AP24534 Designed for Beginners

Blood glucose was between 2.8 and 3.3 mmol/L (51�C60 mg/dL) in 16 episodes and ��2.8 mmol/L (50 mg/dL) in 13 episodes. Subcutaneous insulin or a continuous IV insulin infusion was administered within 24 selleck kinase inhibitor h of the index dose of IV insulin in 68 episodes; however, there was only one episode of hypoglycemia in this group. No patients received a sulfonylurea. Seventy-five percent of hypoglycemic episodes occurred within 3 h after insulin administration. Hypoglycemia occurred at a median of 2 h [interquartile range (IQR) 1�C3 h] and persisted for a median of 2 h (IQR 2�C3 h). Age, sex or race was not significantly different between the groups with and without hypoglycemia. Patients who experienced hypoglycemia tended to have a lower BMI. Compared with those with an established diagnosis of diabetes, patients without a prior diagnosis of diabetes had an increased risk of experiencing hypoglycemia [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.0�C5.1, P = 0.05]. Similarly, the risk for hypoglycemia STI571 chemical structure was significantly higher in those patients not receiving anti-diabetes medications prior to admission [OR 3.6, 95% CI 1.2�C10.7, P = 0.02], compared with those who were taking them. The mean pretreatment blood glucose level was significantly lower in the nondiabetic patients 6.2 �� 1.9 mmol/L (111 �� 34 mg/dL) as compared with the diabetic patients [10.8 �� 10.3 mmol/L (194 �� 185 mg/dL), P UNC2881 was significantly lower in the hypoglycemic group 5.8 �� 3.5 mmol/L (104 �� 63 mg/dL) as compared with the nonhypoglycemic group [9.0 �� 8.2 mmol/L (162 �� 148 mg/dL), P = 0.04]. Mean nadir blood glucose level after insulin was 2.6 �� 0.5 mmol/L (46 �� 9 mg/dL) in episodes with hypoglycemia versus [8.9 �� 5.7 mmol/L (160 �� 102 mg/dL), P = 0.01) in episodes without hypoglycemia. In 94% of the episodes, dextrose was given with insulin. All patients with hypoglycemic episodes received 25 g of dextrose with insulin, while 7% of patients without hypoglycemia received insulin without concomitant dextrose. Three episodes of hypoglycemia occurred despite receiving dextrose with insulin and a second dose of dextrose 1 h later. Hypoglycemia occurred at 3, 4 and 6 h after insulin in these three episodes. Four patients had multiple episodes of hypoglycemia (three patients with two episodes and one patient with four episodes). All four of these patients were nondiabetic. Discussion Hypoglycemia is common in patients with ESRD and can occur by one or several mechanisms. First, renal insufficiency reduces insulin clearance and results in prolonged insulin action and hypoglycemia. Second, hepatic glucose production is reduced. In the nonfasting state, the liver is the site of all endogenous glucose production through glycogenolysis (75%) and gluconeogenesis (25%) [7].