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  • Poster presentation
  • Open Access

Evaluation of glucose intolerance in acutely ill severe patients by means of an artificial pancreas

  • 1,
  • 2,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P253

https://doi.org/10.1186/cc2720

  • Published:

Keywords

  • Blood Glucose
  • Insulin Sensitivity
  • Blood Glucose Level
  • Glucose Intolerance
  • Blood Glucose Control

Purpose

To verify the importance of both the M value (glucose disposal rate measured by the glucose clamp method [GC]) and the I/E ratio (administered insulin/energy [glucose] ratio) measured by means of a bedside-type artificial pancreas (STG-22) in acutely ill severe patients.

Materials and methods

Thirty-four patients in whom blood glucose (BG) levels were controlled by means of the artificial pancreas (aim of BG control: 150 mg/dl) were investigated. The first measurement of GC was performed in acute conditions for all the patients, and the second measurement was done 1 week after the first measurement for 20 patients. GC was performed with a clamped BG level of 80 mg/dl and an insulin infusion rate (IIR) of 1.12 and 3.36 mU/kg/min. M1/M3 and I1/I3 indicate the M value (mg/kg/min) and blood insulin level (μU/ml) when the IIR is 1.12/3.36, respectively (normal value of M1: 5–10). M1/I1 and M3/I3 were calculated as the indicator of insulin sensitivity (IS). Patients were classified in four groups (A, B, C, D) according to M1 and the I/E ratio (mU/kcal): A, M1 < 5 and 30 < I/E ratio; B, M1 < 5 and I/E ratio < 30; C, 5 < M1 and I/E ratio < 30; D, 5 < M1 and 30 < I/E ratio. The following parameters were studied: (1) administered energy (glucose) (E), (2) administered insulin (I), (3) SOFA score, (4) M value, (5) daily mean BG level (BGm), (6) blood C-peptide reactivity (CPR), (7) IS, (5) insulin clearance (IC) (ml/kg/min).

Results

(1) There was negative correlation between the I/E ratio and M1/M3 (r = -0.31/r = -0.44). (2) Comparison between A (M1, 3.3 ± 1.1; I/E ratio, 55 ± 20; n = 23) and B (M1, 3.5 ± 0.8; I/E ratio, 18 ± 9; n = 11): there was significant difference in I (P < 0.005), BGm (183 ± 16 vs 153 ± 18, P < 0.005), and IC (19 ± 7 vs 14 ± 4, P < 0.05), but no significant difference in E, M1, CPR, IS, and SOFA score. (3) Comparison between C (M1, 7.3 ± 1.7; I/E ratio, 12 ± 8; n = 15) and D (M1, 7.8 ± 2.2; I/E ratio, 62 ± 44; n = 5): there was a significant difference in I (P < 0.005) and BGm (145 ± 21 vs 168 ± 16, P < 0.05), but no significant difference in E, M1, M3, CPR, IS, IC, and SOFA score.

Interpretation

The I/E ratio was a daily measurable indicator of glucose tolerance. However, there was discrepancy between the M value and the I/E ratio in some patients (groups B, D). the mechanism of the discrepancy was unclear, but the influence of IC and/or an increase of glucose metabolism by BG itself (ex. mass action effect, activation of glucose transporter-2, etc.) in group B, and a decrease of that in group D was speculated, because the M value was measured under a BG level of 80 mg/dl, while the I/E ratio was under BG control aiming at 150 mg/dl.

Conclusions

Measurement of both the M value and the I/E ratio was considered to be useful not only for the evaluation of glucose tolerance, but also for further understanding of the mechanism of glucose intolerance in acutely ill severe patients.

Authors’ Affiliations

(1)
Tokyo Police Hospital, Japan
(2)
National Hospital Tokyo Disaster Medical Center, Japan

Copyright

© BioMed Central Ltd. 2004

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