Persistent neonatal hypoglycemia insulin glucose ratio

[ashok]

How to calculate insulin glucose ratio?. Insulin reported as microIU/L and glucose as mg/dl.do u need to convert insulin to picomll/l or glucose to mol/Lt, before putting the ratio? 

The reference value said as<.2 normal and >.4 abnormal is without unit conversion or what? 

Do u take insulin levels only during hypoglycemia or induced hypoglycemia to detect hyper insulin em is. 

[bimalc]

The use of a ratio without units implies that both quantities should be in the same units before taking their ratio.  which units you choose to use is irrelevant.

The purpose of the ratio is to detect inappropriately high insulin levels during hypoglycemia.

[ashok]

Hi,thanks for reply.That is not possible. Insulin is in microiu and even if converted glucose will be milli mol/L.if you are using such ratio, explain how you are using and cutoffs or kindly give reference. 

[bimalc]

I have never found the need to use the quantitative ratio of insulin and glucose concentrations (and I assure you, your lab is measuring an insulin concentration in the samples you provide.  If you are getting reports of insulin levels that are not concentrations you need to call your lab director).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141553/ is a review that discusses one demonstration of a modified ratio as well as its limitations, though not in neonatal data.

[ali]

Hi 99ers,

Conversely may I enquire whether any members have encountered the scenario of a premmie who has successfully reached full enteral feeds but remains  hyperglycaemic with blood sugars consistently over 13/14 ? What further investigations may be revealing? 

Thank you in advance

Alistair

 

[bimalc]

On 5/22/2019 at 11:03 AM, ali said:

Hi 99ers,

Conversely may I enquire whether any members have encountered the scenario of a premmie who has successfully reached full enteral feeds but remains  hyperglycaemic with blood sugars consistently over 13/14 ? What further investigations may be revealing? 

Thank you in advance

Alistair

 

I've never seen this, but my first instinct would be to work the child up for diabetes (assuming this isn't sepsis or iatrogenic).  If a biochemical diagnosis was not immediately obvious and you are in the UK, I would see if the genomic medicine service in Cambridge would accept your patient for neonatal whole genome sequencing.  In terms of actually lowering the blood glucose, you could try increasing protein intake (if calories are adequate already, you could even reduce carbohydrate calories).  Branched chain AAs are a key signal for energy balance and can stimulate a more robust insulin.