Why is thiamine administered with dextrose/saline IV infusion for diabetics?

The role of thiamine (vit b1) in the body is to act in a co-enzymatic function to help convert carbohydrates and fats in energy production. Without it you could develop beri-beri, Wernicke's Korsikoff Syndrome, lactic acidosis, or in diabetics, there is a rare disorder called TRMA or Thiamine Responsive Megaloblastic Anemia.

TRMA is characterized by megaloblastic anemia, sensorineural hearing loss, and diabetes mellitus. Megaloblastic anemia occurs between infancy and adolescence. The anemia is corrected with pharmacologic doses of thiamine (vitamin B1) (25-75 mg/day compared to US RDA of 1.5 mg/day). However, the red cells remain macrocytic.

SLC19A2, which encodes the high-affinity thiamine transporter, is the only gene known to be associated with TRMA.

High-dose thiamine supplementation may delay onset of diabetes mellitus, and high-dose thiamine invariably improves the hematologic picture.

TRMA is aka Rogers syndrome.

Fewer than 30 pedigrees are known.

TRMA is exceedingly rare outside of consanguineous pairings or isolated populations. Cases have been observed in Israeli Arab and Lebanese populations, an Alaskan kindred of Native and ethnic Russian descent, and kindreds from Brazil, Japan, Oman, Tunisia, Italy (Venetian and other), Iran, and Pakistan, as well as Kashmiri families in Great Britain, ethnic Kurds, Caucasians, and African-Americans.

TRMA showed that absence of the high-affinity component of thiamine transport results in low intracellular thiamine concentrations. Defective RNA ribose synthesis caused by intracellular thiamine deficiency is thought to be the cause of megaloblastic changes in TRMA.

It is also normal for the administration of Thiamine to patients who are hypothermic for the reason of alcohol abuse. Even if it isn't the case. The MOA here is that thiamine will help reduce potential harmful symptoms that may occur when alcohol is involved. Such as neuropathies.

It is unknown what is the role of thiamine in normal hematopoiesis.

I never had that...not to my knowledge anyway. Nor have I ever given that to a diabetic patient.

I had .9% NACL and if necessary, additional infusions of magnesium and potassium.

The one time I lost consciousness from low sugar, I had an IV of the .9% NACL and IV bolus of glucose. It works faster...and sent me from one extreme to the other.

EMT
Type 1, pump user

Sorry...NACL is the chemical abbreviation for sodium chloride...pronounced "nackle".

In a some cases of type II diabetes, thiamine helps to enhance the sensitiity of the cells to insulin. It would be of no use at all to a type I diabetic.