Persistent glucose production during glucose infusion in the neonate.

Abstract

A B S T R A C T In adults, glucose infusion results in a decreased glucose production rate (GPR) as a mechanism for maintaining euglycemia. To document the development of glucose homeostasis, we derived the GPR in 23 preterm appropriate for gestational age infants, 14 term appropriate for gestational age infants, and in 6 adults. After a 3-h fast, the average plasma glucose and insulin concentration was measured and the GPR was derived. During glucose infusion (5.6±0.3 mg-kg-'min-'), compared with saline controls, the preterms had a rise in plasma glucose and plasma insulin, and the GPR was 1.4 mg * kg-'min-' (range, 0-4.4) vs. 3.0 mg * kg-'min-' (range, 1.8-4.1) (saline controls). In the term infants, only the plasma insulin concentration was elevated when the glucose infused (5.7±0.3 mg * kg-'min-') infants were compared with the saline controls and GPR was 0.4 mg kg-'min-' (range, 0-2.6) vs. 3.4 mg kg-'min-' (range, 2.8-5.7) (saline controls). In comparison to saline infused adults, glucose infusion (3.2±0.1 mg kg-'min-') resulted in a significant rise in plasma glucose and in plasma insulin; and the GPR was reduced to 0.1 mg kg-min-' (range, 0-0.3) from 2.0 mg*kg-'min-' (range, 1.5-2.4). 5 of 13 preterms and 2 of 7 term infants had persistent GPR during glucose infusion; in contrast, the GPR in all adults was unmeasurable. There was no correlation between the plasma glucose concentration and the GPR in the newborn or in the adult. Both

Insulin kinetics and the Neonatal Intensive Care Insulin–Nutrition–Glucose (NICING) model

“…mg/kg/min in unfasted adults [79], EGP is higher at ~ 4 mg/kg/min in fasted adults [79]) and is also unsuppressed at higher BG and/or glucose infusion rate in premature infants [80]. Infants born less than 27 weeks gestation lack glycogen stores, so intravenous/frequent exogenous nutrition is required to meet energy needs.…”

Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname

“…Age is generally considered an important determinant of EGP: glucose requirements in pre-term infants are approximately 44 lmol ⁄ kg ⁄ min (Van Kempen et al 2003), glucose production in term infants is approximately 33 lmol ⁄ kg ⁄ min and ranges between 27 and 43 lmol ⁄ kg ⁄ min in 1-month to 6-year-old children. Thereafter EGP decreases with age to 20 lmol ⁄ kg ⁄ min at the age of 8-10 years and 13 lmol ⁄ kg ⁄ min in adolescents (Bier et al 1977;Cowett et al 1983;Kalhan et al 1986;Haymond & Sunehag 1999;Sunehag et al 2001). Glucose production in children between 2.5 and 3.9 years with idiopathic ketotic hypoglycaemia ranged between 31.2 and 39.6 lmol ⁄ kg ⁄ min after an overnight fast (Huidekoper et al 2007).…”

Development of blood glucose control for extremely premature infants

“…The known mechanisms responsible for hyperglycaemia specific to extremely premature infants are related to their reduced ability to produce insulin [11]; defective beta-cell processing of pro-insulin (which is 10-16 times less active than insulin) to insulin [12]; an inability to suppress hepatic glucose production in response to glucose infusion [13]; and, finally, a decreased uptake of glucose secondary to a limited mass of insulin-sensitivity tissues (e.g. : muscle and adipose tissue) [14].…”