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Management Of Hyperglycemia In The Neurosurgery Patient, Rene Daniel, Satya Villuri, Kevin Furlong

JHN Journal

Hyperglycemia is associated with adverse outcomes in patients who are candidates for or underwent neurosurgical procedures. Specific concerns and settings that relate to these patients are preoperative glycemic control, intraoperative control, management in the neurological intensive care unit (NICU), and postoperative control. In each of these settings, physicians have to ensure appropriate glycemic control to prevent or minimize adverse events. The glycemic control is usually managed by a neurohospitalist in co-management with the neurosurgery team pre- and postoperatively, and by the neurocritical care team in the setting of NICU. In this review article, we outline current standards of care for …

Full Issue: Volume 15, Issue 1 - Summer 2020

JHN Journal

Table of Contents

2 - Farber Hospitalist Service – Last 5 Years Of A Service Dedicated To The Medical Management Of Neurosurgical Patients
Rene Daniel; Catriona McDonald Harrop

5 - Cardiac Risk Stratification of Neurosurgical Patients
Aditya A Munshi

9 - Epidural Abscess of the Central Nervous System
Katherine Belden; Jack Jallo; Linda Mwamuka

15 - Spinal Metastasis – Diagnosis, Management, and the Role of the Hospitalist
Bharath Ganesh; Catriona McDonald Harrop; Jesse Edwards

20 - Textbook Spotlight Medical Management of Neurosurgical Patients

21 - Management of Hyperglycemia in the Neurosurgery Patient
Rene Daniel; Satya Villuri; Kevin Furlong

29 - …

Compliance With Surgical Care Improvement Project Blood Glucose--A Marker For Euglycemia, But Does It Put Our Patients At Risk?, Isaac R Whitman, Maura Murphy, Marta M Gilson, Amy Campfield, Michel Haddad, Elizabeth Moxey, Glenn J R Whitman

Department of Surgery Faculty Papers

To improve outcomes in open heart surgery (OHS) patients, the Surgical Care Improvement Project (SCIP) requires 6 am postoperative day (POD) 1 and 2 blood glucose (BG) to be ≤200mg/dL. This study examined risk factors for SCIP noncompliance when using an insulin infusion protocol (IIP) and evaluated this SCIP metric as a surrogate for glycemic control. The authors divided 99 consecutive OHS patients, all subjected to 1 uniform IIP, into 2 groups: Group 1-SCIP compliant (n=79) and Group 2-SCIP noncompliant (n=20). They determined mean BG for the first 48 postoperative hours, percent of total time with hyperglycemia (% time BG …

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-Centered Approach: Position Statement Of The American Diabetes Association (Ada) And The European Association For The Study Of Diabetes (Easd)., Silvio E Inzucchi, Richard M Bergenstal, John B Buse, Michaela Diamant, Ele Ferrannini, Michael Nauck, Anne L Peters, Apostolos Tsapas, Richard Wender, David R. Matthews

Department of Family & Community Medicine Faculty Papers

No abstract provided.

Chronic Diseases: The Emerging Pandemic., Andre Terzic, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

According to the 2011 World Health Organization Global Status Report, of the 57 million annual global deaths – a staggering 36 million or over 63% are due to chronic diseases.¹ Four noncommunicable diseases - namely cardiovascular, cancer, diabetes, and chronic respiratory diseases - emerge as the leading cause of mortality in the world, accounting respectively for 17, 7.6, 4.2, and 1.3 million deaths based on the latest available global epidemiology data. By 2020, global deaths due to chronic diseases are projected to worsen by at least 15 to 20%. It is estimated that the four major noncommunicable diseases will …

Identification Of Persistent Defects In Insulin Receptor Structure And Function In Capillary Endothelial Cells From Diabetic Rats, Ching Fai Kwok, Barry J. Goldstein, Dirk Muller-Wieland, Tian-Shing Lee, C. Ronald Kahn, George L. King

Department of Medicine Faculty Papers

Insulin actions and receptors were studied in capillary endothelial cells cultured from diabetic BB rats and their nondiabetic colony mates. The endothelial cells from diabetic rats of 2 mo duration had persistent biological and biochemical defects in culture. Compared with normal rats, endothelial cells from diabetic rats grew 44% more slowly. Binding studies of insulin and insulin-like growth factor I (IGF-I) showed that cells from diabetic rats had 50% decrease of insulin receptor binding (nondiabetic: 4.6 +/- 0.7; diabetic: 2.6 +/- 0.4% per milligram protein, P < 0.01), which was caused by a 50% decrease in the number of binding sites per milligram protein, whereas IGF-I binding was not changed. Insulin stimulation of 2-deoxy-glucose uptake and alpha-aminoisobutyric acid uptake were also severely impaired with a 80-90% decrease in maximal stimulation, in parallel with a 62% decrease in insulin-stimulated autophosphorylation (P < 0.05). ¹²⁵I-insulin cross-linking revealed an 140-kD alpha subunit of the insulin receptor similar to …