c-peptide and Diabetic-Coma

Topics: Aged; Biomarkers; C-Peptide; Diabetes Mellitus, Type 1; Diabetic Coma; Diabetic Nephropathies; Female; Humans; Hypoglycemic Agents; Insulin; Male; Middle Aged; Nutrition Disorders; Patient Selection; Pregnancy; Pregnancy in Diabetics

Topics: Artificial Organs; Blood Glucose; C-Peptide; Circadian Rhythm; Computers; Diabetes Mellitus, Type 1; Diabetic Coma; Humans; Hypoglycemia; Insulin; Islets of Langerhans; Pancreas; Prostheses and Implants; Somatostatin; Sulfonylurea Compounds

Topics: Adolescent; Blood Glucose; Body Mass Index; C-Peptide; Diabetes Mellitus; Diabetes Mellitus, Type 2; Diabetic Coma; Diabetic Ketoacidosis; Glycated Hemoglobin; Humans; Insulin; Japan; Male; Obesity

Diabetic hyperosmolar coma is a syndrome of marked hyperglycemia and minimal ketoacidosis. In general, the serum glucose concentrations are not predictive of the serum ketoacid concentrations in acutely decompensated diabetes. The endocrine factors that modulate glucose concentrations may be different from those that modulate ketoacid concentrations in patients with acutely decompensated diabetes. To test this hypothesis, regression analysis was used to determine the endocrine and metabolic characteristics that correlated with serum concentrations of glucose and ketoacids in 26 diabetic patients with spontaneous, acute hyperglycemia. All patients had a serum glucose level greater than 390 mg/dl, and ketoacid levels were from 0.17 to 25.5 mM. Multiple regression analysis showed that increased serum glucose concentrations correlated with increased plasma glucagon levels (p = 0.0007, r2 = 0.45), but with no other factors. Increased total ketoacid levels (acetoacetate plus 3-hydroxybutyrate) correlated with increased free fatty acid levels (p = 0.0001), decreased C-peptide levels (p = 0.002), and increased body mass index (p = 0.002) (r2 = 0.72). Body mass index only correlated with ketoacid levels, when it was analyzed with C-peptide and free fatty acid levels. A model is proposed that predicts the serum glucose and ketoacid concentrations in patients with acutely decompensated diabetes. Glucagon modulates the serum glucose concentration in these patients with an absolute or relative insulin deficiency. Total serum ketoacid levels are determined by the serum free fatty acid concentration, residual pancreatic insulin secretion (as reflected by C-peptide), and the patient's body habitus. This model allows for the marked hyperglycemia and minimal ketosis of diabetic nonketotic hyperosmolar coma, as well as the glucose and ketoacid concentrations in other presentations of acutely decompensated diabetes.

Topics: Acute Disease; Adolescent; Adult; Aged; Blood Glucose; C-Peptide; Diabetes Mellitus; Diabetic Coma; Diabetic Ketoacidosis; Fatty Acids, Nonesterified; Female; Glucagon; Growth Hormone; Humans; Hyperglycemia; Hyperglycemic Hyperosmolar Nonketotic Coma; Keto Acids; Male; Middle Aged; Models, Biological; Regression Analysis

Two diabetic children with nonketotic hyperosmolar coma were treated successfully. In one of the patients, plasma-free fatty acids, insulin, C-peptide and two lipolytic hormones (growth hormone and cortisol) were measured serially during the coma. Free fatty acids, insulin, C-peptide, growth hormone and cortisol levels were within normal ranges and subsequently these levels did not change significantly. The results suggest that the normal levels of lipolytic hormones may account for the normal plasma free fatty acids and the absence of ketosis found in children with nonketotic hyperosmolar coma, in contrast to the elevated levels of lipolytic hormones and ketone bodies in ketoacidotic diabetic coma.

Topics: C-Peptide; Child; Diabetes Mellitus, Type 1; Diabetic Coma; Fatty Acids, Nonesterified; Growth Hormone; Humans; Hydrocortisone; Hyperglycemic Hyperosmolar Nonketotic Coma; Insulin; Male

Topics: C-Peptide; Child; Diabetic Coma; Fatty Acids, Nonesterified; Growth Hormone; Humans; Hydrocortisone; Hyperglycemic Hyperosmolar Nonketotic Coma; Insulin; Male