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Precio de gabapentina 300 mg /day and placebo patients without cardiovascular or renal dysfunction. All the patients with diabetes and cardiovascular or renal disease were taking insulin. Blood glucose levels were measured every second afternoon for 7 consecutive days. Subjects were randomly allocated to one of two groups: a control group receiving placebo, and a diabetes group receiving 300 mg or of cobalamin, divided by 5 (400 mg) and then divided by 3 (150 mg) groups, and receiving placebo or their assigned dose of cobalamin. The main objective these patients was to identify any adverse effect of cobalamin for the development hyperglycemia and any effect of a higher cobalamin dose on the management of hyperglycemia as a consequence diabetes. In addition, the results of all clinical and anthropometric parameters, a serum creatinine test and fasting blood glucose level were measured every second afternoon to exclude a possible effect of cobalamin treatment on the management of hyperglycemia or any possible effect of cobalamin treatment on arteriosclerosis. DISCUSSION Hyperglycemia is a major problem for nearly all patients with diabetes. There is some suggestion that cobalamin supplementation may provide some protection from hyperglycaemia and an important mechanism. Many patients with type 2 diabetes have elevated homocysteine levels and impaired antioxidant defenses due to defense enzymes in the mitochondrial electron transport chain (ETC), and hence, increased oxidative stress. Furthermore, there has been some suggestion that antioxidant defenses are impaired during hyperglycemia in diabetic patients. Elevated homocysteine has been associated with the development of many medical complications, especially coronary atherosclerosis and peripheral arterial disease in patients with underlying cardiovascular disease, especially those with diabetes. [10] It is drugstore coupon code free shipping 25 conceivable that increasing cobalamin intake might reduce the susceptibility to oxidative stress and thus the risk for increased homocysteine and/or of endothelial dysfunction. In our study, a higher cobalamin dose was associated with a significant reduction of the risk hyperglycaemia and atherosclerosis. A reduced body weight was also found in cobalamin treated patients vs. those receiving placebo. In other published studies using different cobalamin doses, a higher dose was associated with an average weight reduction of 7.6 kg. [11] Furthermore, in patients with acute coronary syndromes (e. g. MI), a higher cobalamin dose has also been shown to reduce the Generic drug for diflucan incidence of MI. It is generally accepted that a higher cobalamin dose promotes antioxidant enzymes, such as superoxide dismutase and glutathione peroxidase, as well reduces oxidative stress. [12] The mechanism for antioxidant and/or glutathione enhancing effect of cobalamin is not known, although a number of studies suggest that its antioxidant action and neuroprotective effects are probably mediated by oxidative stress, i. e. it decreases oxidative stress by an antioxidant property [13]. It has also been shown that cobalamin can inhibit the conversion of homocysteine to methionine, another methylated amino acid that is associated with the development of atherosclerosis in patients with type 1 diabetes. [14] Although the increase of homocysteine concentrations has been associated with an increased risk of cardiovascular diseases, [15] a recent systematic review of 6 clinical studies showed that cobalamin or a supplement has little association with the risk of cardiovascular diseases in diabetic patients. [16] It has been suggested that this would be due to other mechanisms, as higher cobalamin levels are also found in normal young adults with blood pressure and in those drinking diet drink with no cobalamin. [17] An important limitation of our study was that we measured a small sample size and that the differences in anthropometric data of the cobalamin treated and placebo groups were not statistically significant. Our study provides additional information on the association of cobalamin and hyperglycemia in patients with type 2 diabetes. randomized to cobalamin had lower average body weight decrease than those receiving placebo. A higher cobalamin dose was associated with a reduction in body weight and a reduction in body fat percentage both the cobalamin treated and placebo groups. This suggests that cobalamin supplementation reduces the fat mass in patients with type 2 diabetes, and this effect is potentially clinically important because the lower body weight is associated with a lower incidence of cardiovascular diseases. The mechanism of cobalamin reducing risk hyperglycemia and arteriosclerosis is not completely understood. Although a number of studies have suggested that oxidative stress may be a causal factor [18], not much is known about the mechanism by which cobalamin protects against lipid oxidation in vivo. It is reasonable to assume that there may be indirect or effects. For example, it has been shown that a higher cobalamin dose increases mitochondrial activity [19].
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