This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hyperglycemia is frequently encountered in Extremely Low Birth Weight (ELBW) infants receiving TPN providing glucose exceeding the infant normal glucose turnover rate. Recent studies in critically ill children and adults have demonstrated that hyperglycemia was associated with increased mortality. Since ELBW infants also constitute a high-risk population, preventing hyperglycemia without compromising their energy intake, may reduce their risk of an adverse outcome. To accomplish this goal requires detailed knowledge about potential factors involved in the development of hyperglycemia (regulation of glucose production, gluconeogenesis, glycogenolysis, glucose utilization; and insulin secretion and insulin resistance), and the mechanisms by which e.g. insulin infusion and reduced glucose infusion rates affect glucose metabolism to reduce blood glucose.
The specific aim of the protocol described below is to determine whether the very frequently observed glucose intolerance in ELBW infants is primarily due to insufficient insulin secretion and/or insulin resistance. If this is the case, the glucose intolerance might be overcome by providing insulin intravenously, thereby, enabling us to maintain higher glucose infusion rates and, thus, higher energy intake. If this is not the case, and the glucose intolerance is rather a result of insufficient glucose uptake due to small mass of insulin dependent tissue, insulin treatment is not likely to be successful. A clear understanding of the mechanisms that control glucose homeostasis in the extremely low birth weight infant will permit us to develop evidence based strategies to maintain euglycemia while providing appropriate energy intak
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