{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["START HERE","Hyperglycemic Clamp ","Stage 2 Max Response Only","HELP!","Calculations","QC Sheet"],"not_rendered":{"charts":2,"images":0,"macros":1,"external_links":0,"defined_names":5,"comments":2,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"START HERE","index":0,"n_rows":42,"n_cols":1,"rows_kept":42,"cut":false,"hidden":false,"merged":[]}
["Disclaimer"]
["This worksheet is provided 'as is' with no guarantees of performance or results. "]
["This worksheet provides guidance only, and the final decision for the selected infusion rate is at the discretion of the investigator or designee performing the procedure."]
["Medical procedures carry intrinsic risk. The safe performance of the procedure is the first priority, and is entirely the responsibility of the team performing the procedure."]
["The investigators performing the procedure must use their best judgment in all aspects of the procedure including any infusion rate decisions guided by this worksheet."]
[]
["Technical Support"]
["This worksheet is provided 'as is'. There is no plan to provide support in the performance of procedures, or in use of the worksheet, by RISE investigators. "]
["There is no planned upgrade path for the worksheet. Suggestions for improvement may be of use to the community, and can be sent to RISE@bsc.gwu.edu"]
[]
["Academic Acknowledgement"]
["Please formally acknowledge the RISE study where the use of this worksheet has contributed to your work."]
["Suggested text is 'The clamp procedures were performed with guidance from the RISE clamp worksheet, obtained from URL'. "]
["Please also reference the RISE publication detailing the technical performance of the clamp procedure guided by this worksheet, REF"]
[]
[]
["Clamp worksheet instructions"]
["Start on the 'Hyperglycemic Clamp' worksheet. You will enter baseline data and fasting glucose there. "]
[]
["If the fasting glucose is ≥200 mg/dl that sheet will direct you to the 'Stage 2 Max Response Only' worksheet"]
["Data must be entered in all yellow boxes before bolus or infusion rate calculations can be made."]
["Enter clock time at the start of each major stage in the appropriate place in the blue cells in Column A. Use clock format e.g. 7:30, 8:05. This helps keep the planned sampling times (column B) aligned with clock time."]
[]
["White boxes are for data entry"]
["Gray boxes are blocked from changes by the user"]
["Column C is provided as a schedule of planned blood sampling times. These may need modification for your use of the worksheet."]
[]
["At each glucose measurement interval, you will enter a glucose reading (column C), an infusion rate (column D), and the time that infusion rate started (column E):"]
["1. As each 5-minute bedside glucose reading comes available, enter it in Column D in the row corresponding to the time of sampling from Column B."]
["The suggested glucose infusion rate is provided in Column I once data are sufficient to provide a calculation. "]
["2. Select your glucose infusion rate (e.g. the one provided by the guidance, or a different one based on your judgment) and enter that value in Column E"]
["3. Record actual timer reading at the time of glucose infusion rate changes in Column F. Use the format xx.yy, with xx minutes and yy seconds since the start of the procedure. If the infusion rate was unchanged, leave the cell in column F unchanged."]
[]
["If participant urinates, record the volume of urine produced in the appropriate timed row in column G. Collect an aliquot for later measurement of urine glucose concentration."]
[]
["For repeat clamps within an individual, set the Stage 1 Target value (cell D6) to match the achieved steady state glucose from the baseline clamp."]
["Repeat clamps should also match the timing of Stage 1 SS sampling and Stage 2 arginine bolus & sampling"]
[]
["Safety Checks"]
["Safety requirements may vary locally, and others may also apply. Investigators must comply with local safety requirements."]
["A pregnancy test must be negative within the last 72 hours (for women of childbearing potential)"]
["Hemoglobin must be >12 (males) or >11 (females) mg/dL on a qualifying Complete Blood Count (within local protocol time period)."]

{"sheet":"Hyperglycemic Clamp ","index":1,"n_rows":71,"n_cols":22,"rows_kept":71,"cut":false,"hidden":false,"merged":[[1,2,1,3],[2,2,2,3],[0,0,0,3]]}
["Hyperglycemic Clamp",null,null,null,"Fill yellow boxes to start"]
[null,"Subject Nickname",null,null,null,"Weight (kg)"]
[null,"Subject ID",null,null,null,"Study Date",null,"2021-01-01"]
[null,null,null,null,null,null,null,{"$f":"IF(OR(ISBLANK(C3), ISBLANK(H3)),\"\",CONCATENATE(\"Hyperclamp\",\"_\",C3, \"_\",TEXT(H3,\"mmddyyyy\")))","v":""}]
[null,null,"Stage 1 Steady State Glucose Target",200]
[null,null,null,null,"If boluses not all delivered add explanations"]
["Stage1     D20 Bolus",{"$f":"IF(OR(ISBLANK(D10),ISBLANK(D11),ISBLANK(H2)),\"Weight or Glucose?\",Calculations!F11)","v":"Weight or Glucose?"},null,"Stage2     D20 Bolus",{"$f":"IF((ISBLANK(D39)),\"Need SS glucose\",IF(Calculations!E12<20,\"20 mL\",Calculations!F12))","v":"Need SS glucose"},null,null,"Total D20W Volume Delivered",{"$f":"IF(ISERROR(L71),\"\",L71)","v":""}]
["Initial D20 Rate",{"$f":"Calculations!B14","v":0},"mL/hr","Arginine Bolus",{"$f":"Calculations!H5","v":"50 mL"},null,null,"Total Urine Volume",{"$f":"IF(SUM(G12:G43)=0, \"0\", SUM(G12:G43))","v":"0"},null,null,null,null,null,null,null,null,null,null,null,null,"Inflate Adjustment"]
["Wall Clock Time","Scheduled Time","Lab Samples due","Blood Glucose (mg/dL)","D20 Set Rate (mL/hr)","Time of D20 Rate Change","Urine Volume","Comments","Infusion Rate Guidance",null,"Time to fractions","Vol Infused",null,"Momentary GIR mg_kg","20 min Pool Corrected",null,"RateRec","Delta","Trend","Pct_distance","Correct Trend",1.1000000000000001]
["Enter Clock Time in hr:min eg 7:30",-10,"X"]
[{"$f":"IF(ISERR(A10+(5/(24*60))),\"\",A10+(5/(24*60)))","v":""},-5,"X"]
[{"$f":"IF(ISERR(A11+(5/(24*60))),\"\",A11+(5/(24*60)))","v":""},0,null,null,{"$f":"B8","v":0},{"$f":"B12","v":0},null,"Manual Bolus D20W IV Push over 60-90 seconds, start D20W infusion. Start timer. ",{"$f":"B8","v":0},null,{"$f":"(MOD(F12,1)*100/60)+INT(F12)","v":0},{"$f":"IF(ISTEXT(E12),0,0)","v":0}]
[null,2,"X",null,{"$f":"B8","v":0},2,null,null,{"$f":"I12","v":0},null,{"$f":"(MOD(F13,1)*100/60)+INT(F13)","v":2},{"$f":"IF(ISTEXT(E13),0,E12*(K13-K12)/60)","v":0}]
[null,4,"X",null,{"$f":"B8","v":0},4,null,null,{"$f":"I13","v":0},null,{"$f":"(MOD(F14,1)*100/60)+INT(F14)","v":4},{"$f":"IF(ISTEXT(E14),0,E13*(K14-K13)/60)","v":0}]
[null,6,"X",null,{"$f":"B8","v":0},6,null,null,0,null,6,0]
[null,8,"X",null,{"$f":"B8","v":0},8,null,null,0,null,8,0,null,{"$f":"$E16*180/(60*$H$2)","v":{"$error":"#DIV/0!"}},null,null,"RateRec","Delta","Trend","Pct_distance","Correct Trend","New Rate %"]
[{"$f":"IF(ISERR(A12+(10/(24*60))),\"\",A12+(10/(24*60)))","v":""},10,"X",null,{"$f":"I17","v":""},10,null,null,{"$f":"IF(ISBLANK($E16),\"\",(IF(ISBLANK($D17),\"\",Q17*0.7)))","v":""},null,10,0,null,{"$f":"$E17*180/(60*$H$2)","v":{"$error":"#VALUE!"}},null,null,{"$f":"IF(R17<3,E16,IF(R17<7,IF(U17=1,E16,V17),V17))","v":0},{"$f":"ABS(D17-$D$5)","v":200},-1,{"$f":"(D17-200)/200","v":-1},{"$f":"IF(SIGN(D17-200) - SIGN(S17) <1, 1, 0)","v":1},{"$f":"IF(ABS(($D$5-D17)/$D$5*E16)>2, ROUND(E16+($D$5-D17)/$D$5*E16*V$9, 0),E16)","v":0}]
[{"$f":"IF(ISERR(A17+(5/(24*60))),\"\",A17+(5/(24*60)))","v":""},15,null,null,"",15,null,null,{"$f":"IF(ISBLANK($E17),\"\",(IF(ISBLANK($D18),\"\",Q18)))","v":""},null,15,0,null,{"$error":"#VALUE!"},null,null,{"$f":"IF(R18<5,E17,IF(R18<10,IF(U18=1,E17,V18),V18))","v":{"$error":"#VALUE!"}},200,{"$f":"(D18-D17)","v":0},-1,{"$f":"IF(SIGN(D18-200)-SIGN(S18)<=1,0,1)","v":0},{"$error":"#VALUE!"}]
[{"$f":"IF(ISERR(A18+(5/(24*60))),\"\",A18+(5/(24*60)))","v":""},20,null,null,"",20,null,null,{"$f":"IF(ISBLANK(E18), \"\",(IF(ISBLANK(D19),\"\",Q19)))","v":""},null,20,0,null,{"$error":"#VALUE!"},null,null,{"$error":"#VALUE!"},200,{"$f":"(D18-D17)+(D19-D18)","v":0},-1,{"$f":"IF(SIGN(D19-200) - SIGN(S19) <1, 0, 1)","v":0},{"$error":"#VALUE!"}]
["",25,null,null,"",25,null,null,"",null,25,0,null,{"$error":"#VALUE!"},null,null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",30,"X",null,"",30,null,null,"",null,30,0,null,{"$error":"#VALUE!"},{"$f":"(($E18*(F18-F17)+$E19*(F19-F18)+$E20*(F20-F19)+$E21*(F21-F20))*180/($H$2*20*60))-($D21-$D17)*0.062","v":{"$error":"#VALUE!"}},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",35,null,null,"",35,null,null,"",null,35,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",40,null,null,"",40,null,null,"",null,40,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",45,null,null,"",45,null,null,"",null,45,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",50,null,null,"",50,null,null,"",null,50,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",55,null,null,"",55,null,null,"",null,55,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",60,"X",null,"",60,null,null,"",null,60,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",65,null,null,"",65,null,null,"",null,65,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",70,null,null,"",70,null,null,"",null,70,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",75,null,null,{"$f":"I30","v":""},75,null,null,"",null,75,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",80,null,null,"",80,null,null,"",null,80,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",85,null,null,"",85,null,null,"",null,85,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",90,"X",null,"",90,null,null,"",null,90,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",95,null,null,"",95,null,null,"",null,95,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",100,"X",null,"",100,null,"Initial Steady State Samples","",null,100,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",105,null,null,"",105,null,null,"",null,105,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",110,"X",null,"",110,null,null,"",null,110,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",115,null,null,"",115,null,null,"",null,115,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["",120,"Blood and Urine",null,"",120,null,"Final Steady State Samples including urine sample and volume measurement","",null,120,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
[{"$f":"IF(ISERR(A39+(5/(24*60))),\"\",A39+(5/(24*60)))","v":""},125,"extra if needed",null,"",125,null,"Use sample tubes from 110 to 120 min for these steady state blood samples",{"$f":"IF(ISBLANK(D40),\"\",Q40)","v":""},null,125,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
[{"$f":"IF(ISERR(A40+(5/(24*60))),\"\",A40+(5/(24*60)))","v":""},130,"extra if needed",null,"",130,null,null,{"$f":"IF(ISBLANK(D41),\"\",Q41)","v":""},null,130,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
[{"$f":"IF(ISERR(A41+(5/(24*60))),\"\",A41+(5/(24*60)))","v":""},135,"extra if needed",null,"",135,null,"Use sample tubes from 110 to 120 min for these steady state blood samples",{"$f":"IF(ISBLANK(D42),\"\",Q42)","v":""},null,135,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
[{"$f":"IF(ISERR(A42+(5/(24*60))),\"\",A42+(5/(24*60)))","v":""},140,"extra if needed",null,"",140,null,"Final Steady State Samples including urine sample and volume measurement",{"$f":"IF(ISBLANK(D43),\"\",Q43)","v":""},null,140,0,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},200,0,-1,0,{"$error":"#VALUE!"}]
["Enter Clock Time in hr:min eg 9:40",0,null,null,{"$f":"I44","v":""},0,null,"Administer 2nd D20W bolus as rapidly as possible, and increase rate. Restart timer ",{"$f":"IF(ISBLANK(D39),\"\",999)","v":""},null,0,null,null,{"$f":"AVERAGE(N39,N37,N35)","v":{"$error":"#VALUE!"}},{"$f":"AVERAGE(O39,O37,O35)","v":{"$error":"#VALUE!"}}]
["",5,null,null,{"$f":"E44","v":""},5,null,null,null,null,5,0]
["",10,null,null,{"$f":"E45","v":""},10,null,null,null,null,10,0]
["",15,null,null,"",15,null,"If glucose <400 mg/dL administer 50 mL D50W over 2 minutes",null,null,15,0]
["",20,null,null,"",20,null,null,null,null,20,0]
["",25,null,null,"",25,null,null,null,null,25,0]
["",30,null,null,"",30,null,"May be able to proceed to Arg T= -5",null,null,30,0]
["",35,null,null,"",35,null,"May be able to proceed to Arg T= -5",null,null,35,0]
["",40,null,null,"",40,null,"May be able to proceed to Arg T= -5",null,null,40,0]
["",45,null,null,{"$f":"E52","v":""},45,null,"Proceed to Arg T= -5",null,null,45,0]
["Enter Clock Time in hr:min eg 10:45","Arg T = -5","X",null,"",45,null,"Draw sample when glucose >450 for at least 15 min, soonest is 30 min post bolus",null,null,45]
[{"$f":"IF(ISERR(A54+(2/(24*60))),\"\",A54+(4/(24*60)))","v":""},"Arg T = -1","X",null,"",46,null,null,null,null,46,0]
[{"$f":"IF(ISERR(A55+(2/(24*60))),\"\",A55+(1/(24*60)))","v":""},"Arg 0",null,null,{"$f":"IF(ISTEXT(E55),\"\",E$54)","v":""},47,null,"Restart timer. Arginine 5g IV over 60 sec",null,null,47,0]
[{"$f":"IF(ISERR(A56+(2/(24*60))),\"\",A56+(2/(24*60)))","v":""},"Arg T = 2","X",null,{"$f":"IF(ISTEXT(E56),\"\",E$54)","v":""},48,null,null,null,null,48,0]
[{"$f":"IF(ISERR(A57+(1/(24*60))),\"\",A57+(1/(24*60)))","v":""},"Arg T = 3","X",null,{"$f":"IF(ISTEXT(E57),\"\",E$54)","v":""},49,null,null,null,null,49,0]
[{"$f":"IF(ISERR(A58+(1/(24*60))),\"\",A58+(1/(24*60)))","v":""},"Arg T = 4","X",null,{"$f":"IF(ISTEXT(E58),\"\",E$54)","v":""},50,null,null,null,null,50,0]
[{"$f":"IF(ISERR(A59+(1/(24*60))),\"\",A59+(1/(24*60)))","v":""},"Arg T = 5","X",null,{"$f":"IF(ISTEXT(E59),\"\",E$54)","v":""},51,null,"Obtain 5mL sample from D20 bag. Decrease D20 infusion rate according to infusion rate guidance.",null,null,51,0,"includes the sampling time interval"]
[null,"T=0",null,null,{"$f":"I61","v":""},0,null,"Start the Taper",{"$f":"IF(ISBLANK(D$54),\"\", ROUND(E60/2,-1))","v":""}]
[{"$f":"IF(ISERR(A60+(5/(24*60))),\"\",A60+(15/(24*60)))","v":""},"T = 15",null,null,{"$f":"I62","v":""},15,null,"Post Clamp glucose monitoring",{"$f":"IF(ISBLANK(D$54),\"\", ROUND(E61/2,-1))","v":""},null,15,{"$f":"IF(ISTEXT(E62),0,I59*(K62-0)/60)","v":0}]
[{"$f":"IF(ISERR(A62+(5/(24*60))),\"\",A62+(15/(24*60)))","v":""},"T = 30",null,null,"",30,null,null,{"$f":"IF(ISBLANK(D$54),\"\", ROUND(E62/2,-1))","v":""},null,30,0]
[{"$f":"IF(ISERR(A63+(5/(24*60))),\"\",A63+(15/(24*60)))","v":""},"T = 45",null,null,"",45,null,null,"",null,45,0]
[{"$f":"IF(ISERR(A64+(5/(24*60))),\"\",A64+(15/(24*60)))","v":""},"T = 60",null,null,"",60,null,"If plasma glucose >80, d/c all Ivs","",null,60,0]
["","T = 75",null,null,"",75,null,null,"",null,75,0]
["","T = 90",null,null,"",90,null,null,"",null,90,0]
["","T = 105",null,null,"",105,null,null,"",null,105,0]
["","T = 120",null,null,"",120,null,null,"",null,120,0]
[]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(L12:L69)+Calculations!E11+IF(ISTEXT('Hyperglycemic Clamp '!E44),0,Calculations!E12)","v":{"$error":"#DIV/0!"}}]

{"sheet":"Stage 2 Max Response Only","index":2,"n_rows":41,"n_cols":12,"rows_kept":41,"cut":false,"hidden":false,"merged":[[1,2,1,3],[2,2,2,3],[3,2,3,5]]}
["Stage 2 Maximal Insulin Response Only",null,null,null,null,"Enter Glucose Readings to Start"]
[null,"Subject Nickname",{"$f":"'Hyperglycemic Clamp '!C2:D2","v":0},null,null,"Weight (kg)",{"$f":"'Hyperglycemic Clamp '!H2","v":0}]
[null,"Subject ID",{"$f":"RISE_Subject_ID","v":0},null,null,"Study Date",{"$f":"'Hyperglycemic Clamp '!I3","v":"00:00:00"}]
[null,null,"Above data come from the Hyperglycemic Clamp worksheet tab"]
[null,null,null,null,null,null,{"$f":"IF(OR(ISBLANK(C3), ISBLANK(G3)),\"\",CONCATENATE(\"RISEclamp\",\"_\",#REF!,\"_\",Rise_Staff_ID,\"_\",C3,\"_\",TEXT(G3,\"mmddyyyy\")))","v":{"$error":"#REF!"}}]
["Stage2     D20 Bolus",{"$f":"IF((ISBLANK(D13)),\"Need Baseline Glucose\",IF(Calculations!E18<20,\"20 mL\",Calculations!F18))","v":"Need Baseline Glucose"}]
["Initial D20 Rate",999,"ml/hr","Arginine Bolus",{"$f":"Calculations!H5","v":"50 mL"},null,"Total D20W Delivered",{"$f":"K41","v":0}]
[]
["Wall Clock Time","Scheduled Time","Lab Samples due","Blood Glucose (mg/dL)","D20 Set Rate (mL/hr)","Time of D20 Rate Change","Comments",null,null,"Time to fractions","Vol Infused"]
["Enter Time e.g. 07:30","T=-30","x",null,null,null,"Fill Stage 1 SS tubes T=100"]
[{"$f":"IF(ISERR(A10+(10/(24*60))),\"\",A10+(10/(24*60)))","v":""},"T=-20","x",null,null,null,"Fill Stage 1 SS tubes T=110"]
[{"$f":"IF(ISERR(A11+(10/(24*60))),\"\",A11+(10/(24*60)))","v":""},"T = -10","x",null,null,null,"Fill Stage 1 SS tubes T=120"]
[{"$f":"IF(ISERR(A12+(5/(24*60))),\"\",A12+(5/(24*60)))","v":""},"T = - 5",null,null,null,null,"No urine sampling needed"]
[{"$f":"IF(ISERR(A13+(5/(24*60))),\"\",A13+(5/(24*60)))","v":""},0,"x",null,{"$f":"B7","v":999},{"$f":"B14","v":0},"Start timer. Start D20 infusion "]
["",5,null,null,{"$f":"E14","v":999},5,null,null,null,{"$f":"(MOD(F15,1)*100/60)+INT(F15)","v":5},{"$f":"IF(ISTEXT(D15),0,D14*(J15-J14)/60)","v":0}]
["",10,null,null,{"$f":"E15","v":999},10,null,null,null,{"$f":"(MOD(F16,1)*100/60)+INT(F16)","v":10},{"$f":"IF(ISTEXT(D16),0,D15*(J16-J15)/60)","v":0}]
["",15,null,null,999,15,"If glucose <400 mg/dL administer 50 mL D50W over 2 minutes",null,null,15,0]
["",20,null,null,999,20,null,"Target is 450 mg/dL. Rate can be adjusted if achieved glucose is too high",null,20,0]
["",25,null,null,999,{"$f":"B19","v":25},"May be able to proceed to Arg T= -5",null,null,25,0]
["",30,null,null,999,30,"May be able to proceed to Arg T= -5",null,null,30,0]
["",35,null,null,999,35,"May be able to proceed to Arg T= -5",null,null,35,0]
["",40,null,null,999,40,"May be able to proceed to Arg T= -5",null,null,40,0]
["",45,null,null,999,45,"May be able to proceed to Arg T= -5",null,null,45,0]
["Enter Time e.g. 08:30","Arg T = -5","x",null,999,null,"Draw sample when glucose >450 for at least 15 min, soonest is 30 min post bolus",null,null,0,0]
[{"$f":"IF(ISERR(A24+(2/(24*60))),\"\",A24+(4/(24*60)))","v":""},"Arg T = -1","x",null,999,null,null,null,null,0,0]
[{"$f":"IF(ISERR(A25+(2/(24*60))),\"\",A25+(4/(24*60)))","v":""},"Arg 0",null,null,{"$f":"IF(ISBLANK(E23),\"\",E20)","v":999},0,"Restart timer. Arginine 5g IV over 30 sec",null,null,0,0]
[{"$f":"IF(ISERR(A26+(2/(24*60))),\"\",A26+(2/(24*60)))","v":""},"Arg T = 2","x",null,{"$f":"E26","v":999},2,null,null,null,2,0]
[{"$f":"IF(ISERR(A27+(1/(24*60))),\"\",A27+(1/(24*60)))","v":""},"Arg T = 3","x",null,{"$f":"E27","v":999},3,null,null,null,3,0]
[{"$f":"IF(ISERR(A28+(1/(24*60))),\"\",A28+(1/(24*60)))","v":""},"Arg T = 4","x",null,999,4,null,null,null,4,0]
[{"$f":"IF(ISERR(A29+(1/(24*60))),\"\",A29+(1/(24*60)))","v":""},"Arg T = 5","x",null,{"$f":"H30","v":""},5,"Obtain 5mL sample from D20 bag. Decrease D20 infusion rate according to infusion rate guidance.",{"$f":"IF(ISBLANK(D24),\"\", ROUND(E29/2,-1))","v":""},null,5,0]
[{"$f":"IF(ISERR(A30+(1/(24*60))),\"\",A30+(1/(24*60)))","v":""},"T = 15",null,null,{"$f":"H31","v":""},15,"Post Clamp glucose monitoring",{"$f":"IF(ISBLANK(D31), \"\", IF(ISTEXT(E30),\"\",ROUND(0.5*E30,-1)))","v":""},null,15,0]
["","T = 30",null,null,{"$f":"H32","v":""},30,null,{"$f":"IF(ISBLANK(D32), \"\", IF(ISTEXT(E31),\"\",ROUND(0.5*E31,-1)))","v":""},null,30,0]
["","T = 45",null,null,"",45,null,"",null,45,0]
["","T = 60",null,null,"",60,null,"",null,60,0]
["","T = 75",null,null,"",75,null,"",null,75,0]
["","T = 90",null,null,"",90,"If plasma glucose >80, d/c all Ivs","",null,90,0]
["","T = 105",null,null,"",105,null,"",null,105,0]
["","T = 120",null,null,"",120,null,"",null,120,0]
[]
[]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(K15:K39)+(IF(ISERR(Calculations!E18),0,Calculations!E18))","v":0},"Total Glucose infusion"]

{"sheet":"HELP!","index":3,"n_rows":30,"n_cols":3,"rows_kept":30,"cut":false,"hidden":false,"merged":[[0,0,0,2],[3,0,9,0],[10,0,11,0],[13,0,17,0]]}
["Hyperglycemic Clamp Troubleshooting"]
[]
["Problem","Possible cause","Solution"]
["Blood sugar unexpectedly low","Sampling hand is not hot","Check the heating pad or hot box "]
[null,"Infusion rate on IV pump is incorrect","Check the IV pump for the proper infusion rate"]
[null,"Diluted sample","Draw minimum of 2mL waste prior to drawing the sample. Make sure the stopcock is turned with the saline off when drawing sample."]
[null,"Insufficient Sample YSI ","Make sure the sipper is completely within the plasma (not into the packed red cells) and hold the sample there until the sipper withdraws"]
[null,"Insufficient Sample iStat","Check that the cartridge is filled to the fill line and no further"]
[null,"Inflitrated D20 IV","Check the infusion site for redness or swelling.  Ask the subject about arm pain. Restart IV if needed."]
[null,"Low glucose concentration in the D20 bag","If you have just replaced the bag, recheck that it is in fact D20W and consider replacing it again."]
["Blood sugar unexpectedly high","Infusion rate on IV pump is incorrect","Check the IV pump for the proper infusion rate"]
[null,"Flushing or infusing with dextrose-containing solution","Check all IV bags and flushes - they should all be NS except the D20 bag"]
["Glucose measurement unavailable or not trustworthy","Sampling or technical problems as above","Enter the most recent trustworthy value as that row's glucose value in order to get a guidance infusion rate. This rate may be different from the current infusion rate. Troubleshoot the glucose readigns and use the comments field of that row to enter the measured glucose number(s)."]
["Unable to draw from hand IV site","Stopcock in the wrong position","Make sure that the stopcock is turned in the correct direction"]
[null,"Sampling hand is not hot","Check the heating pad or hot box "]
[null,"IV catheter is occluded","Flush with NS"]
[null,"IV catheter is kinked ","Apply slight traction to catheter and/or reposition arm and hand inside the heating pad or hot box"]
[null,"IV catheter needs to be replaced","Restart IV in the same hand as quickly as possible.  The next sample will be from a cold hand and will be lower than if it were warm."]
["Unable to raise blood sugar to >450 mg/dL before Stage 2 arginine stimulation","Subject very insulin sensitive or strong beta cell response","Use only D20W  to raise plasma glucose to desired level. If bolus plus maximal infusion (999 ml/hr) does not achieve target, proceed at 45 min following 2nd bolus anyway. "]
["Subject feels flushed or hot following D50 or arginine bolus","Normal physiologic reaction","Reassure subject "]
["Glucose falls after urination during Stage 1 of clamp","Normal physiologic reaction","Increase glucose infusion rate by 5% as part of preparations for urination"]
["Glucose infusion was off","IV trouble, other access issues, pump issues","Leave the rate entry blank and add a comment explaining what happened. Don't enter a rate of zero, just restart at your best guess (based on time in clamp and most recent infusion rate) and allow the guidance to start again with the infusion rate"]
["The guidance infusion rate seems incorrect","The guidance rates are based on current glucose readings and use general assumptions about how people will respond.","Consult PI or other experienced person if necessary, and use your best judgement to choose an infusion rate. The goal for stage 1 is glucose values of 200 mg/dl; the goal for stage 2 is glucose values of 450 mg/dl or higher. "]
["I am overshooting early then undershooting as we get close to steady state","The guidance rates are based on current glucose readings and use general assumptions about how people will respond. ","You may be able to predict changes that are needed better than the guidance. If your experience says you need to make different changes (e.g. being more aggressive with increases in the second hour of the clamp) then you will probably improve on the clamp steady state."]
["The sugar is not high enough early in Stage 2","Participant is insulin sensitive","If sugar reading is bleow 400 mg/dL at Stage 2 +15 minutes, administer a 50 mL bolus of D50W"]
["I am not at 450 and it's 45 min into Stage 2","Participant is insulin sensitive","At 45 min you must proceed with Arginine. That individual's repeat studies need to match the Stage2 glucose exposure as best as possible"]
["I have been at 450 for 20 min in stage 2. Can't I proceed?","Not a problem","We need everyone to have at least 15 minutes of sugars at 450 or higher. But we also have specified that we must be in Stage 2 for at least 30 minutes after the bolus. So if you get there fast you may need to simply wait until 30 or 35 minutes to proceed."]
["In the first clamp the Stage 1 glucose was not 200. What should I do with Stage 1 in subsequent clamps?","Not a problem","We want the glucose stimulus to be comparable between clamps within each individual, so we need to match the achieved steady state glucose as best as possible between study days for that person."]
["The Total D20W delivered is showing an error, or is obviously incorrect","D20 Set Rate' or 'Time of D20 Change' column data is incomplete","There must be data points in every row of these columns for the calculation of total D20W infused."]
["Fasting glucose is high","Planned Contingencies, MOP Vol 2 Chapter 5","Fasting >195, do a modified 'steady state' set of blood samples under fasting conditions using the Stage 1 tubes then proceed with Stage 2; Fasting 180-195 do Stage 1 but without the initial D20W bolus. "]

{"sheet":"Calculations","index":4,"n_rows":18,"n_cols":8,"rows_kept":18,"cut":false,"hidden":false,"merged":[]}
["Clamp Preparation"]
[]
[null,"Weight (kg)",{"$f":"'Hyperglycemic Clamp '!H2","v":0},null,null,"Arginine Bolus",5,"gm"]
[null,"Height (cm)","not used",null,null,"Concentration ",{"$f":"100/10","v":10},"mL/gm"]
[null,"BSA","not used",null,null,"Dose (mL)",{"$f":"G4*G3","v":50},{"$f":"CONCATENATE(TEXT(G5,0), \" mL\")","v":"50 mL"}]
[]
[null,null,null,"Mean Fasting Glucose",{"$f":"AVERAGE('Hyperglycemic Clamp '!D10:D11)","v":{"$error":"#DIV/0!"}}]
[null,null,null,"Calculation to 200",{"$f":"((200-AVERAGE('Hyperglycemic Clamp '!D10:D11))*1.1*C3)/180","v":{"$error":"#DIV/0!"}}]
[null,null,null,"Bolus #1 Rule",{"$f":"IF(E7<180,(IF(E8<15,15,E8)),IF(E7>195,\"Direct To Stage 2\",\"Do Stage 1 with NO Bolus\"))","v":{"$error":"#DIV/0!"}},"No bolus for glucose >180; min bolus 15 mL"]
[]
["D50 Bolus",{"$f":"((200-AVERAGE('Hyperglycemic Clamp '!D10:D11))*1.1*C3)/500","v":{"$error":"#DIV/0!"}},{"$f":"CONCATENATE(TEXT(B11,0), \" mL\")","v":{"$error":"#DIV/0!"}},"D20 Bolus #1",{"$f":"E9","v":{"$error":"#DIV/0!"}},{"$f":"CONCATENATE(TEXT(E11,0), \" mL\")","v":{"$error":"#DIV/0!"}}]
[null,null,null,"D20 Bolus #2",{"$f":"IF(ISBLANK('Hyperglycemic Clamp '!D43),(((450-'Hyperglycemic Clamp '!D39)*1.1*C3)/180),(((450-'Hyperglycemic Clamp '!D43)*1.1*C3)/180))","v":0},{"$f":"CONCATENATE(TEXT(E12,0), \" mL\")","v":"0 mL"}]
[]
["D20 Initial Rate",{"$f":"(5*C3*60)/180","v":0},"mL/hr"]
[]
[]
["Subjects participating in Stage 2 Only due to fasting glucose >195mg/dL"]
["D20 Initial Rate",{"$f":"(((450-AVERAGE('Stage 2 Max Response Only'!D12,'Stage 2 Max Response Only'!D13))*1.1*C3)/180*(60/30))","v":{"$error":"#DIV/0!"}},{"$f":"CONCATENATE(TEXT(B18,0), \" mL\")","v":{"$error":"#DIV/0!"}},"D20 Bolus Stage2 Direct",{"$f":"((450-(AVERAGE('Stage 2 Max Response Only'!D12:D13)))*1.1*C3)/180","v":{"$error":"#DIV/0!"}},{"$f":"CONCATENATE(TEXT(E18,0), \" mL\")","v":{"$error":"#DIV/0!"}}]

{"sheet":"QC Sheet","index":5,"n_rows":3,"n_cols":7,"rows_kept":3,"cut":false,"hidden":false,"merged":[]}
[null,"Stage1","Stage2",null,"Glucose","Stage1","Stage2"]
["SSRow",39,50,null,"Mean",{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
["SSTimer",120,30,null,"CV",{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]