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The clinical and electroencephalographic signs of leucine-induced hypoglycemia in the infant can be alleviated with oral or intravenous administration of sodium glutamate. The improvement occurs in spite of low glucose levels in plasma after intravenous administration; this supports the view that glutamic acid is rapidly metabolized by the brain during hypoglycemia.

1 Ciarias batrachus is sensitive to mammalian insulin but becomes hypoglycemic after several hours of the treatment. The beta cells become degranulated and shrunken in appearance. 2 This species has a low glucose tolerance and becomes hyperglycemic by glucose injection. The beta cells show degranulation, vacuolisation and fusion probably due to hyperfunction but regain their usual form after 36 hours.

RECOGNIZING the evidence for the familial transmission of diabetes, reviewed by White and Pincus (1) and for a low glucose tolerance as the usual precursor of clinical diabetes and the earliest dependable prognostic sign, it seems that the pattern for theinheritance of diabetic traits could be most satisfactorily determined by a study of the inheritance of glucose tolerance. This approach has been used by Pincus and White (2) in man and a similar investigation has been made by the present authors in rats. For several years, the authors (3, 4, 5) and subsequently others (6, 7) have been studying in a strain of rats certain diabetic characteristics: (a) high fasting blood sugar, (b) low glucose tolerance, (c) low R. Q. after glucose, (d) exaggerated response to epinephrin and (e) obesity.

The development of microsclerotia of Verticillium dahliae from a few swollen hyaline cells on a hypha to a multicellular, pigmented "mature" structure is described and illustrated. A method for quantitatively estimating the amount of pigmented microsclerotial material in pure cultures was developed to study quantitative relations between mycelial growth and production of microsclerotial material in media containing different concentrations of glucose. At low glucose concentrations (0.6 to 10 mg/ml) microsclerotial material continued to increase after total dry weight of the cultures had reached a maximum, suggesting conversion of hyaline to pigmented material. At high glucose concentrations (20 to 60 mg/ml) the patterns of increase in total dry weight, microsclerotial material, and hyaline material were similar over a 4-week incubation period. Maximum production of both pigmented and hyaline materials occurred at a glucose concentration of 30 mg/ml (carbon/nitrogen ratio of 50/1).

Summary1. Females of the “Y” strain exhibit a low glucose tolerance similar to that of the males. 2. The estrous cycle has no conspicuous effect on the glucose tolerance. 3. After 240 days of age, the severity of the diabetic curves in the males appears to increase.

Twenty consecutive patients were randomised to receive either a glucose polymer by naso-duodenal tube or glucose by intravenous infusion as nutritional support for 24 h after elective cholecystectomy. Following identical amounts of glucose by the two routes, blood levels of glucose, insulin, C-peptide and pancreatic glucagon were similar except for higher glucose and C-peptide levels in the intravenous group at 4 and 10 h and 10 h after surgery, respectivel. Patients receiving enteral glucose did not have higher insulin and C-peptide levels than patients receiving intravenous glucose. It is concluded that nutritional support by the enteral route alone is feasible immediately following cholecystectomy. The relatively low glucose levels during enteral glucose infusion suggest improved utilisation of glucose as compared to intravenous glucose infusion.

SummaryThe isolated, recirculated, perfused dog pancreas has been used to study the effect of elevated glucose concentrations and GH on the incorporation of 14C labeled amino acids into the insulin containing fraction. The greatest incorporation occurred at the low glucose level. High glucose levels alone and 1 or 3 units of GH at low or high glucose levels caused a reduction of 14C amino acid incorporation into the IRI containing fraction below that seen with low glucose levels alone. Pretreatment of the pancreas donors with GH restored the 14C incorporation to that seen with low glucose alone. The results are discussed.

This article reviews three cases of otherwise clinically normal infants who had low glucose readings via glucose meter at one hour of age. Their diagnosis and treatment is discussed. Parents’narratives as well as case records are included. Psychosocial aspects of the three cases are discussed.

Human diploid fibroblasts deplete 50% of their cellular glycogen by day 4 after subcultivation in 100 mg% glucose medium. The glycogen content increases again as the cells approach confluency. Growth of cells in low glucose medium results in rapid glycogen depletion and indicates that stored glycogen has a limited potential as an energy source.

Publisher Summary This chapter presents the study that directly measured local cerebral glucose use by positron emission tomography (PET) with simultaneous recording of EEG from 16 electrodes spaced over the left hemisphere to maximize spatial resolution. Simultaneous cerebral glucography with positron emission tomography and topographic quantitative electroencephalography is carried out in six normal volunteers. The presence of resting occipital alpha activity is associated with relatively low glucose use consistent with the phenomenon of alpha blocking with visual input. Higher EEG amplitude is associated with higher glucose use in some posterior and central regions. The harmlessness, repeatability, and low cost of EEG topography give it some advantages over the high cost of PET or isotopic regional blood flow techniques. Extended studies are further necessary to define regional relationships; simultaneous PET and EEG studies are able to better characterize metabolic information available in the scalp electrical activity.

A quick computing algorithm to calculate the rate constants ( k*1, k*2, k*3) in the [18F]2-fluoro-2-deoxy-d-glucose (FDG) model was developed. The algorithm solved for the rate constants pixel by pixel using a conventional least-squares method and two tables consisting of a set of various rate constants, to shorten the computing time. Five planes of rate constant images were obtained. A combined study using the dynamic FDG method and the 15O-labeled gas continuous inhalation method was performed on seven healthy male volunteers aged 26–35 years. Results indicated an apparent discrepancy between CMRglu and CMRO2 in the cerebellum, where the low glucose utilization was correlated with a low FDG phosphorylation rate ( k*3) despite a sufficient FDG transportation rate ( k*1) from plasma to tissue.

In order to provide quality control serum in the hypoglycemic range, pooled human serum was treated with yeast. Yeast destroyed about 50% of the serum glucose in about 4 1/2 hrs. The yeast-treated serum remained suitable for quality control of the most commonly analyzed clinical chemistry constituents which showed only very little change in most cases. Serum triglycerides were increased by about 40% and bilirubin decreased by about 20% during the treatment. Lyophilization of serum samples (yeast-treated or not) resulted in significant decreases of some enzymes activities. Exposure at 22 degrees C of samples lyophilized (7 days) and non-lyophilized (4 days) resulted in practically no change except for certain enzymes. No significant differences were observed in the clinical chemistry measurements including glucose one month and three months after preparation of samples lyophilized (stored in a refrigerator) and non-lyophilized (store in a freezer).

1. 1. ATP- d -hexose-6-phosphotransferase activity was measured in red blood cells of man, rabbit, pig and cow. Mean values ranged from 0.60 to 1.06 units/g haemoglobin and no significant difference was obtained with different glucose concentrations. 2. 2. The characteristics of glucose phosphorylating activities in red blood cells of the species studied were similar. 3. 3. Chromatography on DEAE column revealed two different glucose phosphorylating activities in red cells of man, rabbit and pig, and only one in cow red cells. 4. 4.|The first hexokinase activity is the predominant form and is saturated with low glucose concentrations; the second is noticeably marked at high glucose concentrations.

The diffusivity of water, fucose, proline, lysine, glutamic acid, glucose and sucrose was determined in a variety of inflammatory human synovial fluids. In view of the constituents of pathological synovial fluids one would predict impedence to solute movement. In several fluid diffusivity was enhanced relative to translational diffusion in water. In most fluids diffusivity was enhanced relative to diffusion in diluted serum. Diffusivity of the solutes was dependent on size and charge of the solute but independent of fluid characteristics, including glucose, protein, and complement concentrations and cellular constituents. This paper reports aberrant small solute behaviour in synovial fluids. Enhanced diffusivity relative to water was demonstrated in hyaluronate dissolved in diluted serum as well. Hyaluronate domains in the synovial fluids interact with these solutes, facilitating movement. This phenomenon affords a homoestatic mechanism as regards chondrocyte viability in spite of inflammation or a low glucose concentration.

Yucatan miniature pigs have been selectively bred for reduced and increased glucose clearance during an intravenous glucose tolerance test. Pigs with low glucose clearance rates (low K) have been selected through the F-5 generation. They have a significantly reduced rate of glucose clearance and a blunted peripheral IRI increase in response to the challenge. Through the F-5 generation, heritability of glucose tolerance is estimated at 0.26. Sporadic fasting blood glucoses in excess of 100 mg/dl are seen in later generations of this group. High glucose clearance pigs (high K) have been selected through the F-4 generation. They have significantly increased rates of glucose clearance and a greater increase in peripheral IRI than the low K animals. The estimated heritability for high K through the F-4 generation is 0.31. No evidence of fasting hypo- or hyperglycemia has been seen in the high K animals.

An external quality assessment scheme is described for on-ward testing of blood glucose by nursing staff using the Glucometer II/Glucostix system. This involved the distribution of two concentrations of glucose solutions to the wards at 2-week intervals. Initially, results were examined prior to the introduction of a formal training programme for use of the blood glucose meters when the hospital CV was 25 % (low glucose) and 19 % (high glucose). Some improvement was shown after 6 months, with CVs of 13 and 8 %, and a greater improvement after 12 months with CVs of 6 and 8 %, respectively. A ward report was designed to allow easy interpretation of performance by the participants in the scheme. The introduction of this report was well received and generated enthusiasm among the ward staff.

In two experiments, 2-5-year-old children's responsiveness to caloric density cues was examined. In a preloading protocol, consumption of fixed volumes of drinks (205 ml in Experiment 1; 150 ml in Experiment 2), sweetened with sucrose, aspartame, aspartame plus low glucose maltodextrin, or a water control, was followed by ad lib consumption from among a variety of foods. Caloric drinks had about 90 kcal in Experiment 1, 65 kcal in Experiment 2. The delay interval between the preload and the ad lib consumption was 0, 30 or 60 minutes. In Experiment 1, 24 4- and 5-year-old children participated in only one delay interval, while in Experiment 2, all 20 2- and 3-year-old children were seen in all conditions. Results revealed evidence of caloric compensation, but no evidence of preload x time delay interaction. In both experiments, aspartame also produced a significant suppression of intake relative to water, primarily due to the pattern at 30 min following the preload. Across conditions, the suppression following aspartame was usually significantly less than that produced by the caloric sweet drinks, providing evidence for postingestive effects. In Experiment 1, suppression of intake was related to the children's preferences for the foods, not to macronutrient content; consumption of nonpreferred foods was most suppressed. Consumption of sweetened drinks as long as 1 hour prior to eating suppressed food intake, and this common feeding practice may also reduce dietary variety.

The response of serum gastric inhibitory polypeptide (GIP), serum gastrin, and blood glucose to a mixed liquid test meal with a low glucose load was measured in seven controls, in each of five patients after B II resection and proximal duodenopancreatectomy (PDP), and in three patients after jejunoileal bypass. The gastrin and glucose levels behaved as expected. However, in contrast to previously published data with higher glucose loads the integrated GIP response was slightly decreased after B II resection and significantly decreased not only after jejunoileal bypass but also after PDP. Subsequently we studied postprandial GIP release after test meals containing a low and a high glucose load in each of three controls and three patients after PDP. The results confirm a discrepant behavior of GIP release in dependence on the glucose content of the test meal after PDP compared to the controls. The hypothesis is discussed that these results reflect a special dose-effect relationship between glucose and GIP release in man.

To see whether the enhanced evoked release of aspartate and glutamate in the presence of low glucose concentration is due to a decreased glial uptake, the electrical-field stimulation induced release of aspartate and glutamate was measured in rat hippocampal slices in the presence of 5 or 0.2 mM glucose and of graded concentrations of fluoroacetate, a specific inhibitor of glial tricarboxylic acid cycle. In 5 mM glucose, fluoroacetate increased the overflow of both excitatory amino acids equally in a dose-dependent manner, with a maximal effect obtained at 2 mM. This maximal increase of glutamate overflow was about the same as caused by 0.2 mM glucose, but low glucose increased aspartate overflow 5 times more than did fluoroacetate. Fluoroacetate failed to increase any further the large evoked overflow of either glutamate or aspartate induced by 0.2 mM glucose. The absence of an additive effect of fluoroacetate and of low glucose suggests that under both conditions the increased overflow of glutamate is due to a reduced glial uptake. In low glucose an increased synthesis also contributes to the additional large release of aspartate.

• A patient with rheumatoid pleurisy provided the opportunity to observe the time course of development of the low glucose level and low pH characteristic of these pleural effusions. During six days, the effusion evolved from one with a normal glucose value and pH to one with a glucose value of 20 mg/dL and a pH of 6.78. The mechanisms responsible for these phenomena probably are (1) a selective block to glucose transport from blood to pleural fluid, (2) enhanced glucose use by rheumatoid pleura, and (3) an efflux block to the end products of pleural space glucose metabolism. Once the low glucose value—low pH rheumatoid effusion develops, it seems not to revert to an effusion with a normal glucose level and pH. (Arch Intern Med 140:1237-1238, 1980)

Free glucose was assayed in the caecal contents of rats. Whereas control animals had less than 60 nmol glucose per g of caecal contents, 230 nmol glucose/g caecal contents were determined 3 hours after the administration of 300 mg Palatinit by gastric intubation. In contrast to an earlier report (8), caecal fluid thus contained less than 3% of the glucose concentration of 11 mumol/ml claimed to occur after Palatinit administration by these authors (8). Since the anaerobic fermentation capacity for glucose by the caecal contents of rats amounted to at least 630 nmol glucose/min X g fresh weight at 37 degrees C, only the low glucose concentrations reported above are plausible.

The concentration and productivity of α-amylase increased remarkably, 15- and 11-fold respectively, in a continuous culture of Bacillus caldolyticus DSM 405 compared with batch culture, provided starch was used as the sugar source in a casitone medium. In the casitone medium with or without glucose hardly any improvement of enzyme production was observed in continuous culture. The addition of a small amount of starch to the glucose-casitone medium had a marked effect in stimulating amylase formation in continuous culture but no effect in batch culture. It was suggested that the higher production of α-amylase in the continuous culture using starch as the inducer was partly related to the predominance of some conditional non-sporulating variants with a higher amylase forming activity and to derepression of the enzyme at a low glucose concentration.

Reports that Clostridium botulinum toxin can sometimes be detected in the absence of indicators of overt spoilage led to a systematic study of this phenomenon in a model system. Media with various combinations of pH (5.0 to 7.0) and glucose (0.0 to 1.0%) were inoculated with vegetative cells of C. botulinum 62A and incubated anaerobically at 35 degrees C. Although growth and toxin production occurred at all pH and glucose combinations, accumulation of gas was delayed or absent in media with low pH, low glucose levels, or both. Other proteolytic C. botulinum strains gave similar results. Trypsin activation was required to detect toxin in some low pH cultures. The trypsinization requirement correlated with low proteolytic activity in the cultures. Proteolytic activity of the strains examined was 5- to 500-fold lower in botulinal assay medium than in cooked meat medium. The results indicate that the absence of gas accumulation does not preclude the presence of botulinal toxin and that proteolytic cultures grown under adverse conditions may require trypsinization for the detection of toxin.

Diabur-Test 5000 is a new semiquantitative test strip for the determination of urine glucose concentrations up to 5%. The results are comparable to those obtained with the Clinitest method, although Diabur-Test 5000 has the advantage of being sensitive also for low glucose concentrations. Diabur-Test 5000 is easier to use than the Clinitest method. It is well accepted by patients for self control, and might also be used for routine clinical work.

The glucagon-suppressing activity of insulin and somatostatin were compared at high and low glucose concentrations. In normal dogs made hyperglucagonemic by phloridzin pretreatment, insulin and somatostatin suppressed glucagon at rates of 47 +/- 8 and 35 +/- 8%/h (NS), respectively, despite profound hypoglycemia. In severely hyperglycemic alloxan-diabetic dogs, insulin and somatostatin suppressed glucagon at rates of 48 +/- 13 and 54 +/- 6%/h, respectively, not different from the nondiabetic dogs. After phloridzin pretreatment to eliminate hyperglycemia in the diabetic dogs, insulin and somatostatin suppressed 51 +/- 8 and 31 +/- 10%/h (NS), respectively. Glucose infused in the phloridzin-pretreated insulin-deprived group suppressed glucagon only partially; insulin was required to reduce it further. We conclude that insulin and somatostatin suppress glucagon at similar rates irrespective of ambient glucose levels, and that diabetic hyperglucagonemia represents the summation of stimulation by insulin lack minus suppression by the associated hyperglycemia.

1. An immunological method for the purification of small quantities of insulin has been devised. 2. This method has been used to isolate labelled insulin secreted from pancreas slices incubated in vitro. The insulin had previously been labelled by incubation of the slices with [(3)H]leucine in vitro. 3. There is some release of labelled insulin when such slices are further incubated in media of low glucose content. When the glucose content of the medium is raised, little additional radioactive insulin is released in the first hour after labelling. However, there is a marked increase in specific radioactivity of insulin released from slices in response to a high concentration of glucose in the second and third hours. Release of labelled insulin is again diminished in the final phase, 4hr. from the start of the experiment. 4. These results are discussed in relation to possible mechanisms of insulin release from the beta-cell.

Publisher Summary This chapter discusses glucose tolerance in ischemic cardiovascular disease (ICD), which may develop throughout the body, mainly in the heart, legs, brain, and the kidneys. Statistical evidence for an association between abnormal carbohydrate metabolism and ICD was presented in 1922 by Le vine, who found 7% diabetics in a group of patients with angina pectoris. The metabolic events responsible for the development of ICD remain largely unknown, whether diabetes is present or not. Glucose tolerance has been determined by oral and intravenous methods. Obesity is associated with a high prevalence of diabetes mellitus, but the influence of obesity on glucose tolerance in nondiabetics is not clear, as conflicting results have been reported. Studies on patients with ICD have consequently shown an association between this disease and low glucose tolerance. Glucose tolerance in ICD has been studied with oral and intravenous methods. Irrespective of methods used, glucose tolerance is low in groups of patients with ICD, and in samples of subjects with low glucose tolerance the prevalence of ICD is high.

The occurrence of low glucose blood values in newborns has been known for some decades. In some cases one can find extremely low values (less than 20 mg%), we then speak of neonatal hypoglycemia. Sometimes this is attended by clinical symptoms as hypotonia, pallor, cyanosis, tremors or convulsions, in many cases however these symptoms are not found. Hypoglycemia with clinical symptoms in the newborn is called symptomatic neonatal hypoglycemia.

Inverted gut loops from normal rats were incubated in low glucose concentrations. The serosal material was added to pieces of rat pancreas incubated in vitro, with resultant doubling of assayable insulin in the medium, an effect not due to added glucose.

THE PURPOSE of this paper is to report a modification of the standard reagent strip (Dextrostix) technique which distinguishes between glucose values in plasma and cerebrospinal fluid (CSF) of 40, 30, 20, and less than 20 mg per 100 ml. The method is simple, reliable, and produces a permanent color change. The method is suitable as a screening tool to detect low glucose concentrations in blood of term and low birth weight infants, 1 infants of diabetic mothers in whom transient hypoglycemia occurs the first two to six hours of life, 2 as well as to detect low glucose levels in CSF of infants with possible meningitis. Furthermore, the effectiveness of therapy in elevating glucose levels can be easily and inexpensively monitored using the modified reagent strip technique. Material and Methods Blood was drawn by heel puncture from 83 infants in the nurseries at the University of Illinois Research and

The HypoDE study, a randomized multi-center trial, showed that rtCGM use reduces the number of low glucose events ( Disclosure D. Ehrmann: Speaker's Bureau; Self; Berlin-Chemie AG. L. Heinemann: Stock/Shareholder; Self; Profil Institute for Metabolic Research, ProSciento. Consultant; Self; Roche Diabetes Care Health and Digital Solutions. G. Freckmann: Speaker's Bureau; Self; Ascensia Diabetes Care. Research Support; Self; Ascensia Diabetes Care. Speaker's Bureau; Self; Roche Diabetes Care Health and Digital Solutions. Advisory Panel; Self; Roche Diabetes Care Health and Digital Solutions. Research Support; Self; Roche Diabetes Care Health and Digital Solutions. Advisory Panel; Self; Abbott, Novo Nordisk Inc.. Consultant; Self; Sensile Medical AG. Speaker's Bureau; Self; Ypsomed AG. D. Waldenmaier: None. N. Hermanns: Speaker's Bureau; Self; Berlin-Chemie AG. Advisory Panel; Self; Abbott. Research Support; Self; Abbott. Speaker's Bureau; Self; Abbott. Research Support; Self; Berlin-Chemie AG. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Roche Diabetes Care Health and Digital Solutions. Research Support; Self; Ypsomed AG, Dexcom, Inc.. Speaker's Bureau; Self; Novo Nordisk Inc..

Survival upon glucose starvation requires a delicate balance between different metabolic pathways. A recent work by the Roe laboratory provides a mechanistic link between glucose deprivation and the regulation of the pentose phosphate pathway, with the transcriptional repressor Rsv1 playing a key role in the process. Rsv1 regulates the flow of glucose into its possible metabolic fates and promotes long-term survival under low glucose. This work is supported by the Ministerio de Ciencia, Innovación y Universidades (Spain), PLAN E, and FEDER (PGC2018-093920-B-I00) to EH. The Oxida-tive Stress and Cell Cycle group is also supported by Generalitat de Catalunya (Spain) (2017-SGR-539) and by Unidad de Excelencia María de Maeztu from MINECO (Spain) (MDM-2014-0370). EH is recipientof an ICREA Academia Award (Generalitat de Catalunya, Spain)

• This study was undertaken to investigate possible factors [ill]ontributing to altered glucose homeostasis in a patient with a [ill]story of total pancreatectomy and intermittent sepsis. Blood [ill]as drawn when the patient had received no exogenous [ill]sulin for the previous 24 hours, had a serum insulin level of [ill]3 μU/mL, and gave an inappropriately low glucose response [ill]large amounts of infused glucose. The IgG fraction prepared [ill]om this serum stimulated glucose oxidation in vitro and [ill]hibited binding of insulin labeled with I 125 to isolated rat [ill]dipocytes, thus fulfilling some of the criteria for autoan[ill]bodies to the insulin receptor. The results are compatible with [ill]e hypothesis that insulin-receptor autoantibodies may have [ill]eveloped as a result of perturbation of this patient's immune [ill]tatus promoted by intermittent septic episodes and that, [ill]eterminally, as these antibodies converted in vivo to their in [ill]tro—type behavior, they may have been partially responsible [ill]or the severe disturbances of glucose homeostasis. ( Arch Intern Med 1984;144:2019-2022)

IN experiments designed to throw light on the mechanism of sugar absorption and its control by the adrenal cortex, it was previously found1 that with adrenalectomized rats sodium pyruvate restores the normal sugar absorption from the intestine. Similar experiments using the same methods have now been carried out with sodium lactate which was administered continuously in doses of 15–20 mgm. a day subcutaneously. It was found that it shows the same effect as pyruvate does, restoring the low glucose absorption of the adrenalectomized rats to the normal level. (Normal absorption in forty-five minutes, 80.0 per cent of the injected glucose, with adrenalectomized rats 42.3 per cent, after lactate administration 73.7 per cent.)

The Predictive Low Glucose Management (PLGM) system consists of a Medtronic Veo pump, Enlite sensor, MiniLink REAL-Time transmitter, Bluetooth-RF translator and a predictive algorithm operating from a Blackberry smartphone. The system suspended insulin delivery when the pre-set hypoglycaemic threshold of 4.4mmol/L was predicted to be reached in 30 minutes. The aim of this study was to determine the plasma glucose profile with the PLGM system when hypoglycaemia was induced by (a) moderate-intensity exercise, (b) subcutaneous insulin bolus and (c) increasing the overnight basal infusion rate in individuals with type 1 diabetes. The primary outcome was the plasma glucose nadir following each hypoglycaemic stimulus with and without PLGM. Participants performed 30-60 minutes of moderate-intensity exercise or were administered a subcutaneous insulin bolus following a glucose stabilisation period on basal continuous subcutaneous insulin infusion. In participants studied with increased overnight basal rates, hypoglycaemia was induced by increasing basal rates by 180%. They were randomised and studied on 2 separate days; with PLGM off and with PLGM on. On both days, participants were observed until plasma glucose dropped to 2.8mmol/L or were symptomatic.