ABSTRACT We investigated whether oral lactate could prevent seizures and deaths in mice with severe hypoglycemia induced by a high dose of insulin. For this purpose, mice were fasted for 15 h and then given an intraperitoneal injection of regular insulin (5.0 U/kg or 10.0 U/kg). Immediately after insulin injection, the mice received an oral dose of saline (control), glucose (5.5 mmol/kg), or lactate (18.0 mmol/kg). Glucose and lactate levels were measured in the blood and brain before and after the seizures began. Glucose and lactate delayed (p < 0.05) the onset of seizures associated with severe insulin-induced hypoglycemia. Elevated (p < 0.05) brain levels of lactate were associated with an absence of seizures in mice that received glucose or lactate, suggesting that lactate could prevent convulsions associated with severe insulin-induced hypoglycemia. However, the same oral dose of lactate that delayed the onset of convulsions also increased the mortality rate. In contrast, diazepam (3.0 mg/kg) prevented seizures and markedly decreased the frequency of death during severe insulin-induced hypoglycemia. The results demonstrated that in contrast to oral glucose, oral lactate intensifies insulin toxicity.

ABSTRACT We developed a pre-clinical model in which to evaluate the impact of orally administered carbohydrates on postprandial blood glucose levels. For this purpose, we compared the effects of different carbohydrates with well-established glycemic indexes. We orally administered (gavage) increasing amounts (0.2, 0.4, 0.6, 0.8, and 1.0 g/kg) of sucrose and lactose to rats which had been fasted for 6 h or 15 h, respectively. In part of the experiments we administered frutose (gavagem). Three different models were compared for measuring postprandial blood glucose levels: a) evaluation of interstitial glucose concentrations by using a real time continuous glucose monitoring system; b) evaluation of glucose levels in blood obtained from the rat tail; c) evaluation of serum glucose levels in blood collected after decapitation. Our results showed that blood obtained from the tails of 15-h fasted rats was the best model in which to evaluate the effect of carbohydrates on postprandial blood glucose levels.

ABSTRACT The effect of glutamine dipeptide (GDP) supplementation in patients with diabetic foot syndrome was evaluated. A total of 22 patients took part in the study. GDP was supplied in 10 g sachets, and was dissolved in water immediately before use, with ingestion once a day, after lunch or after dinner (20 g/day) over a period of 30 days. Quantification of foot insensitive areas, oxidative stress, blood cytokines, and biochemical, hematological and toxicological parameters was performed before and after GDP supplementation. We observed an increase in blood levels of interferon-α (P=0.023), interferon-γ (P=0.038), interleukin-4 (P=0.003), interleukin-6 (P=0.0025), interleukin-7 (P=0.028), interleukin-12 p40 (P=0.017), interleukin-13 (P=0.001), leukocytes (P=0.037), eosinophils (P=0.049), and typical lymphocytes (P<0.001) due to GDP administration. In addition, we observed a reduced number (P=0.048) of insensitive areas on the foot, and reduction (P=0.047) of fasting hyperglycemia. Patients also showed increased blood high density lipoprotein (P<0.01) and protein thiol groups (P=0.004). These favorable results were associated with the absence of renal and hepatic toxicity. These results are of clinical relevance, since supplementation with GDP over 30 days improved clinical responses in patients with diabetic foot syndrome.

The acute effects of Glycine max (GM) on post prandial glycemia (PPG) in male Wistar rats were investigated. All substances were orally administered by gavage in overnight fasted animals. The elevation of PPG promoted by starch (1g/kg) was prevented by GM (2.5 mg/kg, 5.0 mg/kg, 7.5 mg/kg, 10.0 mg/kg, and 100.0 mg/kg). In conclusion GM showed potential antidiabetic effect.

The aim of this study was to determine whether plasma levels of carbonylated proteins, total antioxidant capacity (TAC) and reduced protein thiols could be suitable biomarkers of risk factors for diabetic foot. Individuals with type 2 diabetes with normal protective sensation (normal foot group) vs. loss of protective sensation and/or signs of peripheral arterial disease and/or foot deformities and/or history of ulcers and/or neuropathic fractures and/or amputation (diabetic foot group) were compared. The diabetic foot group showed higher carbonylated protein levels (P = 0.0457) and lower levels of TAC (P = 0.0148) and reduced protein thiols (P = 0.0088), compared with the normal foot group. In general, several other parameters of risk of diabetes complication (blood levels of glycated hemoglobin, glucose and cholesterol, duration of diabetes, body mass index and waist circumference) showed a tendency of higher values in the diabetic foot group. The results suggest that the plasma levels of carbonylated proteins, TAC and reduced protein thiols could furnish information about the risk of diabetic foot, considering that the changes in these biomarkers were associated with the loss of sensitivity and foot ulcerations.

Neste estudo, desenvolvemos e avaliamos um programa de consulta farmacêutica (PCF) visando melhorar o tratamento de pacientes diabéticos tipo 2 (PDT2) e reduzir os fatores de risco de complicações diabéticas com possibilidade de aplicação em outras doenças crônicas. Para alcançar este propósito, PDT2 recebendo tratamento médico convencional, apresentando glicemia de jejum > 140 mg/dl e/ou hemoglobina glicada >7% foram selecionados. O PCF inclui estratégias obtidas a partir do método de Dader, do modelo de cuidados farmacêuticos PWDT (Pharmacist's Workup of Drug Therapy method), do método SOAP (Subjective data, Objective data, Assessment, and Plan of care) e conceitos baseados em um modelo de cuidados em enfermagem. O PCF avaliou o estilo de vida, farmacoterapia e seu monitoramento através de exames laboratoriais, sinais vitais e antropometria. Estes procedimentos foram repetidos a cada 4 meses durante 1 ano. Os dados obtidos em cada consulta possibilitaram oferecer educação focada no estilo de vida e uso de medicamentos. Para os 50 pacientes que concluiram o PCF houve redução da glicemia (P < 0.0001), hemoglobina glicada (P = 0.0022), colesterolemia (P = 0.0072), triacilgliceridemia (P= 0.0204) e pressão arterial (P < 0.0001). O aumento da concordância e a correção dos problemas relacionados a medicamentos contribuíram para melhoria do tratamento. Assim, podemos concluir que o PCF foi adequado para melhorar a saúde de PDT2 ao reduzir fatores de risco de complicações diabéticas.

This study develops and evaluates a pharmaceutical consultation program (PCP) to improve treatment for Type 2 diabetes patients (T2DP) and reduce risk factors for diabetic complications with possible application in other chronic diseases. We recruited T2DP receiving conventional medical treatment but with fasting glycemia >140mg/dl and/or glycated hemoglobin >7%. The PCP includes strategies obtained from Dader's method, the PWDT (Pharmacist's Workup of Drug Therapy method) model of pharmaceutical care, the SOAP (Subjective data, Objective data, Assessment, and Plan of care) method, and concepts based on a nursing care model. The PCP evaluated lifestyle, pharmacotherapy and monitoring it using laboratory tests, vital signs, and anthropometry. These procedures were repeated every 4 months for 1 year. Data obtained in each consultation were used to provide patient education focusing on healthy lifestyles and medications. Fifty patients completed the PCP. There were reductions in glycemia (P<0.0001), glycated hemoglobin (P=0.0022), cholesterolemia (P=0.0072), triacylglycerolemia (P=0.0204) and blood pressure (P<0.0001). Increased concordance with drug treatment and correction of drug-related problems contributed to improved treatment. We can therefore conclude that our PCP was suitable for improving health outcomes in T2DP by reducing risk factors for diabetic complications.

The effect of infliximab on gluconeogenesis in an animal model of diet-induced liver glucose overproduction was investigated. The mice were treated with standard diet (SD group) or high fat diet (HFD group). HFD group were randomly divided and treated either with saline (100 µl/dose, ip, twice a day) or infliximab (10 µg in 100 µl saline per dose, ip, twice a day, i.e., 0.5 mg/kg per day). SD group also received saline. The treatment with infliximab or saline started on the first day of the introduction of the HFD and was maintained during two weeks. After this period, the mice were fasted (15 h) and anesthetized. After laparotomy, blood was collected for glucose determination followed by liver perfusion in which L-alanine (5 mM) was used as gluconeogenic substrate. HFD group treated with saline showed higher (p < 0.05) liver glucose production from L-alanine and fasting hyperglycemia. However, these metabolic changes were prevented by infliximab treatment. Therefore, this study suggested that infliximab could prevent the glucose overproduction and hyperglycemia related with glucose intolerance and type 2 diabetes.

The effect of oral L-carnitine (LC) or DL-carnitine (DLC) supplementation during one or four weeks (200 or 400 mg.kg-1.day-1) in diabetic rats was investigated. After the supplementation period, the blood was collected for the evaluation of total (TC) and free L-carnitine (FC), glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triacylglycerol. Tissues were collected for the determination of TC and FC concentrations. The carnitine supplementation did not change levels of glucose, total cholesterol, HDL-C and LDL-C in the blood. Diabetic rats showed hypertriacylglycerolemia and decreased blood and tissue levels of FC and TC. Normalization of the blood triacylglycerol and increased blood and tissue levels of FC and TC were observed with the LC or DLC supplementation. However, the hyperglycemia remained unchanged. Thus, the reduction of blood triacylglycerol obtained with carnitine supplementation in the diabetic rats did not depend on an amelioration in the glycemia and was mediated partly at least by an increment of serum and tissue concentrations of FC and TC.

Comparou-se a performance de avaliação da glicemia através de dosagens laboratoriais (DL) ou dispositivo para teste de sangue capilar (DTSC) vs. hemoglobina glicada A1c (A1c). Comparou-se ainda a performance de avaliação da glicemia, colesterol total (CT) e triacilglicerol (DL vs. DTSC). Avaliou-se estes parametros a partir das mesmas amostras de sangue coletadas em pacientes diabéticos tipo 2 (PDT2) em jejum noturno, sendo as comparações realizadas através de análise de regressão linear. A A1c correlacionou-se melhor com a glicemia-DL (r = 0,58) em relação a glicemia-DTSC (r = 0,42). Comparou-se DL vs. DTSC obtendo se r = 0,90, 0,82 e 0,92 para glicemia, CT e triacilglicerol, respectivamente. Concluiu-se que houve melhor performance da glicose-DL em relação a glicose-DTSC. Além disso, considerando que o triacilglicerol e TC avaliado através de DTSC correlaciona-se melhor com DL em comparação a DTSC-glicose vs. DL-glicose, a inclusão de DTSC-TC e DTSC-triacilglicerol visando detectar e monitorar hyperlipidemia in PDT2 deve ser considerada.

The performance of lab tests (LT) and blood testing devices (BTD) to monitor glycemia vs. glycated hemoglobin A1c (A1c) were compared. In addition, the performance of blood glucose, total cholesterol (TC) and triacylglycerol measured by LT and BDT were compared. All parameters were measured based on the same blood samples from overnight fasted type 2 diabetic patients (T2DP). Linear regression analysis was used for all comparisons. The results showed that A1c correlated better with LT-glucose (r = 0.58) than BTD-glucose (r = 0.42). Moreover, LT vs. BTD showed r values of 0.90, 0.82 and 0.92 for glucose, TC and triacylglycerol, respectively. It was concluded that the performance of LT-glucose was better than BDT-glucose. Moreover, since triacylycerol and TC measured by BTD correlated better with LT compared to BDT-glucose vs. LT-glucose, the inclusion of BTD-TC and BTD-triacylglycerol for detecting and monitoring hyperlipidemia in T2DP should be considered.

The effect of severe food restriction since birth on regulation of fasting glycemia in male Wistar rats was investigated. The control group (CG) had free supply of chow, while the restriction group (RG) received 50% of the amount ingested by the CG. The experiments were done in adult (60 days) overnight fasted rats in which glycemia, liver free glucose levels and hepatic glycogen concentration were measured. In part of the experiments in situ liver perfusion was done. The results showed that livers from the RG had higher glycogenolysis rates but lower gluconeogenesis rates from L-alanine (10 mM). Since RG showed maintained glycemia during fasting, it could be concluded that livers from RG produced glucose preferentially from glycogenolysis in detriment of gluconeogenesis. These findings demonstrated that in spite of severe caloric restriction, the metabolic adaptations of the liver did exist to assure the maintenance of blood glucose for brain supply during fasting.

Em estudo recente empregando ratos Wistar com 6 h de privação alimentar demonstramos que ocorre ativação da neoglicogênese hepática durante a hipoglicemia induzida por insulina (HII). Neste estudo, os efeitos da administração intraperitoneal (ip) de glicose (100 mg/kg) sobre a ativação da neoglicogênese hepática durante a HII foi investigada. Assim, ratos com 6 h de privação alimentar que receberam insulina regular ip (1 U/kg) e 30 min depois salina (Grupo Controle) ou glicose ip (Grupo Experimental) foram comparados. Os experimentos foram executados 60 min após a injeção de insulina. A glicemia dos grupos Controle e Experimental não foi diferente (P > 0.05). Para investigar a neoglicogênese, realizouse experimentos de perfusão de fígado. Os resultados demonstraram, exceto para o glicerol, que fígados de ratos que receberam glicose ip (Grupo Experimental), apresentaram menor taxa (P < 0.05) de neoglicogênese a partir de L-alanina, Lglutamina, L-lactato ou L-alanina + L-glutamina + L-lactato + glicerol. Portanto, a ausência de recuperação da glicemia após administração de glicose foi mediada por inibição da neoglicogênese hepática.

The activation of hepatic gluconeogenesis in male Wistar adult 6 h fasted rats during insulin-induced hypoglycemia (IIH) was previously demonstrated. In this study, the effects of intraperitoneal (ip) glucose (100 mg/kg) on the activation of liver gluconeogenesis during IIH was investigated. Thus, 6 h fasted rats that received ip regular insulin (1 U/kg) and 30 min later ip saline (Control group) or glucose (Experimental group) were compared. All the experiments were executed 60 min after insulin injection. The glycemia of Control and Experimental groups were not different (P > 0.05). To investigate gluconeogenesis, liver perfusion experiments were performed. The results demonstrated that excepting glycerol, livers from rats which received ip glucose showed lower (P < 0.05) gluconeogenesis from L-alanine, L-glutamine, L-lactate or L-alanine + L-glutamine + L-lactate + glycerol. Therefore, the absence of glucose recovery after the glucose administration was mediated, at least in part, by an inhibition of hepatic gluconeogenesis.

A tolerabilidade do esteviosideo (2.75 mg/kg/dia) obtido a partir de folhas de Stevia rebaudiana (Bert) Bertoni (Compositae) foi investigada em pacientes hiperlipidêmicos. Para alcançar este objetivo realizamos estudo clínico do tipo duplo cego. Os pacientes foram randomizados em 2 grupos: o primeiro recebeu cápsulas contendo placebo e o segundo recebeu cápsulas contendo esteviosídeo (50 mg). Foram ingeridas duas cápsulas antes do almoço e duas cápsulas antes do jantar durante 90 dias. Após a seleção dos pacientes e a cada 30 dias o índice de massa corpórea e exames laboratoriais (alanina aminotransferase, aspartato aminotransferase, gama-glutamiltransferase, colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade, lipoproteína de muito baixa densidade, trigliceridemia e glicemia) foram realizados. O esteviosídeo não acarretou qualquer alteração clinicamente relevante nos parâmetros investigados. Além disso, os pacientes não relataram efeitos adversos severos. Assim, podemos concluir que o esteviosídeo, na dose empregada neste estudo é seguro, embora não apresente efeito hipolipemiante.

The tolerability of stevioside (2.75 mg/kg/day) obtained from leaves of Stevia rebaudiana (Bert) Bertoni (Compositae) was investigated in hyperlipidemic patients. For this purpose a placebo controlled double blind study was performed. The patients were randomized in two groups: the first group received capsules containing placebo and the second group received capsules containing stevioside (50 mg) during 90 days. All capsules were ingested twice daily, i.e., 2 capsules before lunch and 2 capsules before dinner. After the selection of the patients and each 30 days body mass index and laboratory tests (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, total cholesterol, high density lipoprotein, low density lipoprotein, very low density lipoprotein, triglycerides and glucose) were performed. Stevioside did not show any clinical relevant modification in all parameters investigated. Moreover the patients did not report severe adverse effect. Thus, we can concluded that stevioside, at least in the doses employed in this study was safe.

O efeito anti-obesidade, anorexigeno, diurético e anti-hiperlipêmico de folhas secas pulverizadas de Cordia salicifolia Cham (CS) foi investigado. CS foi dissolvida em água e administrada (20 mg.Kg-1.dia-1) por gavagem durante 13 dias. A dose utilizada correspondente à empregada no Brasil. Contrariamente ao uso popular, o efeito anti-obesidade, anorexigeno e diurético não foi observado. Porém, observamos efeito hipolipidêmico em ratos normais e portadores de diabetes induzidos por aloxana.

The anti-obesity, appetite suppressant, diuretic and hipolipidemic effect of dried powdered leaves of Cordia salicifolia Cham (CS) were investigated. CS (20 mg.kg-1.day-1) dissolved in water was daily administered by gavage during 13 days. In contrast with the popular use as anti-obesity, appetite suppressant and diuretic, no effect were detected. However, hipolipidemic effect was observed in normal and alloxan-diabetic rats.

Neste estudo foi investigado o potencial antidiabético e hipolipemiante da Gymnema sylvestre (GS). O efeito agudo da GS administrada via oral sobre a glicemia e lipidemia foi avaliado em ratos Wistar sob as seguintes condições: a) após refeição balanceada; b) após ingestão de 1000 mg de amylose ou 1000 mg/kg de glicose; c) após ingestão de uma mistura de 12 mL/kg de óleo de soja + 1% de colesterol (OSC). Foi avaliado também o efeito do tratamento com GS durante duas (sub-agudo) ou quatro semanas (crônico) sobre o peso corporal, ingestão de água e alimento, glicemia e lipidemia em ratos não diabéticos e diabéticos induzidos com aloxana. A dose de GS utilizada na maioria dos experimentos (30 mg/kg) corresponde a dose empregada para tratar diabetes no Brasil. A administração aguda de GS não influenciou a elevação da glicemia durante a refeição balanceada, administração de amilose ou glicose; mas intensificou a elevação da concentração sérica de lipídeos após a administração de OSC. Além disso, o tratamento sub-agudo e crônico com GS em ratos não diabéticos e diabéticos induzidos com aloxana não alterou: a) o ganho de peso corporal; b) a ingestão de água e alimento; c) os níveis de glicose e lipídios. Assim sendo, a Gymnema sylvestre pelo menos na forma comercializada no Brasil (folhas secas em pó) requer mais ensaios experimentais e clínicos antes de ser recomendada para tratamento do diabetes e hiperlipidemia.

In this study we investigated the antidiabetic and hypolipidemic potential of dried powdered leaves of Gymnema sylvestre (GS). The acute effect of GS administered by oral gavage on glucose blood level of and lipids in non-diabetic and alloxan-diabetic rats were investigated in the following conditions: a) after a balanced meal; b) after the ingestion of 1000 mg/kg amylose or 1000 mg/kg glucose; c) after the ingestion of a mixture of 12 mL/kg soybean oil + 1% cholesterol (SOC). In addition, the effect of the treatment with GS during two (sub-acute) or four weeks (chronic) on body weight, food and water ingestion, glucose blood level and lipids in non-diabetic and alloxan-diabetic rats were measured. The dose of GS utilized in the majority of the experiments, i.e., 30 mg/kg, corresponds to that given to treat diabetes in Brazil. GS acutely did not influence the elevation of glycemia promoted by a balanced meal or by the administration of amylose or glucose; but promoted more intense (P<0.05) elevation of serum lipids after the administration of SOC. Moreover, the sub-acute and chronic treatment with GS in non-diabetic and alloxan-diabetic rats did not change: a) the body weight gain; b) food and water ingestion; c) the blood level of glucose and lipids. Thus we concluded that GS, at least in the form commercialized in the Brazil, i.e., dried powdered leaves, require further experimental and clinical trials before being recommended to treat diabetes and hyperlipidemia.

O objetivo do presente estudo foi investigar os fatores de risco para doenças coronarianas em uma região pobre do Noroeste do Estado do Paraná - Brasil, onde o acesso a cuidados de saúde pública é deficiente.Toda a população foi convidada a participar do estudo, sendo que a população efetivamente estudada foi de 462 indivíduos, onde a maioria era mulheres (61,3%) com idade média de 42 anos. Os voluntários mostraram alta prevalência de hipercolesterolemia (7%), hipertrigliceridemia (19%), hiperglicemia (11%), hipertensão (30%) e obesidade (16%). Foi realizada uma entrevista com cada participante do estudo, onde a maioria declarou não ter conhecimento sobre as doenças detectadas. Os resultados obtidos através dos exames laboratoriais e entrevistas mostraram que a alta prevalência de hiperlipidemia, diabetes mellitus, hipertensão e obesidade resultam da detecção tardia dessas doenças ou de tratamento inadequado após o diagnóstico.

The aim of this study was to investigate risk factors to coronary heart disease in two countryside villages in the State of Paraná, southern Brazil, typical in terms of the poverty and lack of access to public health care. All population was invited to participate in the study. The 462 volunteers (61.3% female, mean age = 42 years) showed high prevalence of hypercholesterolemia (7.0%), hypertriglyceridemia (19.0%), hyperglycemia (11.0%), hypertension (30.0%) and obesity (16.0%). The majority of the individuals, during the interview did not report the diseases detected by the testes. The results revealed that the high prevalence of hypercholesterolemia, hypertriglyceridemia, obesity, hypertension and diabetes mellitus could be consequence of the delayed detection of these diseases or inadequate treatment after diagnostic.