement of counter-regulatory... fasting test may be ended with intravenous glucagon admininstration to evaluate the glycemic response (de Leon et al, 2008) 16 Diabetes – Damages and Treatments Fasting Hypoglycemia Acidosis Fuel Response Possible Disorders Lactic acidosis G– 6– Phosphatase deficiency Fructose 1,6 – diphosphatase deficiency Pyruvate carboxylase deficiency Normal neonates Further Test Gluconeogenic precursors Glucagon stimulation... 18 Diabetes – Damages and Treatments abnormalities Vomiting, hypotension and hypoglycemia can be provoked by a stressful event in a child who weaned high-dose glucocorticoid therapy Milder clinical manifestation may be caused by topical, inhaled or intranasal glucocorticoid preparations Such treatment is advocated for many persons, and combination of these forms may lead to episodic hypoglycemia and. .. necrosis, pancreatitis, severe enteritis and multiple organ failure Etiopathogenesis of hypoglycemia in these patients is often multifactorial: lack of substrate, undernutrition, accelerated glucose consumption, impaired gluconeogenesis, misplaced infusion line, cytokine and drug effect (Langdon et al, 2008) On 22 Diabetes – Damages and Treatments the other hand, an acute illness may reveal latent disorder... use of standard GH stimulation tests is not recommended in newborns, except for safe glucagon test 0,0 3–0 ,1 mg/kg Cortisol and GH levels are measured in a basal sample, and furthermore in 5 consequent samples (0, 60, 90, 120, 150, 180 min) Cortisol and GH sampling half hour after clinically significant and laboratory proved low blood glucose level (≤ 2,2 mmol/l) can confirm GH deficiency, and protect... relatively rare (1:30 000- 1:50 000) but may lead to neurological damage and lifelong handicap Up to 20% of infants suffering from congenital hyperinsulinism exhibits neurological defect (Menni et al, 2001) Approximately 60% of patients with persistent hyperinsulinism present within the first week of life, the 12 Diabetes – Damages and Treatments most severe forms start earliest However, all of the genetic... (1-10 μg/kg/hr) may be helpful in acute management of infants with hyperinsulinism, rising glycemia reflects the changes in gluconeogenesis and glycogenolysis For long-term therapy, glucagon works like as insulin 14 Diabetes – Damages and Treatments secretagogue and is recommended usually in combination with other treatment lowering insulin secretion (Aynsley-Green, 2000) Considerable distinction has... alternative fuel for brain and prevents the neonate to become symptomatic Even in the absence of any nutritional intake, the blood glucose rises significantly within 3 hrs due to counter-regulatory hormone response Therefore, healthy asymptomatic neonates are proposed to avoid the blood glucose measurement during the 6 Diabetes – Damages and Treatments first 2-3 hrs after birth and only glycemia less than... fatty acid, glycerol and ketone bodies) • Serum electrolytes, liver functions and acid – base status, C reactive protein • Ammonia • Amino acids • Total and free carnitine • Acylcarnitine profile • Insulin, C - peptide, growth hormone, IGF1, IGFBP3, cortisol and thyroid hormones • Galactosemia screen • Ketones by dipstick • Organic acids and aminoacids • Reducing substances (galactose and fructose) • Ophthalmic... high-protein diet has been suggested to protect muscle from lack of 20 Diabetes – Damages and Treatments alanin Biochemical studies of leucocytes may confirm the diagnosis of GSD, except type 1 and 0 Glycogen synthase deficiency (GSD 0) is a rare but probably under-diagnosed cause of hypoglycemia Fasting hypoglycemia is ketotic and unlike of other GSD, hepatomegaly is not observed Diagnosis of GSD . DIABETES – DAMAGES AND TREATMENTS Edited by Everlon Cid Rigobelo Diabetes – Damages and Treatments Edited by Everlon Cid Rigobelo. measure plasma substrates: ketones (aminoacetate and hydroxybutyrate acids), lactate, free fatty acids, ammonia level, and Diabetes – Damages and Treatments 4 hormones: insulin, C-peptide,. measurement during the Diabetes – Damages and Treatments 6 first 2-3 hrs after birth and only glycemia less than 2,0 mmol/l requires other intervention (Desphande & Platt, 2005). However,