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Epinephrine And Diabetes

Lactic Acidosis And Insulin Resistance Associated With Epinephrine Administration In A Patient With Noninsulin-dependent Diabetes Mellitus

Lactic Acidosis And Insulin Resistance Associated With Epinephrine Administration In A Patient With Noninsulin-dependent Diabetes Mellitus

Lactic Acidosis and Insulin Resistance Associated With Epinephrine Administration in a Patient With NonInsulin-Dependent Diabetes Mellitus Epinephrine raises plasma lactate concentrations when infused intravenously in normal subjects. We studied a patient with noninsulin-dependent diabetes mellitus who developed lactic acidosis and marked insulin resistance when treated with epinephrine after open heart surgery. Caruso M, Orszulak TA, Miles JM. Lactic Acidosis and Insulin Resistance Associated With Epinephrine Administration in a Patient With NonInsulin-Dependent Diabetes Mellitus. Arch Intern Med. 1987;147(8):14221424. doi:10.1001/archinte.1987.00370080058013 New! JAMA Network Open is now accepting submissions. Learn more. Customize your JAMA Network experience by selecting one or more topics from the list below. Challenges in Clinical Electrocardiography Clinical Implications of Basic Neuroscience Health Care Economics, Insurance, Payment Scientific Discovery and the Future of Medicine United States Preventive Services Task Force JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Facial Plastic Surgery JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA OtolaryngologyHead & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) AMA Manual of Style Art and Images in Psychiatry Breast Cancer Screening Guidelines Colorectal Screening Guidelines Declaration of Helsinki Depression Screening Guidelines Evidence-Based Medicine: An Oral History Fishbein Fellowship Genomics and Precision Health Health Disparities Hypertension Guidelines JAMA Network Audio JAMA Network Conferences Med Men Medical Education Opioid Management Guidelines Peer Review Congress Research Ethics Sepsis and Septic Shock Continue reading >>

Blood Sugar & Other Hormones

Blood Sugar & Other Hormones

Other hormones also affect blood sugar. Glucagon, amylin, GIP, GLP-1, epinephrine, cortisol, and growth hormone also affect blood sugar levels. There are other hormones other than insulin that affect the blood sugar levels in your body. It is important to know about glucagon, amylin, GIP, GLP-1, epinephrine, cortisol, and growth hormone. Glucagon: Glucagon, made by islet cells (alpha cells) in the pancreas, controls the production of glucose and another fuel, ketones, in the liver. Glucagon is released overnight and between meals and is important in maintaining the body’s sugar and fuel balance. It signals the liver to break down its starch or glycogen stores and helps to form new glucose units and ketone units from other substances. It also promotes the breakdown of fat in fat cells. In contrast, after a meal, when sugar from the ingested food rushes into your bloodstream, your liver doesn’t need to make sugar. The consequence? Glucagon levels fall. Unfortunately, in individuals with diabetes, the opposite occurs. While eating, their glucagon levels rise, which causes blood sugar levels to rise after the meal. WITH DIABETES, GLUCAGON LEVELS ARE TOO HIGH AT MEALTIMES GLP-1 (glucagon-like peptide-1), GIP (glucose-dependent insulinotropic polypeptide) and amylin: GLP-1 (glucagon-like peptide-1), GIP (glucose-dependent insulinotropic polypeptide) and amylin are other hormones that also regulate mealtime insulin. GLP-1 and GIP are incretin hormones. When released from your gut, they signal the beta cells to increase their insulin secretion and, at the same time, decrease the alpha cells’ release of glucagon. GLP-1 also slows down the rate at which food empties from your stomach, and it acts on the brain to make you feel full and satisfied. Amylin: Amylin is released a Continue reading >>

Diabetic Ketoacidosis Treatment

Diabetic Ketoacidosis Treatment

Diabetic ketoacidosis is a life-threatening medical condition that is a complication of diabetes mellitus that is not in control. It is more common among type 1 diabetics that have no insulin but it can also be seen in severe cases of type 2 diabetes. In diabetic ketoacidosis, there are ketones in the bloodstream and urine because the fat in the body is broken down with ketones as a byproduct. Diabetic ketoacidosis occurs when the body isn’t making enough insulin by the pancreatic islet cells. In a normal person, insulin is secreted by the pancreas in response to elevated blood sugar levels. The insulin helps glucose (sugar) to enter the cells to be used as cellular fuel. If insulin is absent, the body breaks down fatty acids to be used for fuel. Ketones build up in the urine and blood, leading to the condition known as diabetic ketoacidosis. The main cause is being a type 1 diabetic who has not taken enough insulin. Symptoms of Diabetic Ketoacidosis The signs and symptoms of diabetic ketoacidosis can come on suddenly, within a day or so of having no insulin. When signs and symptoms do show up, the patient may have any or all of the following symptoms: Confusion Breath that smells fruity Shortness of breath Tiredness or weakness Pain in the abdomen Nausea and vomiting Increased frequency of urination Being excessively thirsty Clinical signs that the individual has diabetic ketoacidosis includes have extremely high blood sugar levels as well as elevated levels of ketones in the urine. Causes of Diabetic Ketoacidosis The main source of cellular fuel is glucose. All of the cells of the body rely on glucose to make energy to allow the cells to function in whatever capacity they happen to be in. When insulin is lacking, the body is unable to use glucose as fuel. These caus Continue reading >>

Physiologic Response To Hypoglycemia In Normal Subjects And Patients With Diabetes Mellitus

Physiologic Response To Hypoglycemia In Normal Subjects And Patients With Diabetes Mellitus

INTRODUCTION The brain relies almost exclusively on glucose as a fuel, but cannot synthesize or store much of it. As a result, adequate uptake of glucose from the plasma is essential for normal brain function and survival. Given the survival value of maintenance of the plasma glucose concentration, it is not surprising that very effective physiological and behavioral mechanisms that normally prevent or rapidly correct hypoglycemia have evolved. As a result, hypoglycemia is an uncommon clinical event except in patients who use drugs that lower glucose levels, particularly those with diabetes who use insulin, a sulfonylurea, or a glinide. In addition to being at increased risk for hypoglycemia, diabetic patients treated with insulin often have impaired neurohumoral responses to and few early symptoms of low blood glucose concentrations [1-4]. This topic card will review glucose metabolism and the response to hypoglycemia in normal subjects and in patients with diabetes. The therapeutic approach to hypoglycemia in diabetic patients is discussed separately. (See "Management of hypoglycemia during treatment of diabetes mellitus".) REGULATION OF GLUCOSE HOMEOSTASIS In normal subjects, the extracellular supply of glucose is carefully regulated primarily by insulin and glucagon (figure 1) [1-4]. As plasma glucose concentrations rise after a meal, glucose enters the pancreatic beta-cells. In the cells, the enzyme glucokinase, which phosphorylates glucose to glucose-6-phosphate, may act as the glucose sensor, initiating a sequence of events leading to entry of calcium and insulin release. (See "Pancreatic beta cell function".) Insulin acts to restore normoglycemia primarily through the following two mechanisms: It decreases hepatic glucose production by diminishing both glycogeno Continue reading >>

Effect Of Epinephrine On Glucose Metabolism In Humans: Contribution Of The Liver.

Effect Of Epinephrine On Glucose Metabolism In Humans: Contribution Of The Liver.

Effect of epinephrine on glucose metabolism in humans: contribution of the liver. Am J Physiol. 1984 Aug;247(2 Pt 1):E157-65. Epinephrine causes a prompt increase in blood glucose concentration in the postabsorptive state. This effect is mediated by a transient increase in hepatic glucose production and an inhibition of glucose disposal by insulin-dependent tissues. Epinephrine augments hepatic glucose production by stimulating glycogenolysis and gluconeogenesis. Although its effect on glycogenolysis rapidly wanes, hyperglycemia continues because the effects of epinephrine on gluconeogenesis and glucose disposal persist. Epinephrine-induced hyperglycemia is markedly accentuated by concomitant elevations of glucagon and cortisol or in patients with diabetes. In both cases, the effect of epinephrine on hepatic glucose production is converted from a transient to a sustained response, thereby accounting for the exaggerated hyperglycemia. During glucose feeding, mild elevations of epinephrine that have little effect on fasting glucose levels cause marked glucose intolerance. This exquisite sensitivity to the diabetogenic effects of epinephrine is accounted for by its capacity to interfere with each of the components of the glucoregulatory response, i.e., stimulation of splanchnic and peripheral glucose uptake and suppression of hepatic glucose production. Our findings suggest that epinephrine is an important contributor to stress-induced hyperglycemia and the susceptibility of diabetics to the adverse metabolic effects of stress. Continue reading >>

Amphetamine-like Analogues In Diabetes: Speeding Towards Ketogenesis

Amphetamine-like Analogues In Diabetes: Speeding Towards Ketogenesis

Case Reports in Endocrinology Volume 2015 (2015), Article ID 917869, 4 pages Division of Endocrinology, Diabetes and Metabolism, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, P.O. Box 693, Rochester, NY 14642, USA Academic Editor: Toshihiro Kita Copyright © 2015 Natalia M. Branis and Steven D. Wittlin. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Obesity is common in patients with type 1 and type 2 diabetes. Amphetamine-like analogues comprise the most popular class of weight loss medications. We present a case of a 34-year-old African American female with a history of type 1 diabetes, dyslipidemia, and obesity who developed diabetic ketoacidosis (DKA) after starting Diethylpropion for the purpose of weight loss. Shortly after starting Diethylpropion, she developed nausea, vomiting, and periumbilical pain. Blood work revealed glucose of 718 mg/dL, pH 7.32 (7.35–7.45), bicarbonate 16 mmol/L (22–29 mmol/L), and anion gap 19 mmol/L (8–16 mmol/L). Urine analysis demonstrated large amount of ketones. She was hospitalized and successfully treated for DKA. Diethylpropion was discontinued. Amphetamine-like analogues administration leads to norepinephrine release from the lateral hypothalamus which results in the appetite suppression. Peripheral norepinephrine concentration rises as well. Norepinephrine stimulates adipocyte lipolysis and thereby increases nonesterified fatty acids (NEFA) availability. It promotes β-oxidation of NEFA to ketone bodies while decreasing metabolic clearance rate of ketones. In the setting of acute insulin deficiency these effects ar Continue reading >>

Phaeochromocytoma And Diabetes Mellitus

Phaeochromocytoma And Diabetes Mellitus

Phaeochromocytomas are rare tumors arising from the intra or extra-adrenal chromaffin cells that produce, store and metabolise catecholamines. Ninety percent of them arise from the adrenal medulla and the rest (para-gangliomas) arise from extra-adrenal sites. Most phaeochromocytomas are either solitary or sporadic but sometimes they occur in familial endocrine tumour syndromes such as MEN IIa, IIb, von Recklinghausens neurofibromatosis and von Hipple Lindau disease. The prevalence of phaeochromocytoma can be estimated at 1:2,500 to 1:6,500 patients in Western countries. Phaeochromocytomas occur most often during young- to mid-adult life. Less than 10% of phaeochromocytomas are malignant. New onset hyperglycaemia or worsening of pre-existing diabetes may be the presenting feature in some patients with phaeochromocytoma. Very rarely, a patient with a phaeochromocytoma may present in diabetic ketoacidosis. The first description of the adrenal glands was in 1563 by Bartolomeo Eustachio, while the first study on the tumour of the adrenal glands is attributed to Felix Frankel, who, in 1886, described an 18-year-old woman with bilateral adrenal neoplasms. Later, in 1912, the pathologist Ludwig Pick formulated the descriptive term Phaeochromocytoma (from Greek: phaios, meaning dark, because the cells are stained with potassium dichromate; cromos, which refers to stained cells; kytos, meaning cell and oma meaning tumour). The first surgical removal of a phaeochromocytoma was performed by Cesar Roux in 1926 in Europe and by Charles Mayo in the USA in 1927. Effects of catecholamines on glucose metabolism Normally epinephrine is the predominant catecholamine secreted from adrenal medulla and it gets converted to norepinehrine by methylastion by the glucocorticoid dependant enzyme Continue reading >>

Diabetic Hypoglycemia

Diabetic Hypoglycemia

Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals. According to the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), and based on a sample examined between 2004 and 2005, an estimated 55,819 cases (8.0% of total admissions) involved insulin, and severe hypoglycemia is likely the single most common event.[1] In general, hypoglycemia occurs when a treatment to lower the elevated blood glucose of diabetes inaccurately matches the body's physiological need, and therefore causes the glucose to fall to a below-normal level. Definition[edit] A commonly used "number" to define the lower limit of normal glucose is 70 mg/dl (3.9 mmol/l), though in someone with diabetes, hypoglycemic symptoms can sometimes occur at higher glucose levels, or may fail to occur at lower. Some textbooks for nursing and pre-hospital care use the range 80 mg/dl to 120 mg/dl (4.4 mmol/l to 6.7 mmol/l). This variability is further compounded by the imprecision of glucose meter measurements at low levels, or the ability of glucose levels to change rapidly. Signs and symptoms[edit] Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed with a small amount of carbohydrates eaten or drunk, or it may be severe enough to cause unconsciousness requiring intravenous dextrose or an injection of glucagon. Severe hypoglycemic unconsciousness is one form of diabetic coma. A common medical definition of severe hypoglycemia is "hypoglycemia severe enough that the person needs assistance in dealing with it". A co-morbidity is the issue of hypoglycemia unawareness. Recent research using machine learning methods have proved to Continue reading >>

Diabetes Information

Diabetes Information

Where a dedicated staff means kids come first! Orcutt Union School District Departments Health Services Diabetes Information Type 1 diabetes is disease in which the body can no longer produce insulin. Insulin is normally needed to convert sugar (also called glucose) and other food sources into energy for the bodys cells. It is believed that in people with type 1 diabetes, the bodys own immune system attacks and kills the beta cells in the pancreas that produce insulin. Without insulin, the body cannot control blood sugar, and people can suffer from dangerously high blood sugar levels (called hyperglycemia). To control their blood glucose levels, people with type 1 diabetes take insulin injections. Before the discovery of insulin, type 1 diabetes was a death sentence (and it still is for patients with poor access to insulin). Can Type 1 Diabetes Be Prevented?Unfortunately, the genetic and environmental triggers for the immune attack that causes type 1 diabetes are not well understood, although we know that family members of people with type 1 diabetes are at more risk. There is currently no known way to prevent type 1 diabetes. Continue reading >>

Epinephrine - Diabetes Self-management

Epinephrine - Diabetes Self-management

The fight or flight hormone that gives us a quick boost of extra energy to cope with danger including the danger of low blood glucose. When blood glucose levels drop too low, the adrenal glands secrete epinephrine (also called adrenaline), causing the liver to convert stored glycogen to glucose and release it, raising blood glucose levels. Epinephrine also causes many of the symptoms associated with low blood glucose, including rapid heart rate, sweating, and shakiness. The epinephrine response spurs the liver to correct low blood glucose or at least raise blood glucose levels long enough for a person to consume carbohydrate. Emotions such as fear or excitement also trigger the release of epinephrine and the racing heart and sweaty palms that come with it. This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management. Disclaimer Statements: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information. Continue reading >>

Local Anesthesia With Epinephrine Is Safe And Effective For Oral Surgery In Patients With Type 2 Diabetes Mellitus And Coronary Disease: A Prospective Randomized Study

Local Anesthesia With Epinephrine Is Safe And Effective For Oral Surgery In Patients With Type 2 Diabetes Mellitus And Coronary Disease: A Prospective Randomized Study

To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease. Key words: Diabetes Mellitus; Coronary Disease; Dentistry; Local Anesthesia; Epinephrine; Lidocaine Diabetes mellitus (DM) is recognized as a worldwide epidemic, and the rate of type 2 diabetes mellitus T2DM is increasing. T2DM is a chronic disease that occurs when Continue reading >>

Glucose Levels – The Effects Of Other Hormones

Glucose Levels – The Effects Of Other Hormones

Living with diabetes is hard work. Understanding the changes in your blood glucose level can be frustrating and can lead to burnout. Here’s some information that is not often discussed when the subject of blood glucose level is raised with health care professionals. There are other hormones other than insulin that affect the blood sugar levels in your body. To help you understand your blood glucose level it is important to know about glucagon, amylin, GIP, GLP-1, epinephrine, cortisol, and growth hormone. Glucagon The effects of glucagon are the opposite of the effects induced by insulin. The two hormones need to work in partnership with each other to keep blood glucose levels balanced. Made by islet cells (alpha cells) in the pancreas, glucagon controls the production of glucose and another fuel, ketones, in the liver. Glucagon is released overnight and between meals and is important in maintaining the body’s glucose and fuel balance. It signals the liver to break down its starch or glycogen stores and helps to form new glucose units and ketone units from other substances. It also promotes the breakdown of fat in fat cells. In contrast, after a meal, when glucose from the ingested food rushes into your bloodstream, your liver doesn’t need to make glucose. The consequence? Glucagon levels fall. In people living with diabetes the opposite occurs – while eating their glucagon levels rise, which causes the blood glucose level to rise after a meal. More about glucagon here GLP-1 & GIP GLP-1 (glucagon-like peptide-1), GIP (glucose-dependent insulinotropic polypeptide) and amylin are other hormones that also regulate mealtime insulin. GLP-1 and GIP are incretin hormones. When released from your gut, they signal the beta cells to increase their insulin secretion and, a Continue reading >>

My Next Patient Is Diabetic: What Are The Implications For The Dental Treatment I Provide?

My Next Patient Is Diabetic: What Are The Implications For The Dental Treatment I Provide?

(Peer-reviewed content that will appear in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca – which will be introduced at the beginning of 2013. Diabetes Mellitus Diabetes mellitus (DM) is a disease of glucose, fat, and protein metabolism characterized by hyperglycemia, which results from impaired insulin secretion or varying degrees of insulin resistance, or both. • Types: Type 1 DM, Type 2 DM, Gestational DM Local Anesthetic Precautions Use vasoconstrictors with caution: Routine use of local anesthetic with 1:100,000 epinephrine is generally well tolerated. However, epinephrine has a pharmacologic effect that is opposite to that of insulin, so blood glucose could rise with the use of epinephrine. In diabetic patients with hypertension, post-myocardial infarction, or cardiac arrhythmia caution may be indicated with epinephrine. RECOMMENDATION: Guidelines for diabetic patients are similar to those for patients with cardiovascular conditions: Consider limiting epinephrine to 0.04 mg (2 cartridges of 1:100,000 or 4 cartridges of 1:200,000 epinephrine) and levonordefrin to 0.2 mg. AVOID 1:50,000 concentrations of epinephrine in dental anesthetic and epinephrine-impregnated retraction cord. Drug Interactions Prescribe with caution. Adverse interactions likely: NSAIDs, corticosteroids with: Insulin-dependent DM or noninsulin-dependent DM Concurrent use may increase blood sugar. Chlorpropamide (sulphonylureas) Avoid large doses and long-term use as they raise blood sugar levels and have antagonistic effects (steroids, chlorpropamide). Repaglinide (meglitinides) Concurrent use increases risk of hypoglycemia. Significant interaction – monitor closely: Prednisone will decrease the level or effect of repaglinide by affecting hepatic / intestinal en Continue reading >>

Epinephrine Injection

Epinephrine Injection

Pronunciation: EP i NEF rin Brand: Adrenaclick Two-Pack, Adrenalin, Auvi-Q, EpiPen 2-Pak, EpiPen JR 2-Pak, EPIsnap What is the most important information I should know about epinephrine injection? Seek emergency medical attention after any use of epinephrine to treat a severe allergic reaction. After the injection you will need to receive further treatment and observation. What is epinephrine injection? Epinephrine is a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction. Epinephrine injection is used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis. Epinephrine auto-injectors may be kept on hand for self-injection by a person with a history of an severe allergic reaction. Epinephrine injection may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before using epinephrine injection? Before using epinephrine, tell your doctor if any past use of this medicine caused an allergic reaction to get worse. To make sure epinephrine injection is safe for you, tell your doctor if you have: heart disease or high blood pressure; asthma; Parkinson's disease; depression or mental illness; a thyroid or adrenal gland disorder; or diabetes (you may need to adjust your dose of insulin or other diabetes medication after using epinephrine injection). It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether epinephrine passes into breast milk or if it could harm a n Continue reading >>

The Dawn Phenomenon: What Can You Do?

The Dawn Phenomenon: What Can You Do?

What is the dawn phenomenon that some people with diabetes experience? Can anything be done about it? Answers from M. Regina Castro, M.D. The dawn phenomenon, also called the dawn effect, is the term used to describe an abnormal early-morning increase in blood sugar (glucose) — usually between 2 a.m. and 8 a.m. — in people with diabetes. Some researchers believe the natural overnight release of the so-called counter-regulatory hormones — including growth hormone, cortisol, glucagon and epinephrine — increases insulin resistance, causing blood sugar to rise. High morning blood sugar may also be caused by insufficient insulin the night before, insufficient anti-diabetic medication dosages or carbohydrate snack consumption at bedtime. If you have persistently elevated blood sugar in the morning, checking your blood sugar once during the night — around 2 a.m. or 3 a.m. — for several nights in a row will help you and your doctor determine if you have the dawn phenomenon or if there's another reason for an elevated morning blood sugar reading. What you can do Your doctor may recommend a number of options to help you prevent or correct high blood sugar levels in the morning: Avoid carbohydrates at bedtime. Adjust your dose of medication or insulin. Switch to a different medication. Change the time when you take your medication or insulin from dinnertime to bedtime. Use an insulin pump to administer extra insulin during early-morning hours. Continue reading >>

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