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Glucose Homeostasis: Regulation of Blood Glucose01:02

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Carbohydrates consumed through foods are converted into glucose, a crucial energy source for the body. In the prandial state, high blood glucose levels stimulate the secretion of insulin from the pancreas. Insulin inhibits hepatic glucose production and stimulates glucose uptake and metabolism by muscle and adipose tissue. The excess glucose is converted into glycogen and stored in the liver and muscles.
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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Overview of Carbohydrate Metabolism01:19

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Carbohydrate metabolism is a fundamental biochemical process that ensures a constant supply of energy to living cells. The most important carbohydrate is glucose, which can be broken down via glycolysis to enter into the Krebs cycle and eventually lead to the production of ATP through oxidative phosphorylation.
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The pancreatic islets comprising only 1%-2% of the volume are highly vascularized and innervated mini-organs. They contain five endocrine cell types, including β cells that secrete insulin, which is synthesized as a single polypeptide chain, preproinsulin, processed to proinsulin, and finally to insulin and C-peptide. This process is complex and regulated, involving the Golgi complex, the endoplasmic reticulum, and the secretory granules of the β cell.
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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Glucose control in critical care.

Jeremy Clain1, Kannan Ramar1, Salim R Surani1

  • 1Jeremy Clain, College of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States.

World Journal of Diabetes
|August 13, 2015
PubMed
Summary

Glycemic control in critical care has shifted from tight to moderate targets. Recent research emphasizes hypoglycemia, glycemic variability, and patient history for better outcomes in critically ill patients.

Keywords:
Blood sugar in intensive care unitCritical careDiabetes in intensive care unitGlycemic control

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Area of Science:

  • Critical care medicine
  • Endocrinology
  • Metabolic disorders

Background:

  • Glycemic control in critically-ill patients has evolved significantly over 15 years.
  • Initial focus on hyperglycemia led to intensive insulin therapy.
  • Current understanding acknowledges risks of tight control and emphasizes other factors.

Purpose of the Study:

  • To review key studies on glucose control in critical care.
  • To provide perspective on glycemic management strategies for critically-ill patients.
  • To highlight recent shifts in understanding glucose control.

Main Methods:

  • Literature review of key studies on glycemic control in critical care.
  • Analysis of the evolution of glycemic management strategies.
  • Synthesis of current perspectives on glucose control.

Main Results:

  • Intensive glycemic control (tight control) was initially pursued but found counterproductive.
  • Moderate glycemic control is now the standard in intensive care units.
  • Hypoglycemic episodes, glycemic variability, and premorbid diabetic status are crucial factors influencing outcomes.

Conclusions:

  • Glycemic management in critical care requires a nuanced approach beyond simple glucose targets.
  • Understanding glycemic variability and hypoglycemia is essential for optimizing patient outcomes.
  • Future research should consider these multifactorial aspects in critically-ill patients.