Blood Glucose in the Neonate and Its Clinical Significance

Cornblath, Marvin; Reisner, Salomon H.

doi:10.1056/nejm196508122730707

Cited by 178 publications

(68 citation statements)

References 19 publications

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“…However, the incremenits in glucose and insulin were small in comparison to the glucagon response. DISCUSSION The initial fall in blood gluicose with subsequent return to euglycemic levels by days 2-3, as well as the sluggishness of insulin secretion in fetal and newborn humans, primates, and other animiifals miiodels is well documented in the literature (20)(21)(22)(23)(24)(25)(26)(27)(28). Plasma glucagon concentrations in the present studies were observed to increase during the first 2 h of life in infants studied both cross-sectionally and longitudinally.…”

Section: Iximated 4% In the Mid Portion Of The Standardmentioning

confidence: 84%

Spontaneous and Amino Acid-Stimulated Glucagon Secretion in the Immediate Postnatal Period

Sperling¹,

DeLamater²,

Phelps³

et al. 1974

J. Clin. Invest.

127

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Section: Iximated 4% In the Mid Portion Of The Standardmentioning

confidence: 84%

Spontaneous and Amino Acid-Stimulated Glucagon Secretion in the Immediate Postnatal Period

Sperling¹,

DeLamater²,

Phelps³

et al. 1974

J. Clin. Invest.

127

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“…During late gestation, glucose and insulin levels are higher than adult levels, and aas are abundant, which parallels low rates of autophagy (4). Immediately after birth, serum levels of glucagon increase and insulin levels fall (6,7), in concert with a rapid decline of glucose and aa concentrations (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Insulin receptor substrate signaling suppresses neonatal autophagy in the heart

Riehle¹,

Wende²,

Sena³

et al. 2013

J. Clin. Invest.

107

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The induction of autophagy in the mammalian heart during the perinatal period is an essential adaptation required to survive early neonatal starvation; however, the mechanisms that mediate autophagy suppression once feeding is established are not known. Insulin signaling in the heart is transduced via insulin and IGF-1 receptors (IGF-1Rs). We disrupted insulin and IGF-1R signaling by generating mice with combined cardiomyocyte-specific deletion of Irs1 and Irs2. Here we show that loss of IRS signaling prevented the physiological suppression of autophagy that normally parallels the postnatal increase in circulating insulin. This resulted in unrestrained autophagy in cardiomyocytes, which contributed to myocyte loss, heart failure, and premature death. This process was ameliorated either by activation of mTOR with aa supplementation or by genetic suppression of autophagic activation. Loss of IRS1 and IRS2 signaling also increased apoptosis and precipitated mitochondrial dysfunction, which were not reduced when autophagic flux was normalized. Together, these data indicate that in addition to prosurvival signaling, insulin action in early life mediates the physiological postnatal suppression of autophagy, thereby linking nutrient sensing to postnatal cardiac development.

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“…15 Routine measurement of neonatal blood glucose shows that 5% of apparently normal neonates have CBG <1.7 mmol/L in the first few hours of life. 16 Many experts, however, feel that symptomatic hypoglycaemia and a measured glucose of <2.5 mmol/L should be managed aggressively. 17 Others have recommended intravenous glucose for infants with glucose <1.4 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

et al. 2017

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Aims: The aim of this study was to report on the practicality, feasibility and impact of implementing the National Institute for Health and Care Excellence (NICE) guidelines for the control of diabetes in women during labour and birth. Methods: We analysed case records of pregnant women with diabetes who delivered in the period between July 2014 and June 2015. The data were collected in relation to the availability of a plan in the notes, capillary blood glucose (CBG) monitoring, use of variable rate intravenous insulin infusion (VRIII), maintenance of CBG targets within 4-7 mmol/L, maternal hypoglycaemia during labour and neonatal hypoglycaemia. Results: Fifty-one women with diabetes delivered during this period. Only 45% of women were monitored by complete hourly CBGs until delivery. 27.4% of women had CBG ≥7 mmol/L but only 17.6% were started on VRIII. The VRIII group had a 22.2% incidence of minor maternal hypoglycaemia. Neonatal hypoglycaemia occurred in 47% of the babies. Conclusion: A CBG target of 4-7 mmol/L during labour and initiation of VRIII when levels are above this target in pregnant women with diabetes is difficult to achieve and is associated with some maternal hypoglycaemia. Repeat CBG measurements within half an hour and strict adherence to clear guidelines and protocols supported by more education and adequate staffing may improve results.Br J Diabetes 2017;17:ONLINE AHEAD OF PUBLICATION

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Blood Glucose in the Neonate and Its Clinical Significance

Cited by 178 publications

References 19 publications

Spontaneous and Amino Acid-Stimulated Glucagon Secretion in the Immediate Postnatal Period

Spontaneous and Amino Acid-Stimulated Glucagon Secretion in the Immediate Postnatal Period

Insulin receptor substrate signaling suppresses neonatal autophagy in the heart

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

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