From the Elliot P. Hyperglycemia, increased gluconeogenesis, nitrogen wasting, and increased ketogenesis occur in the perioperative period, partly as a result of contrainsulin hormones provoked by stress and trauma. These untoward events are aggravated in the diabetic. Zones of levels of blood glucose control are charted, as well as the corresponding insulin needs for each of these zones. Intermediate insulins should provide basic coverage; regular insulin is recommended only as a supplement. Several blood glucose determinations per day are necessary to maintain control. The hazards of dependence on urine testing and the “sliding scale” for control are among a number of caveats discussed. Arch Surg. Coronavirus Resource Center. This Issue. Aldo A.
Insulin resistance is a major cause of diabetes and is highly associated with adipose tissue AT inflammation in obesity. RBP4, a retinol-transporter, is elevated in insulin resistance and contributes to increased diabetes risk. We aimed to determine the mechanisms for RBP4-induced insulin resistance. Here we show that RBP4 elevation causes AT inflammation by activating innate immunity which elicits an adaptive immune-response. The immune system plays an important role in obesity-related insulin resistance which is a major pathogenic factor in type 2 diabetes T2D and the related cardiovascular disease Moraes-Vieira et al. Large epidemiologic studies demonstrate that elevated circulating RBP4 levels are a biomarker for insulin resistance, prediabetes, the metabolic syndrome Meisinger et al. Genetic studies indicate that elevated RBP4 markedly increases diabetes risk and may play a causative role in the disease van Hoek et al. Emerging evidence suggests a possible role for pro-inflammatory pathways in RBP4-induced insulin resistance. RBP4 levels in serum Balagopal et al. RBP4 impairs insulin signaling in adipocytes indirectly by inducing pro-inflammatory cytokine production from macrophages through Toll-like receptor 4 TLR4 and c-Jun N-terminal protein kinase JNK pathways Norseen et al.
Triglyceride levels were measured by colorimetric enzyme assays and free fatty acid levels were measured in serum using the NEFA-C kit Wako, Richmond, Virginia. Aldo Rossini for helpful comments on the manuscript; Dr. Create a free personal account to access your subscriptions, sign up for alerts, and more. Steiner, DF. Close Send. Rent this article from DeepDyve. C Glycemia following food removal.