Natural Hypoglycemia Cure and Treatment

Guide To Beating Hypoglycemia

Here's Just A Tiny Glimpse Of The Topics Covered: The 3 main types of hypoglycemia and which type you're most likely suffering from. How snacking on chocolate bars can actually make you Fat and worsen your condition! (If you thought those delicious dark brown bars were great energy- boosters.think again!) The No. 1 question most folks have when it comes to hypoglycemia and hyperglycemia. Why you should insist on a 6-hour Gtt and not a 5-hour one. ( Why it might not be a good idea to consult a doctor to confirm your hypoglycemia. Aside from taking a Gtt, what other methods can you use to determine whether or not you're suffering from this condition? Well, refer Chapter 4, Pgs. 23-26 to take a revealing 67-question test especially designed to find out if you've got the symptoms. An inspiring motivational exercise that will help you effectively banish all of your negative thoughts that prevent you from having peace of mind. 2 good reasons why you should keep a food journal. 3 powerful nutrients that limit the effect of glucose on your blood sugar level. This is vital to a hypoglycemic as it helps slow down the absorption of sugar in the food. The secret impulse that literally forces you to say 'yes' to a candy bar or chocolate whenever you feel the hunger pangs gnawing at you. 2 ingredients that are lethal to a hypoglycemic. 'Hidden sugars' you must know to avoid buying products that can easily worsen your condition. 8 essential rules of food planning that are crucial to your speedy recovery from hypoglycemia. Leave out one of them and it could hurt your chances of recovering. How to create a healthy food plan that's suitable for both vegetarian and non- vegetarian hypoglycemics. Most food plans only focus on non-vegetarians, but this one works great for everybody! Continue reading...

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Hypoglycemic Agent Pharm Chem

Timing Glipizide And Hypoglycemia

O SYNTHETIC HYPOGLYCEMIC AGENTS In 1942, (an antibacterial sulfonamide) was found to produce hypoglycemia. This result stimulated research for the development of synthetic hypoglycemic agents, several of which are in use today. For a time, tolbutamide, chlorpropamide, and acetohexamide were the only oral hypoglycemic agents. Subsequently, a second generation of these drugs became available. Although they did not present a new method of lowering blood glucose levels, they were more potent than the existing drugs. Glipizide and glyburide are the second-generation oral hypoglycemic agents. Acetohexamide is metabolized in the liver to a reduced form, the a-hydroxyethyl derivative. This metabolite, the main one in humans, possesses hypoglycemic activity. Acetohexamide is intermediate between tolbutamide and chlorpropamide in potency and duration of effect on blood sugar levels. Glipizide. Structurally, glipizide, (Glucotrol), is a cyclohexylsulfonylurea analog similar to acetohexamide and...

HT2CR Mutant Mice Demonstrate a Metabolic Syndrome Consistent with Type II Diabetes

Prior to the development of obesity (but in the context of ongoing hyperphagia), young constitutive 5-HT2CR - Y mice have normal serum glucose, insulin, triglyceride, free fatty acid, corticosterone, and leptin concentrations. A separate study revealed no phenotypic differences in hepatic expression of peroxisome proliferator-activated receptor (PPAR) a and g, two transcription factors with key roles regulating lipid metabolism and energy balance (Memon et al. 2000). By 9 months of age, constitutive 5-HT2CR - Y mice are significantly more obese than wild-type littermates and demonstrate increased hepatic expression of both PPAR-a and PPAR-g. In these mice, no differences were noted in serum glucose, insulin, triglyceride, free fatty acid, corticosterone, or leptin concentrations. However, constitutive 5-HT2CR - Y mice older than 9 months are much less responsive to 3 days of leptin treatment, showing less blunting of food intake and less short-term decline in body weight. These...

Adverse Effects And Precautions

METABOLISM b adrenergic blockade may blunt recognition of hypoglycemia and may delay recovery from insulin-induced hypoglycemia. b receptor antagonists should be used with caution in diabetic patients who are prone to hypoglycemic reactions -selective agents may be preferable.

Choosing the Surgical Procedure

In focal CNS disorders, such as Parkinson's disease or spinal cord injuries (SCI), intralesional administration of NSCs are perhaps best suited to treat local cell deficiencies. ES-cell-derived neuronal precursors have been shown to induce dopaminergic neuron differentiation in the substantia nigra to treat parkinsonism in rodent model brains.66,67 In SCI or experimental ischemic rodent models, intralesionally-transplanted aNSCs integrated with host tissue, differentiated preferentially into glial cells, released neurotrophic growth factors (i.e., BDNF, glial-derived neurotrophic factor (GDNF) and nerve growth factor (NGF)) and facilitated neurogenesis while inhibiting astrocytosis (the abnormal destruction of nearby neurons, generally caused by hypoglycemia or oxygen deprivation). Overall motor recovery was observed.17,68-70 In another experiment involving chemically demyelinated rat spinal cords, ES cells not only integrated and differentiated within the lesion, but in fact were...

Initiation Of The Ketogenic Diet

During the initiation of the diet, the child is at risk for hypoglycemia, dehydration, acidosis, and antiepileptic drug toxicity. Therefore, initiation is recommended in a hospital setting under the guidance of the ketogenic diet team. Initiation of the diet has been managed in the home setting when 24-h nursing care is present. Methods of keto-genic diet initiation vary among medical centers, from fasting prior to initiating the diet to initiating the diet without any fasting period at all. Initiating the diet gradually (with or without a fast) is the usual practice among medical centers.

A1C Home Testing Metrika AlCNoW For home A1C testing [Fingerstick blood None

DEXTROSE (Glutose, B-D Glucose, Insta-Glucose, Dex-4) Hypoglycemia 0.5 to 1 g kg (1 to 2 mL kg) up to 25 g (50 mL) of 50 soln IV. Dilute to 25 for pediatric administration. OTC Generic Trade Chewable tabs 4 g (Dex-4), 5 g (Glutose). Trade only Oral gel 40 . L 2C EXENATIDE (Byetta) Type 2 DM adjunctive therapy when inadequate control on metformin, a sulfonylurea, or a glitazone (alone or in combination) 5 mcg SC bid (within 1 h before the morning and evening meals, or 1 h before the two main meals of the day at least 6 h apart). May increase to 10 mcg SC bid after 1 month. Trade only Prefilled pen (60 doses each) 5 mcg dose, 1.2 mL 10 mcg dose, 2.4 mL. K 2C GLUCAGON (GlucaGen) Hypoglycemia 1 mg IV IM SC, onset 5 to 20 min. Diagnostic aid 1 mg IV IM SC. Trade only Injection 1 mg. LK 2B GLUCOSE HOME TESTING (Accu-Chek Active, Accu-Check Advantage, Accu-Check Aviva, Accu-Check Compact, Accu-Check Compact Plus, Accu-Check Complete, Accu-Check Voicemate, FreeStyle Flash, FreeStyle Freedom,...

Outpatient or Inpatient Initiation of the Diet

The outpatient initiation of the diet is gradual, starting at a very low ratio and increasing over several weeks. The parents are provided with a glucometer, trained to obtain finger-stick blood sugars, and educated about the symptoms of hypoglycemia and how to treat it. Children who are fed by gastrostomy tube are much easier to begin as outpatients because the parents can make sure the fluid intake is sufficient, and the child cannot refuse the diet.

Actions of VP and OT in Nonneural Tissue Sites and Glucose Regulation Role in Memory Processing

VP and OT actions in nonneural tissues and within the brain have an important role in glucose storage and utilization. VP promotes eating behavior and or increased hepatic production of glucose after hypoglycemia (Baylis and Robertson, 1980 Keppens and de Wulf, 1974), and inhibits food intake in association with food satiation (Kow and Pfaff, 1986). Similarly, an OT neuronal system of PVN origin projects to brainstem ANS centers and regulates feeding, digestion, and metabolism (McCann and Rogers, 1990 Sofroniew and Schrell, 1981 Tribollet et al., 1988). This OT pathway appears to inhibit feeding and associated digestive processing in response to food satiation or gastric distress (Olson et al., 1991 Verbalis et al., 1986), but promotes feeding, digestion, and anabolic metabolism (tissue growth and fat storage) during pregnancy and lactation (Uvnas-Moberg, 1989, 1994). A number of physiological stressors (also known as homeostatic stressors) and emotional stressors release VP and or OT...

Growth Hormone And The Hypothalamicpituitarysomatotrophic Axis

It appears that cholinergically mediated suppression of somatostatin plays a significant role in regulating nocturnal GH release (Ghigo et al. 1990 Mendelson et al. 1978 Peters et al. 1986). Factors that can enhance GH release include estrogen (Devesa et al. 1991b Ho et al. 1987), thyroid-releasing hormone, vasoactive intestinal peptide, hypoglycemia, sleep, exercise, and stress (Devesa et al. 1992 Muller 1987 Uhde et al. 1992). Finally, GH exerts a negative feedback inhibition of its own secretion (Devesa et al. 1992 Muller 1987). It appears to act at the level of the hypothalamus and or median eminence to stimulate somatostatin release (Devesa et al. 1992). It may also inhibit GHRH release (Devesa et al. 1992). GH also stimulates the production of somatomedin-C insulin-like growth factor 1 (IGF-1) in peripheral tissues, including liver. Somatomedin-C in turn has a dual inhibitory feedback effect. It directly suppresses GH secretion at the pituitary level and stimulates somatostatin...

Common Adverse Effects And Toxicity

The most serious acute adverse effect of overdosage of acetaminophen is a potentially fatal hepatic necrosis. Renal tubular necrosis and hypoglycemic coma also may occur. The mechanism by which overdosage with acetaminophen leads to hepatocellular injury and death involves its conversion to the toxic NAPQI metabolite (see Chapter 64). The glucuronide and sulfate conjugation pathways become saturated, and increasing amounts undergo CYP-mediated N-hydroxylation to form NAPQI. This is eliminated rapidly by conjugation with GSH and then further metabolized to a mercapturic acid and excreted into the urine. In the setting of acetaminophen overdose, hepato-cellular levels of GSH become depleted. The highly reactive NAPQI metabolite binds covalently to cell macromolecules, leading to dysfunction of enzymatic systems and structural and metabolic disarray. Furthermore, depletion of intracellular GSH renders the hepatocytes highly susceptible to oxidative stress and apoptosis.

Adverse Effects During Initiation Of The Ketogenic Diet

Short-term complications during the initiation of the KD include dehydration, hypo-glycemia, acidosis, vomiting, diarrhea, and refusal to eat (3). These complications may be secondary to either the fast or the diet itself. Fluid restriction, which remains a controversial aspect of the KD, contributes to the dehydration and metabolic acidosis, which in turn can cause vomiting and lethargy. Children should therefore be monitored carefully during the initiation of the KD, so that these complications can be avoided and treated if necessary. In children with undiagnosed underlying metabolic abnormalities, including por-phyria, pyruvate carboxylase deficiency, carnitine deficiency, fatty oxidation defects, and mitochondrial disorders, the fasting phase can cause a life-threatening decompensation (4). In their series of 32 infants treated with the KD, Nordli et al. (5) reported one infant who became hypoglycemic and comatose 8 d after diet initiation. DeVivo and colleagues (6) also reported...

Antiobesity effects of seaweeds

The parauterus adipose tissue weight, and hepatic TG, serum TG, and TC levels in the HFD-TK group were significantly less than those in the HFD-NSK group. The fecal TG and TC levels in the HFD-TK group were significantly higher than those in the HFD group, and fecal TG in the HFD-TK-group was significantly higher than that in the HFD-NSK group. Consequently, it was demonstrated that TK consumption reduced the accumulation of visceral fat caused by HFD, and this effect of TK was more powerful than that of NSK, due to TG and cholesterol excretion in the feces. This report concluded that alginate may be one of the active components in Laminaria sp. In previous reports, alginate has been reported to have hypoglycemic and cholesterol-lowering effects by acting as a viscous soluble dietary fiber (Kimura et al., 1996 Pasquier et al., 1996 Paxman et al., 2008).

Antidiabetic effects of seaweeds

The rhizoid of LJ is widely used in Chinese medicine as a treatment for diabetes. Bu et al. (2010) focused on the a-glucosidase inhibitor in the LJ rhizoid. This compound was determined to be butyl-isobutyl-phthalate (BIP) by spectral analysis. BIP exhibited significant concentration-dependent, noncompetitive inhibitory activity against a-glucosidase in vitro, with an IC50 of 38 mm. The ethyl acetate fraction (EAF) and purified BIP had a significant hypoglycemic effect in streptozotocin-induced diabetic mice in vivo. These results conclude that BIP could be considered an a-glucosidase inhibitor and may become an important agent for diabetes therapy.

Mr Imaging And Spectroscopy

The ability of magnetic resonance to noninvasively and nonradioactively evaluate structures, metabolites, and processes places it among the most important technologies for the evaluation of brain function. Given the very high concentration of water in the brain, and its varying environments within different brain compartments, MR imaging of water is the workhorse in the structural evaluation of the brain. However, MR imaging can readily be applied to compounds other than water, and therefore MR spec-troscopy and spectroscopic imaging are being increasingly used to image compounds such as N-acetyl aspartate (NAA), lactate, adenosine triphosphate (ATP), all of which are important in neuronal function as well as in pathological processes such as neuronal damage, ischemia, and hypoglycemia.

Acute Vs Chronic Administration

An example of a peptide drug that has been explored for IN delivery as an alternative to injections is glucagon (21-24). IN glucagon provides for a rapid drug onset, critical for use in treating insulin-induced hypoglycemia. Furthermore, IN dosing provides for facile administered by a family member and is safer and faster than oral glucose in an unconscious subject. Additional examples in this context include IN epinephrine (25), cardiovascular agents such as nitroglycerin (26), and the peptide desmopressin (27).

Ischemiareperfusion In Diabetes Mellitus

Microvascular dysfunction has been studied extensively in animal models. One of the most widely used models is streptozotocin-induced diabetes in the rat. In this model, rats are treated with a single toxic dose of streptozotocin, which destroys the islets of Langerhans (27). The effect of hyperglycemia on the microvasculature is then evaluated after 4-12 weeks (21,28-37). Gly-cemic control by insulin treatment can prevent the microvascular dysfunction. In diabetic humans, metabolic status is not stable, and episodes of normogly-cemia are followed by phases of hyper- and hypoglycemia. Thus, blood sugar levels vary considerably, and in consequence to the pathophysiological changes presented above, the status of oxidative stress changes and blood flow will go up and down. Therefore, it is reasonable to assume that under realistic conditions, a diabetic patient undergoes episodes of ischemia and reperfusion

Biology Of Malarial Infection

Malaria is typified by high spiking fevers, chills, headache, myalgias, malaise, and gastrointestinal (GI) symptoms. Each Plasmodium species causes a distinct illness (1) P. falciparum is the most dangerous. By invading erythrocytes of any age, sequestering in the vasculature, and producing vasoactive products, this species can cause an overwhelming parasitemia, hypoglycemia, and shock with multiorgan failure. Treatment delay may lead to death. If treated early, the infection usually responds within 48 hours. If treatment is inadequate, recrudescence of infection may result. (2) P. vivax infection has a low mortality rate in untreated adults and is characterized by relapses due to reactivation of latent tissue forms. (3) P. ovale causes infection with a periodicity and relapses similar to those of P. vivax but is milder. (4) P. malariae causes a generally indolent infection. Clinical attacks may occur years or decades after infection.

Stimuli Inducing Crosssensitization And Ne Ur O Pl Asticity

CRH neurons as induced by IL-1 also occurs after other stimuli. In other words, do different stimuli that induce long-lasting cross-sensitization of HPA responses, all induce similar neuroplastic changes in hypothalamic CRH neurons and vice versa This is most probably not the case. Let us consider the effects of different manipulations of adult male rats on AVP stores in CRH terminals in the median eminence as an index of AVP hyperproduction in CRH neurons. As summarized in Table 1, various stimuli lead to increased AVP stores 1-3 weeks after the primary event, whereas other stimuli, including cocaine (Schmidt et al., 1995b), amphetamine (Schmidt et al., in press) novel environment, ether, restraint, insulin induced hypoglycemia (Schmidt, Binnekade, Janszen, & Tilders, 1996), road transport from the animal supplier facilities to our labs (unpublished observations), and social defeat (Buwalda, De Boer, Schmidt, Sgoifo, Van Der Vegt, Tilders, Bohus, & Koolhaas, in press) do not.

Pharmacokinetic And Pharmacodynamic Case Example In Insulin

IN administration of insulin provides an attractive option for a noninvasive diabetes treatment. Currently, marketed prandial (meal time) insulin products are dosed by injection immediately before each meal, posing a barrier among patients and physicians to initiate therapy. The rapid PK profile of IN insulin also offers the potential to reduce postmeal hypoglycemia caused by longer halflife insulin preparations.

Action Target Systemic Vs Portal PDPK Profiles

Oral administration of insulin mimics the physiological pathway, where, after absorption from the GI tract, insulin enters into the portal vein and targets the liver. Hence, oral insulin not only replaces the needle but can also be used as a targeted drug delivery system. Potential clinical advantages of the first-pass hepatic insulin extraction include (i) less incidence of hypoglycemia,

Metabolic Fuel Adaptation

Thus, when blood glucose concentrations begin to decrease, during starvation or the conditions imposed by the KD, liver hepatocytes respond by switching from using blood glucose as a fuel to using blood fatty acids. Furthermore, they use the energy derived from the catabolism ( burning ) of fatty acid fuel to synthesize glucose from blood amino acid carbon skeletons. Such glucose is then exported back to the blood, thus compensating for the initial diet-imposed decreases in blood glucose concentrations. This process of generating blood glucose from the liver is known as gluconeoge-nesis and serves to maintain a steady supply of blood glucose fuel for the brain. The liver therefore acts as a thermostat for the maintenance of a steady concentration of blood glucose. A consequence of switching from using glucose to using fatty acids for fuel is that hepatocytes also return to the blood high concentrations of the ketone bodies acetoacetate and 3-hydroxybutyrate, partial breakdown products...

Gcp Ii Inhibitors In The Clinic

In further trials, daily doses of 375 mg and 750 mg were administered for 14 consecutive days to healthy volunteers and to patients with diabetes. In normal volunteers, the safety and tolerability profile was similar to placebo at doses up to 750 mg in the fasted state. In diabetic patients, complaints of mild hypoglycemia were reported at the highest dose, but were not associated with documented laboratory changes. In neither group were there any apparent effects on glutamate sensitive parameters.

Side Effects And Toxicology

As was discussed earlier in this chapter, fluoxetine is unlikely to alter DA function nonetheless, some side effects, such as hyperprolactinemia, extrapyramidal symptoms, sexual and cognitive dysfunction, galactorrhea, mammary hypertrophy, and gynecomastia, have been attributed to SSRI effects on the dopaminergic system (Damsa et al. 2004). Anecdotal reports of EPS (Meltzer et al. 1979) associated with SSRIs are not more frequent than those reported historically with TCAs (Fann et al. 1976 Zubenko et al. 1987), MAOIs (Teusink et al. 1984), or trazodone (Papini et al. 1982). Very rare events, including arthralgia, lymphadenopathy, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, agranulocytosis, and hypoglycemia, have been reported during clinical trials or postmarketing surveillance however, causality typically is uncertain.

Evidence That The Kd Suppresses Seizure Susceptibility Through Caloric Restriction

The association between blood glucose levels and seizure susceptibility is less clear in epileptic humans than in animal models of epilepsy, perhaps because of the capricious nature of glucose measurements in humans and from the broad range of glucose levels in normal individuals (60-120 mg dL) (78,79). A normal glucose level for one person could be hypoglycemic or hyperglycemic in another person. Indeed, some children can function normally with blood sugar levels as low as 20 mg dL (78). The reduction of body weight and restriction of calories in children on the KD implies reduced glucose levels relative to the levels prior to the initiation of the diet. To determine the relationship between glucose and seizure protection under the KD, it would be necessary to monitor glucose levels in children prior to the initiation of the KD. In other words, glucose levels should be monitored both before and during the KD with each child serving as his or her own control. According to Livingston,...

Drug Interactions And Glucose Metabolism

Many drugs can cause hypoglycemia or hyperglycemia or alter the response of diabetic patients to their existing therapeutic regimens. Aside from insulin and oral hypoglycemic drugs, drug-induced hypoglycemia is most often caused by ethanol, fi adrenergic receptor antagonists, and salicylates. The primary action of ethanol is to inhibit gluconeogenesis. In diabetics, fi adrenergic receptor antagonists pose a risk of hypoglycemia because of their capacity to inhibit cate-cholamine effects on gluconeogenesis and glycogenolysis. These agents also may mask the autonomic symptoms associated with hypoglycemia (e.g., tremor and palpitations). Salicylates enhance fi-cell sensitivity to glucose and potentiate insulin secretion and also have a weak insulin-like action in the periphery. A number of drugs have no direct hypoglycemic action but may potentiate the actions of sulfonylureas (see below). ORAL HYPOGLYCEMIC AGENTS Sulfonylureas

Glucagon In Diabetes Mellitus

Plasma glucagon concentrations are elevated in poorly controlled diabetic patients. Because it enhances gluconeogenesis and glycogenolysis, glucagon exacerbates the hyperglycemia of diabetes. However, this abnormality of glucagon secretion appears to be secondary to the diabetic state and is corrected with improved control of the disease. Although somatostatin-mediated inhibition of glucagons secretion does not restore glucose metabolism to normal, it significantly slows the rate of development of hyperglycemia and ketonemia in insulin-deficient subjects with type 1 DM. In normal individuals, glucagon secretion increases in response to hypoglycemia, but this important defense mechanism against insulin-induced hypoglycemia is lost in type 1 DM.

Rational Design of Protein Hormones Tomorrow Is Here

The introduction of recombinant insulin by itself did not lead to major changes in the management of patients with diabetes mellitus. However, demonstration of the importance of glycemic control in preventing certain long-term complications of diabetes (by The Diabetes Control and Complications Trial Research Group in 1993) resulted in greater interest in optimizing insulin regimens. Attempts at stricter control of blood glucose levels, however, also had undesirable consequences such as increased risk of hypo-glycemia and weight gain. The problems associated with aggressive titration of insulin are particularly challenging in infants and young children with diabetes 16 . Parents may give a dose of insulin before a meal only to discover that the toddler, as toddlers are wont to do, does not want to eat. must precede a meal. Hence, attempts to achieve euglycemia result in wide excursions of insulin levels and sometimes precipitate clinical hypoglycemia.

Recommended dosage and monitoring

Requirements Insulin dosage should be titrated to achieve near-normal levels of glucose, while avoiding hypoglycemia. For newly diagnosed type 1 diabetes melli-tus, the initial daily dosage of insulin is 0.6 to 0.75 units kg. For patients with type 2 diabetes mellitus, the starting dosage of insulin is usually 10 units and may be increased weekly in increments of 5 to 10 units. The label for all products that contain human insulin (recombinant DNA origin) warns human insulin products differ from animal-source insulins because they are structurally identical to the insulin produced by your body's pancreas and because of their unique manufacturing process. any change of insulin should be made cautiously and only under medical supervision. changes in strength, manufacturer, type (e.g., regular, nph, lente), species (beef, pork, beef-pork, human), or method of manufacture (rdna versus animal-source insulin) may result in the need for a change in dosage.

Pharmacology and pharmaceutics

Drug interactions Acarbose co-administered with insulin is likely to cause a lowered blood glucose concentration, thereby increasing the hypoglycemic potential of insulin. At adult doses of greater than 650 mg daily, aspirin may enhance the hypoglycemic effect of insulin through an intrinsic hypoglycemic effect. Corticosteroid therapy tends to increase blood glucose in diabetic patients, and higher doses of insulin may be required. Ethanol use in patients with diabetes or cirrhosis impairs the recovery from insulin-induced hypoglycemia. G. Other applications Delivery of insulin via an implantable insulin pump has resulted in good glycemic control with fewer episodes of severe hypoglycemia.

Critical Aspects Of Conjugates Targeted To The Liver

Another factor that should be taken into account is that binding of carriers to specific receptors may evoke a biological response that is connected to this receptor. In other words, receptors are not cellular markers but play an integral role in the regulation of many cellular functions, including growth, metabolism, differentiation, contraction, and migration. This aspect is reviewed by Feener and King 175 . The primary role of hormone and growth factor receptors, for instance, is to mediate a transmembrane signal transduction. For example, targeting to the brain is performed with an insulin fragment, which binds to the insulin receptor but does not have an effect on the glucose homeostasis, rather than with insulin itself. Insulin cannot be used as a carrier molecule, because the systemic delivery of insulin in nondiabetics patients can result in hypoglycemia because of a receptor-induced increased glucose uptake in the cells 185 . PDGF constitutes another example of targeting with...

Clinical pharmacology Glucagon is

Therapeutic response Glucagon (rDNA origin) is usually administered intramuscularly or subcutaneously. After injection, patients in hypoglycemia usually recover within 15 minutes. In a study of fasting healthy human subjects, a subcutaneous dose of Glucagon (Eli Lilly) 1 mg resulted in a mean peak glucose concentration of 136mg dl 30 minutes after injection. Simi F. Role in therapy According to Micro-medex, glucagon (rDNA origin) is effective in the treatment of hypoglycemia due to severe insulin reactions and idio-pathic hypoglycemia of neonates. In the treatment of insulin reactions it may be used alone or in combination with intravenous glucose. Glucagon has the advantage that it may be given intramuscularly or subcutaneously and may be administered in cases where it is difficult or impossible to establish venous access. Hypoglycemia from excessive doses of a sulfonylurea may not respond adequately to glucagon because the oral agent may cause the secretion of insulin. Although...

Heterocyclic Ring Present In Glipizide


Glipizide, 1 -cyclohexyl-3- (Glucotrol), is an off-white, odorless powder with a pKa of 5.9. It is insoluble in water and alcohols, but soluble in 0.1 N NaOH. Even though on a weight basis, it is approximately 100 times more potent than tolbutamide, the maximal hypoglycemic effects of these two agents are similar. It is rapidly absorbed on oral administration, with a serum half-life of 2 to 4 hours, whereas the hypoglycemic effects range from 12 to 24 hours. Metabolism of glipizide is generally through oxidation of the cyclohexane ring to the -hydroxy and m-hydroxy metabolites. A minor metabolite that occurs involves the -acetyl derivative, which results from the acetylation of the primary amine following hydrolysis of the amide system by amidase enzymes. The metaglinides are nonsulfonylurea oral hypoglycemic agents used in the management of type 2 diabetes (non-insulin-dependent diabetes mellitus, NIDDM). These agents tend to have a rapid onset and a short duration of...

GABAGlutamate Glutamine Cycle

Cultured neurons as well as synaptosomes synthesize considerable amounts ofaspartate from exogenously added glutamine via a truncated'' TCA cycle producing 9-12 molecules of ATP. This pathway is upregulated during hypoglycemic conditions (Hertz et al., 1992 Yudkoff et al., 1994 Waagepetersen et al., 2005). In neurons and synaptosomes in which PAG is predominantly localized, glutamine seems to be a superior energy substrate compared to glutamate (Westergaard et al., 1995). In astrocytes, on the other hand, glutamate seems to be the preferred precursor in contrast with glutamine for net synthesis of aspartate via a truncated TCA cycle, a process which is also upregulated during hypoglycemic conditions (Bakken et al., 1998).

Other Neuromodulators Cytokines Substance P Glutamate yAminobutyric Acid and Enkephalins

Of these effects, the effects on calcium, reducing calcium conductance and calcium ATPase pump activity, are likely to be most significant (68). Thus, it appears that glucocorticoids, when increased, impair the ability of neurons to survive coincident insults, such as hypoxia, metabolic poisons, hypoglycemia, oxygen radical generators, and seizure-related neurotoxicity. Suicide victims have been noted to have desensitization of N-methyl-aspartate (NMDA) receptors in the PFC as evidence that glutamate transport might be impaired in depression (169). In addition, NMDA antagonists are active in the forced swim test (170-173). Subanesthetic doses of the NMDA antagonist ketamine were found to produce rapid, but time limited, relief of depression in patients with major depression a decade ago (172), a finding that continues to be of interest with a recent extension to treatment-resistant depression (174).

Organic Cation Transporters Oct Octn Slc22A

Mutations in hOCTN2 lead to a recessive hereditary disorder called primary systemic carnitine deficiency (SCD) (Nezu et al., 1999 Lahjouji et al., 2001). This potentially lethal disease is characterized by progressive infantile-onset cardiomyopathy, skeletal myopathy, hypoketotic hypoglycemic encephalopathy, and extremely low plasma and tissue carnitine concentrations (Tein et al., 1990 Stanley et al., 1991 Pons et al., 1997). Nonsense or missense mutations in hOCTN2 have been demonstrated to cause low or nonfunctional carnitine transporters. Therefore, defect of carnitine reabsorption in kidney and carnitine uptake in cardiac muscles and other organs leads to systemic carnitine depletion, which lead to the inhibition of (3-oxidation of fatty acids (Tein, 2003). Patients with SCD are treated by oral administration of carnitine. Due to the potential drug-drug interaction, mediation with carnitine drugs interacting with hOCTN2 in patients with partial defects of hOCTN2 is suggested to...

Structureactivity Relationships

Sulconazole Nitrate

Hepatotoxicity, primarily of the hepatocellular type, is the most serious adverse effect of ketoconazole. Ketoconazole is known to inhibit cholesterol biosynthesis,47 suggesting that lanosterol 14a-demethylase is inhibited in mammals as well as in fungi. High doses have also been reported to lower testosterone and corticosterone levels, reflecting the inhibition of cytochrome P450-requiring enzymes involved in human steroid hormone biosynthesis.48 Cytochrome P450 oxidases responsible for the metabolism of various drugs may also be inhibited by ketoconazole to cause enhanced effects. Thus, ketoconazole causes clinically significant increases in plasma concentrations of cy-closporine, phenytoin, and terfenadine. It may also enhance responses to sulfonylurea hypoglycemic and coumarin anticoagulant drugs.

O Recombinant Drug Products Hormones

The hormone glucagon (GlucaGen) is biosynthesized in the pancreas as a high-molecular-weight protein from which the active macromolecule is released by proteolytic cleavage. Glucagon is a single chain of 29 amino acids and generally opposes the actions of insulin. Bovine and porcine glucagons, which possess structures identical with human glucagon, have been in use for years. The rDNA form has been approved by the FDA for use in severe hypoglycemia and as a radiological diagnostic aid. Glucagon relaxes smooth muscles in the gastrointestinal (GI) tract, decreasing GI motility and improving the quality of radiological examinations. In the treatment of severe hypoglycemia in insulin-dependent diabetics, GlucaGen causes the liver to convert glycogen to glucose. Left untreated, severe hypoglycemia (low-blood-sugar reactions) can cause prolonged loss of consciousness and may be fatal. The rDNA drug has the benefit that there is no chance of acquiring bovine spongi-form encephalopathy from...

Pregnancy and Lactation

Expectant females treated with other medications classified as nonteratogenic. In this trial, Costei et al. (2002) found that third-trimester paroxetine exposure was associated with significant increases in neonatal distress (odds ratio 9.53) compared with the other two groups. The most commonly observed forms of distress were characterized as respiratory distress and hypoglycemia. Results like these have stirred debate among neonatologists as to whether newborn distress attributed to SRIs is a manifestation of toxicity or of withdrawal (Stiskal 2005). Numerous case reports and case series have described transient neonatal symptoms following in utero exposure to SRI antidepressants, and these include (but are not limited to) tremor, hypertonicity, irritability, and poor feeding (Knoppert et al. 2006). Large trials correlating neonatal distress symptoms with infant serum drug levels, however, have not been performed thus far with paroxetine. Reduced or absent CYP2D6 isoenzyme activity...

The Crises of the Newborn Norepinephrine is Still a Necessity

The TH-null mutants are so very hungry they suck avidly and their mothers take good care of them. However, in spite of stomachs full of milk throughout their lives, the mutants fail to thrive. Mutant neonates do not gain weight after their second or third day they weigh between 3 and 4 grams throughout their lives. The TH-nulls maintain the weight of a normal 4 day-old pup which would be expected to weigh between 8 and 10 grams at two weeks of age. The mutants are deficient in length, crown to tail, as if they had been starved (Figure 1). But unlike unfed normal pups with equivalent weight and length, the TH-null mutants become severely hypoglycemic though they always have milk in their stomachs and their livers store glycogen. The TH-null mutants display normal insulin responses though they do not experience the normal rise in blood insulin levels that occur with age. After a glucose challenge, blood glucose levels rise to the levels that are produced in controls after the same...

Inborn Errors of Metabolism in Which the KD Is Contraindicated

There is tremendous clinical heterogeneity in fatty acid oxidation defects. Patients may be asymptomatic between attacks or severely affected from a young age. Attacks are brought on by illness, stress, and prolonged fasting. The spectrum of clinical symptoms may include hypotonia, myopathy, cardiomyopathy, recurrent rhabdomyolysis with myoglobinuria, Reye-like syndrome with liver failure, intermittent altered levels of consciousness, neuropathy, and seizures. Concurrent with the symptoms are often a nonketotic hypoglycemia, unexplained metabolic acidosis, hyperammonemia, dicar-boxylic aciduria, elevated creatinine kinase, and carnitine deficiency.

N-dealkylation Of Barbiturates

Cyclophosphamide Pathway

Various other N-alkyl substituents present in benzodiazepines (e.g., flurazepam)136-138 and in barbiturates (e.g., hexobarbital and mephobarbital)128 are similarly oxidatively N-dealkylated. Alkyl groups attached to the amide moiety of some sulfonylureas, such as the oral hypoglycemic chlorpropamide,236 also are subject to dealkylation to a minor extent.

Risk Of Systemic Absorption

Famille Ejercise

The symptoms of Addison disease illustrate the great importance of the adrenocortical steroids in the body and, especially, the importance of aldosterone. These symptoms include increased loss of body sodium, decreased loss of potassium, hypoglycemia, weight loss, hypotension, weakness, increased sensitivity to insulin, and decreased lipolysis.

Antiobesity activity

Body, soluble and insoluble fiber acts in a very different way. Consumption of marine algae soluble fiber such as carrageenan, agar, alginate are primarily associated with hypocholesterolemic and hypoglycemic effects (Panlasigui et al., 2003). In example, alginates have been shown to modulate appetite and energy intake in models of acute feeding. Upon reaction with gastric acid (acid-soluble calcium source), alginates undergo ionic gelation to form an alginate gel that can slow gastric emptying, stimulate gastric stretch receptors, reduce intestinal nutrient uptake, and influence the glycaemic response (Dettmar et al., 2011). In accordance, ingesting calcium-gelled, alginate-pectin twice per day has been reported to reduce spontaneous food intake in overweight and obese females (Pelkman et al., 2007). Further, insoluble fiber such as cellulose, xylans, mannans are associated with excretion of bile acids, increase fecal bulk, and decrease intestinal transit time (Burtin, 2003 Moore et...

Antidiabetic activity

Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels. Diabetes without proper treatments can cause many complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and retinal damage. Hence, antidiabetic agents are urgently required. It has been reported that fucosterol from P. siliquosa have antidiabetic activity. Fucos-terol at a dose of 100 and 300 mg kg reduced hyperglycemic effect by 25-33 in epinephrine-induced diabetes mouse model. Moreover, fucosterol at a dose of 100 and 300 mg kg was shown to decrease the glycogen degradation of mouse liver by 23-29 . Hence, it was suggested that fucosterol from marine alga P. siliquosa has potential in development of antidiabetic agent (Lee et al., 2004).

Pharmacotherapy Of Alcoholism

Disulfiram (tetraethylthiuram disulfide ANTABUSE) was taken in the course of an investigation of its potential anthelmintic efficacy by two Danish physicians, who became ill at a cocktail party and were quick to realize that the compound had altered their responses to alcohol. They initiated a series of pharmacological and clinical studies that provided the basis for the use of disulfiram as an adjunct in the treatment of chronic alcoholism. Similar responses to alcohol ingestion are produced by various congeners of disulfiram, namely, cyanamide, the fungus Coprinus atramentarius, the hypoglycemic sulfonylureas, metronidazole, certain cephalosporins, and animal charcoal.

Neural and physiological mechanisms

Caffeine also acts to disturb calcium (Ca2+) homeostasis, releasing Ca2+ from the neuronal sarcoplasmic endoplasmic reticulum and hence depleting neural calcium stores.35 This results in an inhibition of protein synthesis due to the suppression of translational initiation,36 an effect similar to that seen in transient metabolic stress, such as that associated with ischemia and hypoglycemia. In chronic use, caffeine selectively increases opioid neuropep-tide messenger RNA (mRNA) expression,37 affecting both preproenkephalin (PPE) and preprodynorphin (PPD) mRNA.38 The result is up-regulation of both adenosine and prostacyclin receptors.39


First, it is necessary to review some basic definitions. A seizure is a temporary disruption of brain function owing to the hypersynchronous, excessive discharge of cortical neurons. Sometimes, the term epileptic seizure is used to distinguish this event from a nonepileptic seizure such as a psychogenic ( pseudo ) seizure, which involves abnormal clinical behavior but is not caused by hypersynchronous neuronal firing. The clinical manifestations of a seizure depend on the specific region and extent of brain involved and may include alteration in motor function, sensation, alertness, perception, autonomic function, or some combination of these. Anyone might experience a seizure in the appropriate clinical setting, e.g., meningitis, hypoglycemia, or toxin ingestion, attesting to the innate capacity of even a normal brain to support hypersynchronous discharges under specific circumstances.


NOTE See also antihypertensive combinations. Hyperkalemia possible, especially If used concomitantly with other drugs that increase K+ (including K+ containing salt substitutes) and in patients with heart failure, diabetes mellitus, or renal impairment. Monitor closely for hypoglycemia, especially during first month of treatment when combined with insulin or oral antidiabetic agents. ACE inhibitors are contraindicated during pregnancy. Contraindicated with a history of angioedema. Renoprotection and decreased cardiovascular morbidity mortality seen with some ACE inhibitors are most likely a class effect.


Massive sequestration of the parasite in the brain is believed to be the underlying cause of coma in cerebral malaria. The reason for parasite sequestration is unknown, but it has been speculated that binding to the endothelium is a way to circumvent spleen-dependent destruction. Two receptors, CD36 and chondroitin sulfate A (CSA), seem to provide stable stationary adherence. A single parasite protein, P. falciparum erythrocyte membrane protein 1 (PfEMPl), which is expressed at the infected erythrocyte surface, mediates parasite binding to these receptors. In pregnant women, RBCs sequester in the placenta, causing premature delivery, low birth weight, and increased mortality in the new born and anemia in the mother. Other pathogenic effects of malaria include anemia, hypoglycemia, and metabolic acido-sis. The two latter are strongly associated, suggesting that parasite and or host metabolism may be contributing to both. Hypoglycemia, which produces deleterious effects on the central...

Diet Initiation

On Day 1 of hospitalization, the child is admitted. Fluids are restricted to 60-75 mL per kilogram of body weight, and children often require encouragement to drink owing to thirst arising from ketosis. Blood glucose is monitored with finger sticks every 6 h unless it falls below 40 mg dL, in which case it is checked every 2 h. If the child has symptoms of hypoglycemia or the glucose level falls below 25 mg dL, 30 mL of orange juice is provided and the glucose is checked one hour later. Even small children tolerate the fast well, with rare symptomatic hypoglycemia. Urine ketones are checked daily as well. Ketosis can begin during the fasting period, and the resultant nausea and vomiting can occasionally require intravenous hydration using fluids containing no dextrose.


Manifestations of poisoning with b receptor antagonists depend on the pharmacological properties of the ingested drug. Hypotension, bradycardia, prolonged AV conduction times, and widened QRS complexes are common manifestations. Seizures and depression may occur. Hypoglycemia is rare, and bronchospasm is uncommon in the absence of pulmonary disease. Significant bradycardia should be treated with atropine, but a cardiac pacemaker often is required. Large doses of isoproterenol or an a receptor agonist may be necessary to treat hypotension.

Vitamin E

The pain practitioner must be keenly aware of vitamin E supplementation as it may increase the effects of anticoagulant and antiplatelet drugs. Concomitant use of vitamin E with these drugs may increase the risk of hemorrhage (Liede et al. 1998). Further, preliminary evidence suggests that type 2 diabetics may have an increased risk of hypoglycemia since vitamin E may enhance insulin sensitivity, and therefore adjustment of oral hypoglycemics would be advisable (Paolisso et al. 1993a, b). Cholestyramine, colestipol, isoniazid, mineral oil, orlistat, sucralfate, and the fat substitute olestra may possibly decrease the absorption of vitamin E, leading to decreased levels in the serum (Hendler and Rorvik 2001).

Sick Days

The caregiver must also receive counseling on management of intercurrent illnesses ( sick days ). If the child is vomiting or has diarrhea, ketogenic meals should be temporarily stopped and the emphasis should be on maintaining hydration with fluids. Diluted broth, noncaloric caffeine-free soda and sugar-free gelatin can be offered. If vomiting and or diarrhea persists, an oral rehydration solution may be given at half-strength. Easy-to-digest ketogenic meals such as ketogenic eggnog or chicken salad with applesauce can be restarted in half portions when the child is ready to begin eating. The signs and symptoms of hypoglycemia and excessive ketosis should be taught during the hospitalization, and the method of treatment should be outlined for home use. A visit to the pediatrician or emergency room may be necessary if symptoms persist after treatment. Caregivers should be assured that these problems are unlikely to occur once the child has begun to consume the full diet. Close contact...


Diabetes was first related to manganese by a report that a diabetic man had reductions in blood glucose in response to doses of 5-10 mg manganese and elevated urinary excretion as determined by doses of 54Mn.58 Also, protracted hypoglycemia following a glucose load was observed in workers with manganese toxicity.59 Yet a clinical trial in which subjects were given varying manganese doses (to 10 mg) showed no influence on blood glucose.10 Nonetheless, several studies have found that insulin mRNA is decreased in manganese-deficient rats, suggesting a role for manganese in its transcription or turnover.10 Another possible association could be the protective role that SOD2 plays in


The sulfonylurea linkage is present in many hypoglycemic drugs, such as tolbutamide (4.249). Although the metabolism of these drugs has been studied in detail, direct hydrolysis of the sulfonylurea linkage has not been observed. Only in the case of chlorpropamide (4.250) has some hydrolytic breakdown of the urea moiety been detected. The resulting 4-chloroben-zenesulfonamide (4.251), however, was not a genuine metabolite but an artifact formed from the intermediate (4-chlorophenyl)sulfonylurea by chemical hydrolysis at acidic pH during extraction 162 .


GC levels above the seasonal baseline are generally correlated with protein utilization and muscle tissue breakdown 243, 244 . Experimental manipulations confirm the involvement of elevated GC levels in such metabolic changes GC administration induces protein loss and muscle atrophy in a variety of species 245-248 . GCs may also promote gluconeogenesis through enhanced substrate delivery. Studies in dogs suggest that cortisol treatment enhances de novo glucose synthesis through increased amino acid uptake in the liver 249, 250 . Studies in a variety of vertebrate species verify the role of GCs in the acute provisioning of glucose. Treatment with GC equivalents increases plasma glucose in birds 251, 252 and can reverse hypoglycemic effects of insulin injections 253 . It is important to note that GC manipulations may not always affect plasma glucose levels 254, 255 .


Most studies have not found developmental delays in infants whose mothers took antidepressants during pregnancy although one study (118) found gross motor delays and delays in attention in children whose mothers had taken SSRIs in the second or third trimester compared to a control group of women who were depressed during pregnancy and not taking antidepressants. Scores remained within the normal range for the exposed group, and the clinical significance of these findings was uncertain. A withdrawal syndrome is sometimes seen in neonates whose mothers took antidepressants up to the time of delivery. Symptoms include jitteriness, poor muscle tone, weak or absent cry, respiratory distress, hypoglycemia, seizures, and low Apgar scores. It is possible to avoid this by a slow taper prior to delivery however, the clinician should be cautious about recurrence of depression in the mother.

O Concluding Remarks

Drugs of the hypoglycemic sulfonylurea class have the general molecular structure shown at right. The potencies of these molecules as oral hypoglycemic agents parallel to a very great extent the affinity with which they bind to ATP-sensitive potassium channels, as discussed in an early section of this chapter. Using the information from Table 20.3, and the structures shown in Figures 20.4 and 20.5, fill in the following table, listing the drugs from top to bottom according to daily dose

Calorie Restriction

The effect of calorie restriction on seizure threshold in a model of genetic epilepsy (the EL mouse) is described in detail by Seyfried and colleagues (see ref. 94 and Chapter 19, this volume). EL mice normally develop seizures by about 50 d of age, either spontaneously or in response to handling. When EL mice are fed a KD from infancy, the onset of seizures is delayed by several weeks. However, these investigators found that simply restricting calories had as robust an effect of seizure suppression as did the KD. They postulated that calorie restriction may underlie the mechanism of the KD, either from ketosis or hypoglycemia. The authors believe that the mechanism of seizure suppression is probably related to glucose dysregulation (95). Most likely, a combination of the two factors is operative e.g., the brain metabolizes ketones better under conditions of reduced glucose.

Caloric Restriction

In 2001 we showed that in addition to the KD, caloric restriction (CR) alone could reduce seizure susceptibility in epileptic EL mice (41). CR is a natural dietary therapy that improves health, extends longevity, and reduces the effects of neuroinflammatory diseases in humans and rodents (42-47). CR involves a reduction of total dietary energy intake while maintaining adequate levels of vitamins and minerals (48,49). In contrast to prolonged fasting or starvation, which produce clinical hypoglycemia and ketoacido-sis, CR lowers glucose levels and raises ketone levels within normal physiological ranges. The shift from glucose to ketone energy produces enhanced vitality and metabolic efficiency (11,50,51).

Daily Requirements

A regimen that is gaining widespread use involves multiple daily injections consisting of basal administration of long-acting insulin (e.g., insulin glargine or detemir) either before breakfast or at bedtime and preprandial injections of a short- or rapid-acting insulin (Figure 60-3C). This method, called basal bolus, is very similar to the pattern of insulin administration achieved with a subcutaneous infusion pump (Figure 60-3E). Following the successful demonstration that intensive glycemic control can reduce the risk of complications in patients with type 2 DM, there has been increased interest in using insulin earlier in the treatment of these patients. Data indicate that 50 of relative fi-cell insulin secretory capacity is lost for every 6 years of type 2 DM. This progressive insulin deficiency as type 2 DM progresses makes it increasingly difficult to achieve glycemic control with oral antihyperglycemic agents. An option in this setting is to introduce basal-acting insulin in...


Like sulfonylureas, repaglinide stimulates insulin release by closing ATP-dependent K+ channels in pancreatic 3 cells. The drug is absorbed rapidly from the GI tract, and peak blood levels are obtained within 1 hour with a t1 2 of 1 hour. These features permit multiple preprandial use as compared with the classical once- or twice-daily dosing of sulfonylureas. Repaglinide is metabolized primarily by the liver to inactive derivatives and should be used cautiously in patients with hepatic insufficiency. Caution is also indicated in patients with renal insufficiency. The major adverse effect of repaglinide is hypoglycemia. Nateglinide (starlix) is derivative of d-phenylalanine that stimulates insulin secretion by blocking ATP-sensitive K+ channels in pancreatic 3 cells. Nateglinide promotes a more rapid but less sustained secretion of insulin than do other available oral antidiabetic agents. The drug's major therapeutic effect is reducing postprandial glycemic elevations in type 2 DM...


Glucagon extracted from bovine and porcine pancreas has a sequence identical to that of the human hormone. For hypoglycemic reactions, 1 mg is administered intravenously, intramuscularly, or subcutaneously. The first two routes are preferred. The hyperglycemic action of glucagon is transient and may be inadequate if glycogen hepatic stores are depleted. After the initial response to glucagon, patients should be given glucose or urged to eat to prevent recurrent hypo-glycemia. Nausea and vomiting are the most frequent adverse effects.


Indications Treatment for severe hypo-glycemia severe hypoglycemic reactions that may occur in patients with diabetes treated with insulin. Because Glucagon (rDNA origin) depletes glycogen stores, the patient should be given supplemental carbohydrates as soon as he she awakens and is able to swallow, especially children or adolescents with type 1 diabetes. Glucagon (rDNA origin) is also indicated for use during radi-ologic examinations to temporarily inhibit movement of the gastrointestinal tract. It is as effective for this examination as are anti-cholinergic drugs.


Recommended dosage and monitoring requirements For the treatment of hypo-glycemia, the dose of GlucaGen for adult and pediatric patients weighing more than 25 kg is 1mg by injection. Half the adult dose (0.5 mg) is recommended for pediatric patients weighing less than 25 kg or younger than 6 to 8 years old. Glucagon (Eli Lilly) 1 mg is recommend for all patients weighing more than 20 kg. Emergency assistance should be sought if the patient fails to respond within 15 minutes after subcutaneous or intramuscular injection of glucagon. The glucagon injection may be repeated while waiting for emergency assistance. Intravenous glucose must be administered if the patient fails to respond to glucagon. When the patient has responded to the treatment, oral carbohydrate should be given to restore the liver glycogen and prevent recurrence of hypoglycemia.


Synthesis Capreomycine

Toxic effects associated with rifampin are relatively infrequent. It may, however, interfere with liver function in some patients and should neither be combined with other potentially hepatotoxic drugs nor used in patients with impaired hepatic function (e.g., chronic alcoholics). The incidence of hepatotoxicity was significantly higher when rifampin was combined with isoniazid than when either agent was combined with ethambutol. Allergic and sensitivity reactions to rifampin have been reported, but they are infrequent and usually not serious. Rifampin is a powerful inducer of hepatic cytochrome P450 oxygenases. It can markedly potentiate the actions of drugs that are inactivated by these enzymes. Examples include oral anticoagulants, barbiturates, benzodiazepines, oral hypoglycemic agents, phenytoin, and theophylline.

Stephen J Cutler

The drugs discussed in this chapter are used for their action on the heart or other parts of the vascular system, to modify the total output of the heart or the distribution of blood to the circulatory system. These drugs are used in the treatment of angina, cardiac arrhythmias, hypertension, hy-perlipidemias, and disorders of blood coagulation. This chapter also includes a discussion of hypoglycemic agents, thyroid hormones, and antithyroid drugs.

The Trpm Subfamily

Proposed based on experiments in which the GABA receptor antagonist bicu-culline was employed to initiate spontaneous epileptic activity in neocortical slices. TRPM4-like channels are activated during paroxysmal depolarization shift (PDS) discharges and appear to play a role in maintaining subsequent sustained after-depolarization waveforms. The latter effect depends on an increase in Ca'+ i and can be blocked by maneuvers that inhibit TRPM4 (Schiller, 2004). Neuronal damage evoked by reduced blood supply to the brain ( vascular stroke ), which induces severe hypoxia and hypoglycemia, is very often accompanied by a phenomenon in which susceptible neurons slowly lose their membrane potential and then suddenly enter a transient state of complete depolarization, known as spreading depression (SD) -like hypoxic depolarization. SD is associated with an increase in Ca2+ i. Intriguingly,TRPM4 (and TRPM5) could be a candidate for triggering this dramatic event, although there is at present no...


Garlic (Allium sativum) has a history as a medicinal agent going back thousands of years. Hippocrates, Dioscorides, and other prominent medical experts of ancient and medieval eras deciphered its medicinal uses.60 Garlic is mentioned in the Bible, and it may be one of the most widely used natural supplements. Its first known origin may be Central Asia (3000 B.C.), later spreading to other parts of the world.60 It is a regular part of the diet for most people in Asian and Middle Eastern countries. Its potential therapeutic uses include antimicrobial, antithrombotic, hypolipidemic, anti-arthritic, hypoglycemic, and antitumor activity.61


There are three main groups of ginseng that are classified based on their geographic origin (Hughes et al. 2004). These are Asian ginseng, American ginseng, and Siberian ginseng, with the pharmacologically active ingredient in ginseng being ginsenosides (Hughes et al. 2004, Leak 1999, Kaye et al. 2000). Asian and American ginsengs have been used to increase resistance to environmental stress, promote diuresis, stimulate the immune system, and aid digestion (Ng et al. 1987, Jellin et al. 2003). Further, while Asian ginseng has shown promise in improving cognition when combined with the herbal agent Ginkgo, American ginseng has been studied for its potential to stimulate human tumor necrosis factor-a (TNF-a) production in cultured human white blood cells (Jellin et al. 2003, Zhou and Kitts 2002). American ginseng may also possess hypoglycemic activity (Jie et al. 1984, Sotaniemi et al. 1995). Such effects have been observed in both normal and diabetic subjects and may be attributed to...


Tremor is usually increased in fatigue, weakness, anxiety, hypercapnia, drug and alcohol withdrawal, and some metabolic and endocrine syndrome (uremia, hypoglycemia, hepatic disease, thyro-toxicosis and heavy-metal intoxication). Some medications increase physiological tremor, e.g. amphetamines, valproic acid, theophyllines, lithium,


Magnesium may also interfere with the absorption of antibiotics such as tetracyclines, fluoroquinolones, nitrofurantoins, penicillamine, angiotensin-converting enzyme (ACE) inhibitors, phenytoin, and histamine (H2) blockers. Absorption problems can be ameliorated by not taking doses of magnesium within 2 h from these other medications (Tatro 1999, Shiba et al. 1995, Naggar and Khalil 1979, Osman et al. 1983). The mineral may also make oral hypoglycemics, specifically sulfonylureas, more effective when used, thus increasing the risk of hypoglycemic episodes (Kivisto and Neuvonen 1992).

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