Diurnal Variation of Blood Ketone Bodies in Insulin-Dependent Diabetes mellitus and Noninsulin-Dependent Diabetes mellitus Patients: The Relationship to Serum C-Peptide Immunoreactivity and Free Insulin

Ubukata, Eiichi

doi:10.1159/000177607

Cited by 9 publications

(4 citation statements)

References 21 publications

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“…Supranormal ␤-OHB values were also found in type 1 diabetic subjects with near-normal fasting plasma glucose concentrations (Ͻ150 mg/dL). 27 If we use the ROC curve approach, comparing the DK with the NKD group (data not shown), the cutoff value of 0.30 mmol/L showed the higher sensitivity for the diagnosis of DK (100%, with specificity ϭ 24%), whereas the cutoff value of 1.3 mmol/L showed the higher specificity (100%, with sensitivity ϭ 81%). The overall accuracy of the ␤-OHB determination as a diagnostic test for DK was high (0.93 Ϯ 0.03).…”

Section: Discussionmentioning

confidence: 97%

“…23 Diurnal changes of ␤-OHB are strongly associated with plasma-free insulin in human IT patients. 25,27,28 More recently, Laffel et al 29 evaluated ␤-OHB determination in children and adults with type 1 DM and found that high ␤-OHB concentrations (Ͼ1 mmol/L) occurred more frequently in individuals with poor glycemic control. These investigators concluded that home monitoring of ␤-OHB can help patients and physicians optimize glycemic control and avert DKA.…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of Serum β‐Hydroxybutyrate Measurements for the Diagnosis of Diabetic Ketoacidosis in 116 Dogs

Duarte

Simões

Franchini

et al. 2002

Veterinary Internal Medicne

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The aim of this study was to evaluate the accuracy of serum beta-hydroxybutyrate (beta-OHB) measurements for the diagnosis of diabetic ketoacidosis (DKA) in dogs. One hundred sixteen diabetic dogs were prospectively enrolled in the study: 18 insulin-treated (IT) diabetic dogs that had a positive urine ketone test and 88 untreated, newly diagnosed diabetic dogs. Venous blood gas tensions and pH, serum glucose and urea nitrogen (SUN), and electrolyte (Na+, Cl-, and K+) and urine acetoacetate (AA) concentrations were measured concurrently with serum beta-OHB concentrations. On the basis of laboratory findings, the patients were assigned to I of 3 groups: diabetic ketoacidosis (n = 43); diabetic ketosis (DK, n = 41); and nonketotic diabetes (NDK, n = 31). Serum beta-OHB concentrations differed significantly (P < .001) among the study groups. Although marked differences in beta-OHB concentrations were found, a considerable overlap exists between the distributions of dogs with DK and those with DKA. The overall accuracy of beta-OHB determination as a diagnostic test for DKA, determined by the area under the receiver operating characteristic (ROC) curve, was 0.92. In the 1.9- to 4.8-mmol/L range, serum beta-OHB determination sensitivity varied from 100 to 35.7%, whereas specificity varied from 39 to 100%. The cutoff value of 3.8 mmol/L showed the best equilibrium between specificity (95%), sensitivity (72%), and likelihood ratio (14.8). We concluded that the quantitative measurement of serum beta-OHB may be a potential tool for diagnosing and monitoring ketosis and ketoacidosis in diabetic dogs.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Accuracy of Serum β‐Hydroxybutyrate Measurements for the Diagnosis of Diabetic Ketoacidosis in 116 Dogs

Duarte

Simões

Franchini

et al. 2002

Veterinary Internal Medicne

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“…Plasma ketone bodies increase around midnight and in the early morning, which is most likely because of the decreased glucose supply and the elevation in the cortisol and growth hormone levels [12,13]. During the daytime, ketone body levels are largely influenced by the ingestion of carbohydrates, which potently suppress ketogenesis.…”

Section: Resultsmentioning

confidence: 99%

Age-related changes in the diurnal variation of ketogenesis in patients with type 2 diabetes and relevance to hypoglycemic medications

et al. 2015

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“…28 Daily first urine was checked for urinary pH, glucose, βHB, urobilinogen, proteins, occult blood, bilirubin, nitrate, and relative gravity using the Uropaper III ® (Eiken, Tokyo, Japan). A sample of about 10 ml of urine was stored in a frozen tube for quantitative analysis of creatinine, acetoacetate (AcAc), βHB and catecholamines by the Serum Research Laboratory (SRL).…”

Section: Programmentioning

confidence: 99%

Ketone Body Production and Excretion During Wellness Fasting

Watanabe¹,

Hirakaw²,

Utada³

et al. 2017

Diabetes Res Open J

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Introduction : The importance of ketone body metabolism in diabetic patients has been known since the 1970s, but recently β-hydroxybutyrate (βHB) has been identified as a key component of a metabolic signaling pathway. However, many questions remain unanswered about individual differences in the production and excretion of ketone bodies. Objectives: Fourteen healthy subjects were admitted in the ARSOA Wellness Fasting program. During a 4-day fasting period, they received a combination of very low-energy vegetarian diet, physical exercise, meditation, and lectures about healthy lifestyles. Methods: Every morning, participants measured their body composition, blood glucose, and β-hydroxybutyrate (βHB). The first urine of the day was analyzed for βHB, glucose, pH and 7 other elements. Ten milliliters of urine were deep frozen for further quantitative analysis. Peripheral blood was collected on days 1 and 4 for routine biochemical analyses and for the determination of serum levels of hormones. All data were collated in an Microsoft Excel ® file, and transferred to SPSS for statistical analysis. Results: Ketone bodies in the blood increased from 0.3±0.2 mM at day 1 to 1.8±0.9 mM at day 4 of fasting, while the glucose level decreased from 5.8±1.9 mM to 4.5±1.5 mM. Increases in peripheral blood βHB were assigned to 3 groups (0.8-1.2 mM, 1.3-1.8 mM, 1.8-4.8 mM). Pass analysis suggested that decreased insulin and glucose levels under 4.5 mM both seemed to trigger ketogenesis. The βHB/Acetoacetate (AcAc) ratio in blood was about 5, regardless of the βHB concentration, but the range varied from 0.56 to 3.36 in the urine. The highest excreted concentration of βHB was 597 mmol/g creatinine. These values returned to normal ranges on the 14 th day (10 days after fasting). Changes in blood ketone bodies significantly correlated with total thyroxin, while urinary epinephrine changes correlated with urinary ketone bodies. Ketone body production seemed to cause hepatic and renal damage, as indicated by a slight alteration in markers of hepatic function and a 12% decrease in eGFR. Conclusions: Four days of fasting induces hyperketosis with some metabolic changes. The magnitude of changes in ketone body concentrations correlates with the levels of insulin, glucose, triacylglycerol and several hormones. The urinary excretion of βHB abruptly increased in group 3 (more than 1.8 mM). It was 100 times higher than the blood βHB concentration. Further studies are necessary to establish the safety of fasting as a way to induce hyperketosis for therapeutic needs. Our observations of a slight decrease in hepatic function and a 12% decrease in eGFR call for caution.

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Diurnal Variation of Blood Ketone Bodies in Insulin-Dependent Diabetes mellitus and Noninsulin-Dependent Diabetes mellitus Patients: The Relationship to Serum C-Peptide Immunoreactivity and Free Insulin

Cited by 9 publications

References 21 publications

Accuracy of Serum β‐Hydroxybutyrate Measurements for the Diagnosis of Diabetic Ketoacidosis in 116 Dogs

Accuracy of Serum β‐Hydroxybutyrate Measurements for the Diagnosis of Diabetic Ketoacidosis in 116 Dogs

Age-related changes in the diurnal variation of ketogenesis in patients with type 2 diabetes and relevance to hypoglycemic medications

Ketone Body Production and Excretion During Wellness Fasting

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