bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes Mellitus and Autonomic Dysfunction After Vacor Rodenticide Ingestion
Authors: Miller Leona V , Stokes John D , Silpipat Chutima
Published: March 2007

A case of N-3 pyridylmethyl-N' 4 nitrophenyl urea (Vacor) rodenticide poisoning in a 52-year-old man is resented. Vacor is structurally related to alloxan and streptozotocin, agents that have been used extensively to produce diabetes mellitus in laboratory animals. Seven days after ingestion of Vacor, the patient presented in diabetic ketoacidosis complicated by postural hypotension and adynamic ileus. The patient recovered from ketoacidosis but has continued to require insulin. With infusion of arginine, glucagon rose from 185 to 650 pg./ml. and C-peptide from 0.5 to 3.4 ng./ml. Six weeks after onse.t of diabetes, no anti-islet-cell antibodies were detected. Muscle capillary basement membrane thickness on electron microscopy was found to be 1,918 ± 194 Å. The absence of hyperglycemia after Vacor ingestion should not lead to complacency on the part of the attending physician. The patient must be observed closely for development of ketoacidosis and treated prophylactically with nicotinamide, the suggested antidote.
Long-term Effects of High-carbohydrate, High-fiber Diets on Glucose and Lipid Metabolism: A Preliminary Report on Patients with Diabetes
Authors: Anderson James W , Ward Kyleen
Published: March 2007

High-carbohydrate, high-fiber (HCF) diets have beneficial therapeutic effects for selected patients with diabetes mellitus. We have treated 10 patients with HCF diets on a metabolic ward and followed them for an average of 15 months while they were on maintenance diets at home-. The HCF diets containing 70 per cent of calories as carbohydrate were accompanied by significant reductions in requirements for insulin or sulfonylureas. Fasting plasma glucose, serum cholesterol, and triglyceride values were significantly lower on the HCF diet than on a 43 per cent carbohydrate diet. On the HCF diet, insulin therapy was discontinued for five patients and sulfonylurea therapy for three. After an average of 15 months on the maintenance diet containing 55 per cent to 60 per cent carbohydrate, seven patients were still managed without insulin or sulfonylureas. Average fasting plasma glucose values during maintenance diets at home were identical to values on the HCF diets in the hospital. On the maintenance diet, serum cholesterol values were similar to initial values but serum triglyceride values were significantly lower than values on the 43 per cent carbohydrate diet. These studies indicate that moderately highcarbohydrate, high-fiber diets can be successfully followed at home and that improvements in glucose metabolism achieved in the hospital can be sustained outside the hospital.
Computerized Surveillance of Diabetic Patient/Health Care Delivery System Interfaces
Authors: Bryant Douglas , Van Son Allene , Davis Paul J , Segal Carol
Published: March 2007

DIASURV is a computerized surveillance program developed to monitor the interaction of a large cohort of diabetic patients with a tertiary care institution. The input of this simple program consists of a file of diabetic patients, the daily census of hospital inpatients, and the daily census of hospital outpatients. Written in COBOL, the program consists of edit and file-maintenance components and inpatient and outpatient search components. The output is a daily listing of all inpatient (x¯ = 60) and outpatient transactions (x¯ = 20) for the cohort of 1,800 patients. The output also summarizes previous exposures of patients to specific bedside and classroom activities in diabetes education. DIASURV has a variety of applications in terms of organization of teaching efforts and facilitated access to a limited amount of patient management information.
Microbiology of Deep Tissue in Diabetic Gangrene
Authors: Sharp Charles S , Bessman Alice N , Wagner F William , Garland Douglas
Published: March 2007

Information on the incidence and nature of the causative organisms in the infected tissues of patients with diabetic gangrene is scanty. Studies in which material for culture was obtained from the presenting lesion reveal multiple organisms in host isolates. No data are available regarding the bacterial flora of the deep infected tissue itself, uncontaminated by surface organisms. In this investigation 58 specimens from 52 patients were obtained utilizing aerobic and anaerobic culture techniques. In the surgical theater, material was obtained from the infected deep tissues using careful aseptic dissection techniques. All patients had been on antibiotic therapy from 2 to 10 days before the study. An average of 2.3 organisms per specimen was found. The predominant organisms were Proteus sp. Enterococcus, Staphylococcus aureus, and other enterobacteriacae in that order. Anaerobes were isolated in 27 per cent of cases, but never as the only organism. Prior antibiotic therapy did not eradicate infection in infected diabetic gangrene.
Cheiralgia paresthetica in Diabetes Mellitus
Authors: Massey E Wayne , O'Brian John T
Published: March 2007

Cheiralgia paresthetica is a sensory mononeuropathy of the superficial ramus of the radial nerve. A case is presented here in a patient with diabetes mellitus.
Remission in IDDM: Prospective Study of Basal C-Peptide and Insulin Dose in 268 Consecutive Patients
Authors: Agner Tove , Damm Peter , Binder C
Published: March 2007

To elucidate β-cell function, insulin requirement, and remission period in insulin-dependent diabetes mellitus (IDDM), a study was undertaken comprising 268 patients consecutively admitted to Steno Memorial Hospital with newly diagnosed IDDM. The patients were characterized by sex, age, and seasonal variation at onset of diabetes mellitus. Duringthe first 36 mo of the disease, an evaluation was performed for basal C-peptide, HbA1c, and insulin dose per kilogram. Total remission was interpreted as complete discontinuation of insulin therapy for at least 1 wk while still metabolically well controlled, and partial remission was interpreted as an insulin need that was <50% of the insulin dose at discharge from the hospital. During the first 18 mo of the disease, 12.3% of the patients entered total remission (median 6 mo), and 18.3% of the patients entered partial remission (median 6 mo). Patients entering remission had significantly higher basal C-peptide levels than those who did not. Sex, age, and initial HbA1c levels did not influence the frequency of remission.
Assessment of Value of Glycosylated Albumin and Protein in Detection of Gestational Diabetes
Authors: Ryan Edmond A , Stark Renee , Crockford Peter M , Suthijumroon Ampha
Published: March 2007

There is a recognized need for the early detection of gestational diabetes, and a single blood test, if reliable, would be advantageous. Because serum albumin and total protein are glycosylated and have short life spans, we investigated the usefulness of glycosylated albumin and glycosylated protein in the detection of gestational diabetes. We studied five groups, each with 20 subjects: nonpregnant and pregnant controls, nonpregnant and pregnant insulin-dependent diabetic (IDDM) patients, and gestational diabetic patients. All patients with no history of diabetes had an oral glucose tolerance test to define their carbohydrate status.

Our results showed that percent glycosylated albumin and percent glycosylated proteinwere significantly elevated in both groups of IDDM patients compared with the other groups. However, gestational diabetic patients had glycosylated albumin and glycosylated protein values similar to those of both control groups. Both glycosylated albumin and glycosylated protein correlated well with HbA1c determinations. Thus, glycosylated albumin and glycosylated protein may be a good index of glycemic control, but they are of little value in the diagnosis of gestational diabetes because of a lack of sensitivity: 8 and 3% for glycosylated albumin and glycosylated protein, respectively.
Assessment of Glycosylated Hemoglobin Measurement With Sample Collection Papers
Authors: Broussolle Christiane , Saudek Christopher D
Published: March 2007

It would be advantageous to be able to measure glycosylated hemoglobin (GHb) from a sample of blood dried on paper and sent to the physician by the patient. Indeed, such a technique has been introduced by Isolab (Akron, OH). We tested the validity of the method to determine whether 1) applying the blood to paper and immediately assaying it correlates with the same sample assayed by the usual wholeblood technique, 2) the size of sample applied to paper affects apparent GHb results, 3) time and temperature of storage of the sample paper affect apparent GHb resu ts, and 4) plasma glucose concentration of the sample affects GHb results.

The GHb of samples assayed immediately after application to sample paper versus those assayed as whole blood showed very good correlation (r = .93, P < .001). Volume of the drop of blood applied to paper (25–100 μl) did not affect results. However, there was a dramatic, temperature-dependent increase in apparent GHb when samples were stored on sample paper, averaging 12.5, 16.3, and 19.5% when stored at room temperature for 3, 6, and 9 days, respectively. Overall, apparent GHb rose from 1.3-fold in 3 days at 4°C to 3.8-fold in 9 days at 37°C. The rate of GHb formation was proportional to plasma glucose concentration, but removal of free glucose by ethanol or glucose oxidase did not yield consistent results for this method. We conclude that these sample papers are not useful as an approach to collecting blood samples for GHb measurement.
Absorption Kinetics and Action Profiles After Sequential Subcutaneous Administration of Human Soluble and Lente Insulin Through one Needle
Authors: Bilo Henk J , Heine Robert J , Sikkenk Anneke C , van der Meer Jan , van der Veen ED A
Published: March 2007

The effects of sequential administration through one needle of human soluble and human lente insulin on plasma insulin levels and action profiles, assessed with glucose clamping, were studied in six healthy volunteers. Insulin kinetics after administration of human soluble insulin (0.22 IU/kg) alone were compared with those after sequential administration of 1) human soluble insulin followed by human lente insulin and 2) human lente insulin followed by human soluble insulin. Total insulin dose in both sequences was 0.55 IU/kg, 40% of which was short-acting insulin.

Plasma insulin levels were not significantly different at any time point between 0 and 240 min after soluble insulin compared with either combination. Although insulin levels were slightly but significantly lower at 30 and 105 min after lente followed by soluble insulin compared with soluble followed by lente insulin, these differences probably reflect chance occurrences. Glucose requirements were not significantly different after either of the three administrations.

We therefore conclude that the unwanted retarding effect after mixing of human soluble insulin with human lente insulin in the syringe on the onset of action of the soluble insulin can be prevented by sequential subcutaneous injection of these insulins with two syringes through one needle.
Prevention of Metabolic Alterations by Insulin Supplements Administered Either Before or After 2-h Nocturnal Interruption of CSII
Authors: Scheen André J , Henrivaux Philippe , Jandrain Bernard , Paolisso Giuseppe , Lefèbvre Pierre J
Published: March 2007

To evaluate the efficacy of a bolus insulin injection to prevent the metabolic alterations induced by a 2-h nocturnal interruption of a continuous subcutaneous insulin infusion (CSII), nine type I (insulindependent) C-peptide-negative diabetic patients were studied from 2200 to 0800 h during two randomized tests. An insulin bolus (2.1 ± 0.2 U) was administered via the pump either at 2300 h, just before CSII interruption, or at 0100 h, after reactivating the pump at its usual basal rate (1.05 ± 0.11 U/ h). The insulin bolus at 2300 h induced a significant rise in plasma free-insulin levels at 2400 h (+ 6.9 ± 1.8 mU/L, P < .01), resulting in an early and marked fall in blood glucose concentrations between 2300 and 0100 h (−2 .7 ± 0.5 mM, P < .001), with hypoglycemic values in five patients. The insulin bolus at 0100 h counteracted the fall in plasma free-insulin levels observed between 2300 and 0100 h and significantly increased plasma insulin at 0200 h (+ 3.2 ± 0.8 mU/L, P < .01). Blood glucose concentrations that remained stable during the 2-h arrest of the pump fell significantly between 0100 and 0400 h (- 2.1 ± 0.5 mM, P < .005). This fall rate was significantly lower than that measured within the 3 h after the insulin bolus given before CSII interruption but significantly higher than that observed in a reference control group of patients whose pump was functioning normally throughout the night. Thus, an insulin bolus equivalent to the amount of insulin not infused during a 2-h CSII interruption is able to prevent the metabolic alterations resulting from the pump arrest. However, to reduce the risk of hypoglycemia, the insulin bolus should preferably be administered after rather than before the 2-h CSII interruption.
Overnight Metabolic Control With Bedtime Injection of Intermediate-Acting Insulin or Continuous Subcutaneous Insulin Infusion
Authors: Olsson Per-Olof , Arnqvist Hans , Schenck Henning Von , Ottosson Anna-Maria
Published: March 2007

Ten insulin-dependent diabetic patients were investigated from 2100 to 0700 h during treatment with either a bedtime injection (BI) of intermediate-acting insulin or continuous subcutaneous insulin infusion (CSII) at a constant basal rate. In the evening, blood glucose was slightly higher during treatment with BI than with CSII, whereas the metabolic control in the morning was equal on both regimens with a fasting blood glucose of 5.7 mM (4.2–7.1) (median and interquartile ranges) on BI and 5.4 mM (4.6–5.8) on CSII (NS). No rise in morning blood glucose was seen, but serum β-hydroxybutyrate tended to rise (NS). There was a significant hyperinsulinemia at midnight during BI compared with CSII with a serum free insulin of 14.5 (11.7–16.0) vs. 9.6 (7.2–11.2) mU/L (P < .05), respectively, and the area under the curve during the middle of the night (midnight to 0400 h) was greater with BI than CSII (P < .02). A greater fall in blood glucose was seen with BI than with CSII during this period (P < .02). Differences in blood glucose and serum free-insulin profiles between those using NPH or lente insulin at bedtime were registered. We conclude that, although the same metabolic control in the morning was achievable with CSII at a constant basal rate and BI, CSII is superior for overnight metabolic control due to less-pronounced hyperinsulinemia during the night and a steady-state level of free insulin in the morning.
U-100 Insulin Gives Some Protection Against Metabolic Deterioration Due to CSII Interruption
Authors: Scheen André J , Henrivaux Philippe , Jandrain Bernard , Lefébvre Pierre J
Published: March 2007

We investigated the influence of insulin concentration within the insulin pump on the metabolic and plasma free-insulin changes induced by a 6-h nocturnal interruption of continuous subcutaneous insulin infusion (CSII) in five C-peptide-negative insulin-dependent diabetic patients with low circulating levels of anti-insulin antibodies. We compared the changes in blood glucose, plasma free fatty acids, 3-hydroxybutyrate, and free insulin during the interruption from 2300 to 0500 h of the Nordisk Infuser loaded with either U-100 or U-20 regular insulin. The decrease in plasma free-insulin levels was slower, resulting in a significantly delayed and smaller increase in blood glucose levels (2.4 ± 1.6 vs. 7.6 ± 2.9 mM, P < .025) when the pump contained U-100 instead of U-20 insulin. Although the increases in levels of plasma free fatty acids were similar in both tests, the rise in plasma 3-hydroxybutyrate levels tended to be reduced with U-100 insulin (414 ± 139 vs. 639 ± 67 μM, P < .10). Thus, our observations indicate that U-100 insulin gives some protection against the metabolic deterioration due to the interruption of CSII so that diabetic patients may be able to remain without the pump for longer periods with concentrated rather than diluted insulin.
Postoperative Management of Diabetes Mellitus: Steady-State Glucose Control With Bedside Algorithm for Insulin Adjustment
Authors: Watts Nelson B , Gebhart Suzanne S P , Clark Richard V , Phillips Lawrence S
Published: March 2007

An algorithm was developed to determine whether an individualized insulin infusion could maintain plasma glucose in a desirable steady state after surgery. In 24 patients, insulin was provided according to a “glucose-feedback” formula to maintain plasma glucose between 120 and 180 mg/dl (6.7–10.0 mM). Initial plasma glucose was elevated, 218 ± 16 mg/dl (mean ± SE 12.1 ± 0.9 mM), but reached the target range after 8 h and remained steady for the rest of the study period. Insulin requirements varied considerably, 0.5–5.0 U/h. Infusion rates were correlated with initial plasma glucose but not with previous insulin dose, HbAlc, or percent ideal body weight. Although insulin needs cannot be predicted, plasma glucose can be maintained in a desirable range after surgery via a simple formula suitable for implementation by general ward nurses.
Metabolic and Hormonal Changes in IDDM During Long-Distance Run
Authors: Meinders Arend E , Willekens Frans L A , Heere Leo P
Published: March 2007

Hormonal and metabolic changes were compared in five insulin-dependent diabetic men and five control men during a 3-h marathon-training run. Insulin was withheld 16–26 h before the start of the run, and a normal breakfast was finished 2.5 h before the start of the run. Blood glucose concentrations decreased significantly in the diabetic subjects but remained constant in the control subjects. During the run, plasma free fatty acids, 3-hydroxybutyrate, and alanine concentrations behaved similarly in both groups. Only postexercise ketosis was more pronounced in the diabetic subjects. Peripheral serum free-insulin concentrations were slightly lower in the diabetic subjects at the start of the study, but these insulin concentrations became significantly elevated afterward compared with the control subjects. Plasma glucagon levels increased in the diabetic but not in the control subjects. Growth hormone levels increased sharply and to significantly higher levels in the diabetic than in the control subjects, who presented a slow gradual increase. Plasma cortisol levels were slightly, but at some moments significantly, higher in the diabetic subjects. The plasma catecholamine concentrations increased in both groups but to significantly higher levels in the diabetic subjects. There is no evidence from this study for an insufficient secretion of counterregulatory hormones if a hypoglycemic reaction occurs during a long-distance run in reasonably well controlled, well-trained diabetic subjects without longterm complications.
Treatment of Allergy to Heterologous Monocomponent Insulin With Human Semisynthetic Insulin: Long-Term Study
Authors: Bruni Bruno , Barolo Patrizia , Blatto Alberto , Carlini Maurizio , Ansaldi Silvia Gamba , Grassi Giorgio
Published: March 2007

Eight type II (non-insulin-dependent) diabetic subjects (7 women, 1 man, aged 42–61 yr), initially treated with oral hypoglycemic agents and intermittently treated with conventional insulins, were identified as developing allergic reactions to porcine and mixed-species monocomponent insulin. Allergy was systemic (urticaria and nonthrombocytopenic purpura) and local delayed in two subjects and local immediate or biphasic in six subjects. Lipoatrophy was present in two subjects. After treatment with human semisynthetic insulin (Monotard HM and Actrapid HM), systemic allergy disappeared. Local allergy disappeared in five subjects and was reduced in three subjects. No lipoatrophy occurred in new injection areas. The clinical results were accompanied by a significant decrease in serum insulinspecific IgE after 6, 12, 18, 24, 30, and 36 mo. Insulinspecific IgG showed an evident decrease in five of eight patients, but the difference in mean values was not significant after 6, 18, 24, 30, and 36 mo. With one exception, intradermal skin tests were positive to human, bovine, and porcine insulin before and after human insulin treatment.
Laboratory Evaluation of New Reusable Blood Glucose Sensor
Authors: Updike Stuart J , Shults Mark C , Capelli Chris C , von Heimburg Don , Rhodes Rathbun K , Joseph-Tipton Nilufer , Anderson Brian , Koch David D
Published: March 2007

An enzyme-electrode sensor designed specifically for pocket-portable self-monitoring of blood glucose is described. The sensing device in this instrument is unique because it is reusable for at least 30 days, at which time it is easily replaced by placing a new enzyme-membrane cartridge over the electrode. As little as 7 μl of undiluted whole blood, plasma, or serum is applied directly to the sensor, and glucose is automatically determined in 30 s. No manual timing or wiping step is required after sample application. On eight production instruments, plasma glucose concentration was determined (n = 20) at 57, 125, 246, and 347 mg/dl. The average coefficient of variation for the 80 determinations for each instrument ranged from 2 to 5%, averaging 3.7%. The instrument is inherently linear, independent of hematocrit, and without oxygen limitation when dissolved oxygen concentration is >35 mmHg. No interferences were found from plasma constituents, heparin, or acetaminophen.
Polyunsaturated and Saturated Fat, Cholesterol, and Fatty Add Supplementation
Authors: Kissebah Ahmed , Schectman Gordon
Published: March 2007

Almost all of the risk factors for arteriosclerosis and coronary heart disease identified in population studies are overrepresented in diabetes. Of these risk factors, plasma lipids and lipoproteins are the target for altered dietary habits, particularly regarding fat. Such an alteration must be qualified with an understanding of the relationship between diabetes mellitus and lipoprotein metabolism and evidence of a favorable outcome of a fat-modified diet on this relationship. In seeking a revision of the current dietary fat recommendations of the American Diabetes Association, we have addressed five major questions. Is the serum lipid or lipoprotein concentration in diabetes different from that of the nondiabetic population? Are the familial or genetic forms of hyperlipidemia coinherited and/or overrepresented in diabetic subjects? What is the mechanism of the lipid/lipoprotein disorder in diabetes, and to what extent could it be related to the diabetic metabolic milieu? What is the effect of antidiabetic treatment on plasma lipids and lipoprotein metabolism? What evidence is there that a modified-fat diet could exert favorable benefits over and above what could be achieved by optimal antidiabetic therapy? This article outlines the revised dietary fat recommendations of the American Diabetes Association Nutrition Task Force and their rationale.
Evaluating Outcomes of Pregnancy in Diabetic Women: Epidemiologic Considerations and Recommended Indicators
Authors: Braveman Paula , Showstack Jonathan , Browner Warren , Selby Joseph , Teutsch Steven , Sepe Stephen
Published: March 2007

Many programs have been applied in various settings to reduce adverse outcomes of pregnancy in women with diabetes. Efforts to standardize criteria and methods for evaluating these programs are relatively recent. Without such standardization, evaluation of the impact of many programs and comparisons among programs have not been possible. We review the suitability of available data sources for monitoring adverse outcomes of pregnancy in women with diabetes in light of epidemiological considerations relevant to selection of indicators of program impact. This article is intended to be a resource to help evaluate in a standardized fashion the impact of programs at a regional, state, or local level. We conclude that primary data (information collected by programs themselves) collected in a standardized manner are necessary for evaluation of programs for diabetes in pregnancy. Secondary data sources alone are of limited value for monitoring outcomes because of underreporting of maternal diabetes, especially in the absence of identified complications. Ultimately, the ability to rigorously assess the impact of efforts to improve outcomes of diabetes in pregnancy may depend on the creation of comprehensive statewide systems to identify women of childbearing age who have diabetes.
Impact of SMBG on Control of Diabetes as Measured by HbA1: 3-yr Survey of a Juvenile IDDM Clinic
Authors: Belmonte Mimi M , Schiffrin Alicia , Dufresne Jackie , Suissa Samy , Goldman Hy , Polychronakos Constantin
Published: March 2007

Three hundred twelve diabetic children and adolescents were seen in our diabetic clinic and instructed to test their capillary blood glucose (CBG) twice daily and to use an algorithm to adjust their short-acting insulin. Of this group, 219 youngsters had a full 3-yr period of observation. At each clinic visit, blood was obtained for fasting blood glucose and HbA, and, once a year, cholesterol and triglycerides were also measured. Patient and parent accuracy in measuring CBG was found to be adequate. The changes over time in HbA, were nondifferential across age and sex, and there was no difference in the level of HbA, between age and sex groups, the number of tests reported to have been done by the patients, the number of injections of insulin per day, or the serum cholesterol. There was a significant relationship between the HbA1 and the fasting blood glucose (P < .001) measured by the laboratory as well as with the serum triglyceride (P < .01). The failure to improve diabetic control, despite measures that would have been expected to do so, was believed to relate more to a lack of compliance than to a flaw in the therapeutic approach. It was interesting to note that the adolescent patients in the study were in no worse control than the younger children in the group. Although better technical skills are available today to manage diabetes, the psychosocial approach to patient motivation requires improvement.
Glucagon Responses to Hypoglycemia in Children and Adolescents With IDDM
Authors: Singer-Granick Carol , Hoffman Robert P , Kerensky Kirk , Drash Allan L , Becker Dorothy J
Published: March 2007

To investigate plasma glucagon counterregulatory responses to hypoglycemia, an intravenous insulin bolus was given over 2 min to 73 children, aged 8.5–18.8 yr, with diabetes duration 1.2–17.1 yr. The plasma glucagon responses of the 61 children without glucagon antibodies or abnormal glucagon molecules were compared with those of 13 nondiabetic control subjects, aged 8.3–18.3 yr. Glucagon increments from baseline (73 ± 10 pg/ml) and peak glucagon responses (212 ± 13 pg/ml) were markedly lower in diabetic patients than in control subjects (341 ± 49 and 462 ± 51 pg/ml, respectively, P < .001). Glucagon responses were found to correlate positively with the age of the patients at the time of testing (r = .478, P < .001) and inversely with metabolic control as measured by glycosylated hemoglobin (r = −.342, P < .02). There was no relationship between glucagon responses and diabetes duration. There was also no relationship between the glucagon increments and free-insulin levels during the test. Glucose recovery from the nadir was impaired in diabetic subjects compared with control subjects and correlated inversely with free-insulin levels. However, glucose recovery did not correlate with the rise of plasma glucagon. Glucose recovery was not different in patients with glucagon antibodies. In this study, we have demonstrated a deficient glucagon response to hypoglycemia in children with insulin-dependent diabetes mellitus. However, the clinical significance of this deficit is not clear.
Computer Simulation of Plasma Insulin and Glucose Dynamics After Subcutaneous Insulin Injection
Authors: Berger Markus , Rodbard David
Published: March 2007

We developed a computer program for the simulation of plasma insulin and glucose dynamics after subcutaneous injection of insulin. The program incorporates a pharmacokinetic model to calculate the time courses of plasma insulin for various combinations of popular preparations (regular, NPH, lente, and ultralente). With the use of a pharmacodynamic model describing the dependence of glucose dynamics on plasma insulin and glucose levels, the program can predict the expected time course of plasma glucose in response to a change in carbohydrate intake, insulin dose, timing, or regimen. A set of typical parameters has been obtained by analysis of data from the literature. The results of several computer simulations are presented showing the effect on a 24-h insulin and glucose profile of systematically changing insulin regimen, dose, timing of meals, or timing of preprandial insulin administration. The program can be used to explore on a theoretical basis the impact of various factors associated with glycemic control in insulin-dependent diabetes mellitus. As an educational tool, the program provides a realistic environment for demonstration of the combined or isolated effects of insulin and diet on glycemia
Preventive Care in Diabetes Mellitus: Current Practice in Urban Health-Care System
Authors: Payne Thomas H , Gabella Barbara A , Michael Sharon L , Young Walter F , Pickard Jeffrey , Hofeldt Fred D , Fan Frances , Stromberg Jerome S , Hamman Richard F
Published: March 2007

Early identification and treatment of complications of diabetes mellitus may reduce the severity of the complications. As part of a program to reduce these complications in the Denver Department of Health and Hospitals patient population, our study determined how frequently preventive care, e.g., fundoscopic examinations, referral to an ophthalmologist, foot examinations, and assessment of cardiovascular risk factors, was provided to diabetic patients. With the use of billing records to identify a large sample of diabetic patients, a chart review of 544 patients was conducted. During the study year, the mean ± SE number of visits to primary-care clinics was 5.7 ± 0.22, with 86.4% having at least one visit. Most diabetic patients were seen by primary-care physicians; only 9% received care in a specialized diabetes clinic. Despite frequent primarycare visits, most diabetic patients in this county healthcare system did not have documentation of care to detect complications of diabetes mellitus, and referral services for detection and treatment of these complications were infrequently used. Moreover, among patients seen on >10 occasions in a primary-care setting, preventive care was not provided to 30% of the patients. Preventive care does not appear to be a regular part of a primary-care visit for most of the diabetic patients in this study.
Effects of Replacing Saturated Fat With Complex Carbohydrate in Diets of Subjects With NIDDM
Authors: Abbott William G H , Boyce Vicky L , Grundy Scott M , Howard Barbara V
Published: March 2007

This study examined the safety of an isocaloric highcomplex carbohydrate low-saturated fat diet (HICARB) in obese patients with non-insulin-dependent diabetes mellitus (NIDDM). Although hypocaloric diets should be recommended to these patients, many find compliance with this diet difficult; therefore, the safety of an isocaloric increase in dietary carbohydrate needs assessment. Lipoprotein cholesterol and triglyceride (TG, mg/dl) concentrations in isocaloric high-fat and HICARB diets were compared in 7 NIDDM subjects (fat 32 ± 3%, fasting glucose 190 ± 38 mg/dl) and 6 nondiabetic subjects (fat 33 ± 5%). They ate a high-fat diet (43% carbohydrate; 42% fat, polyunsaturated to saturated 0.3; fiber 9 g/1000 kcal; cholesterol 550 mg/day) for 7–10 days. Control subjects (3 NIDDM, 3 nondiabetic) continued this diet for 5 wk. The 13 subjects changed to a HICARB diet (65% carbohydrate; 21% fat, polyunsaturated to saturated 1.2; fiber 18 g/1000 kcal; cholesterol 550 mg/day) for 5 wk. NIDDM subjects on the HICARB diet had decreased low-density lipoprotein cholesterol (LDL-chol) concentrations (107 vs. 82, P < .001), but their high-density lipoprotein cholesterol (HDL-chol) concentrations, glucose, and body weight were unchanged. Changes in total plasma TG concentrations in NIDDM subjects were heterogeneous. Concentrations were either unchanged or had decreased in 5 and increased in 2 NIDDM subjects. Nondiabetic subjects on the HICARB diet had decreased LDL-chol (111 vs. 81, P < .01) and unchanged HDL-chol and plasma TG concentrations). In summary, replacing dietary saturated fat with complexcarbohydrate, independent of cholesterol intake, lowered LDL-chol without an adverse effect on HDLchol, TG, and glucose in most obese Pima Indian NIDDM subjects. Before concluding that these diets are safe in obese NIDDM subjects who are unable to restrict their calorie intake, more data are needed on lipoprotein particle flux.
Nutrition Education and Social Learning Interventions for Type II Diabetes
Authors: Glasgow Russell E , Toobert Deborah J , Mitchell Dayna L , Donnelly Jodie E , Calder David
Published: March 2007

Two diabetes education programs were compared to a control condition. Seventy-eight type II (non-insulindependent) diabetic outpatients were randomly assigned to nutrition education, nutrition education plus social learning intervention, or wait-list control conditions. Both interventions involved five weekly meetings that focused on reducing calorie intake, increasing dietary fiber, and decreasing fat consumption. The social learning condition also included individualized goal setting and feedback and training in problem-solving and relapse prevention. Within-group analyses and between-group comparisons generally revealed greater improvement in targeted goals (e.g., calorie intake, fat reduction) among intervention conditions than the control condition. There were few differences in more distal measures of outcome such as weight or glycosylated hemoglobin. The social learning component did not improve outcome more than the nutrition education program. Possible reasons for the observed findings and the advantages and limitations of focused time-limited diabetes education efforts are discussed.
Reliability of Self-Monitoring of Blood Glucose by CSII Treated Patients With Type I Diabetes
Authors: Ziegler Olivier , Kolopp Marianne , Isabelle Got , Genton Pierre , Debry Gérard , Drouin Pierre
Published: March 2007

The reliability of patient-generated data from self-monitoring of blood glucose (SMBG) was studied in 14 patients with type I (insulin-dependent) diabetes mellitus treated by continuous subcutaneous insulin infusion (CSII) (7 women, 7 men). The reflectance meters (Glucometer I, Ames, Elkhart, IN) used by the patients were replaced for a period of 21 days by memory-reflectance meters; patients were unaware of the memory capacity of the new meters and were instructed to continue their practice of recording the meter readings in their logbook. This study compares the data recorded in the memory-reflectance meters with those reported in the logbook. The number of SMBG measurements was different in 11 patients (differences ranging from 2 to 66). Mean glycemia was similar (8.23 ± 0.36 mM in logbook vs. 8.49 ± 0.48 mM in memory-reflectance meters), but both the M value and mean amplitude of glycemic excursions (MAGE) index were lower when calculated from logbook data (38 ± 5 vs. 48 ± 7 mM, P < .05 and 6.91 ± 0.43 vs. 7.72 ± 0.52 mM, respectively; P < .05). Overreporting (addition of phantom values in logbook) and underreporting (omission of SMBG measurements from logbook) indexes were 19 ± 7 and 12 ± 3%, respectively. Precision (percent of identical values in logbook and in memory-reflectance meters at the corresponding time) was 77 ± 6.8%. The number of SMBG measurements recorded in the memory-reflectance meter was negatively correlated with glycosylated hemoglobin [HbA1c; (r = −.85, P < .001)], whereas overreporting was positively correlated with HbA1c (r = .76, P < .01). Unreliable patients (n = 5) had slightly but not significantly higher HbA1c levels than the others (n = 9; 7.4 ± 0.5 vs. 6.2 ± 0.2% NS). Sixty-five percent of the patients had recorded values in a manner that obscured hyper- or hypoglycemia.
Changes in Cortical Functioning With Acute Hypoglycemia and Hyperglycemia in Type I Diabetes
Authors: Hoffman Richard G , Speelman Diana J , Hinnen Deborah A , Conley Kirby L , Guthrie Richard A , Knapp Robert K
Published: March 2007

In this study, 18 type I (insulin-dependent) diabetic subjects aged 22–35 yr (mean age 29.3) and within 10 yr of diagnosis (mean 7.7) performed a battery of cognitive and psychomotor tasks under conditions of hypoglycemia (50 mg/dl), normoglycemia (100 mg/dl), and hyperglycemia (300 mg/dl). Blood glucose levels during testing were precisely maintained at the preselected level via a Biostator insulin/glucose-infusion system. The order of glycemic level was counterbalanced across subjects in a single-blinded design. Performance on tasks requiring visual tracking, visuomotor speed, concentration, and planning ability (pursuit rotor and trails B) were significantly impaired under conditions of hypoglycemia compared with normoglycemic levels. Visual reaction time was not significantly impaired under conditions of hypoglycemia or hyperglycemia.
Improved Insulin Response and Action by Chronic Magnesium Administration in Aged NIDDM Subjects
Authors: Paolisso Giuseppe , Sgambato Saverio , Pizza Gennaro , Passariello Nicola , Varricchio Michele , D'Onofrio Felice
Published: March 2007

In eight aged non-insulin-dependent diabetes mellitus (NIDDM) subjects, insulin response and action were studied before and after chronic magnesium supplementation (2 g/day) to diet. Chronic magnesium supplementation to diet versus placebo produced 7) a significant increase in plasma (0.83 ± 0.05 vs. 0.78 ± 0.06 mM, P < .05) and erythrocyte (2.03 ± 0.06 vs. 1.88 ± 0.09 mM, P < .01) magnesium levels, 2) an increase in acute insulin response (AIR) (4.0 ± 0.6 vs. - 1 .6 ± 0.6 mU/L, P < .05) to glucose pulse, and 3) an increase in glucose infusion rate (GIR) (3.6 ± 0.6 vs. 2.9 ± 0.5 mg kg∼1 min−1 P < .025) calculated in the last 60 min of a euglycemic-hyperinsulinemic (100U m2 · min−1 during 180 min) glucose clamp. Net increase in AIR, glucose disappearance rate after glucose pulse, and GIR were significantly and positively correlated to the net increase in erythrocyte magnesium content calculated after chronic magnesium supplementation to diet. In conclusion, our data suggest that NIDDM subjects may benefit from therapeutic chronic administration of magnesium salts.
Increased Insulin Action and Clearance in Hyperthyroid Newly Diagnosed IDDM Patient: Restoration to Normal With Antithyroid Treatment
Authors: Nijs Hubert G T , Radder Jasper K , Frölich Marijke , Krans H Michiel J
Published: March 2007

In a patient with hyperthyroidism and newly diagnosed insulin-dependent diabetes mellitus (IDDM), insulin action and clearance were studied before the initiation of antithyroid treatment and at 3-mo intervals for 1 yr thereafter. The sequential euglycemic clamp technique (5 mM) was used with insulin infusion rates of 0.5, 1.0, 2.0, and 5.0 mil · kg−1 · min−1 in four steps of 2 h. The data were compared with nine control subjects and nine newly diagnosed euthyroid IDDM patients treated with insulin for 0.5 mo. Insulin sensitivity was increased in the patients (ED50 40 vs. 52 mU/L, range 43–70, in controls and 70 mU/L, range 59–120, in IDDM subjects). Insulin responsiveness was markedly elevated; the steady-state glucose infusion rate (SSGIR) of step 4 was 104 vs. 64 μmol · kg−1 · min−1 (range 50–79) in controls and 61 junol · kg−1 · min−1 (range 47–69) in IDDM subjects. Insulin clearance was elevated in all steps (1-3, 20–23 vs. 9–15 ml · kg−1 · min−1; 4, 18 vs. 6–12 ml · kg−1 · min−1 in control and IDDM subjects). Parallel to the normalization of thyroid metabolism, insulin action (ED50 60 mU/L, SSGIR in step 4, 51 μmol · kg−1 · min−1) and insulin clearance (steps 1–3, 11–14 ml · kg−1 · min−1; step 4, 7 ml · kg−1 · min−1) returned to the normal range in 6 mo. Both remained within the normal range until 12 mo. In the patient with newly diagnosed IDDM, the initial marked increases of insulin action and clearance were due to coexistent hyperthyroidism. With the amelioration of the hyperthyroid state, both processes became normal. The parallelism between insulin action and clearance suggests a functional relationship.
Assessment of AlbuSure and Its Usefulness in Identifying IDDM Subjects at Increased Risk for Developing Clinical Diabetic Nephropathy
Authors: Coonrod Beth A , Ellis Demetrius , Becker Dorothy J , Dorman Janice S , Drash Allan L , Kuller Lewis H , Orchard Trevor J
Published: March 2007

This study, which included 154 participants in a 10-yr follow-up study of diabetes complications, was conducted to evaluate AlbuSure (a qualitative test designed to detect urinary albumin concentrations > 0.03 g/L) for its ability to discriminate between albumin concentrations above and below the manufacturer's concentration threshold and to identify individuals at increased risk for developing diabetic nephropathy (i.e., those with albumin excretion rate [AER] > 0.0288 g/24 h). The reproducibility of AlbuSure results was also evaluated. The results of these evaluations were examined by three different types of urine collections (24 h, overnight, and timed postclinic) and overall. AlbuSure's validity was examined by comparing its results to immunonephelometrically measured concentrations and AER. When compared to albumin concentration, AlbuSure had an overall sensitivity of 81.8%, specificity of 94.8%, and positive predictive value of 90.6%. AlbuSure's sensitivity was lower (71.4%) when compared with AER; however, this was higher than the sensitivity achieved by dipsticks against AER (50.7%). On testing urine samples stored for 3 days at 4°C, AlbuSure results were 100% reproducible after 1 day and had an overall reproducibility of 92% after 3 days. When urine was retested after 3 and 15 mo of storage at −70°C, AlbuSure was ≥ 90% reproducible, with some of the differing results attributable to corresponding changes in albumin concentration. The overnight sample appeared to be the sample of choice for testing with AlbuSure in that it showed excellent reproducibility and the highest sensitivity (compared to both albumin concentration and AER).
Family Functioning and Metabolic Control of School-Aged Children With IDDM
Authors: Kovacs Maria , Kass Robert E , Schnell Theresa M , Goldston David , Marsh Judith
Published: March 2007

The relationship of two aspects of family life to metabolic control wereexamined as part of a longitudinal study of school-aged children with newly diagnosed insulin-dependent diabetes mellitus (IDDM). Glycosylated hemoglobin level was the primary index of metabolic control; weight-adjusted insulin dosage served as an indirect index. Neither the quality of family life nor aspects of the parents' marriage predicted the child's metabolic control over the next 3–4 mo, and they were also unrelated toconcurrent weight-adjusted insulin dosage. Longitudinal data spanning a 6-yr period of the child's diabetes also failed to reveal an association between aspects of family life and metabolic control. The significance ofthe findings are discussed in light of the sample's characteristics and possible methodological constraints.
Correlation Between Amount of Carbohydrate in Mixed Meals and Insulin Delivery by Artificial Pancreas in seven IDDM Subjects
Authors: Halfon Patricia , Belkhadir Jamil , Slama Gérard
Published: March 2007

The effects of mixed meals containing varying amounts of carbohydrate (CHO) on blood glucose levels and insulin delivery by an artificial pancreas were studied in seven insulin-dependent diabetes mellitus subjects. Each patient received, at random over 3 consecutive days, three mixed meals containing 60, 80, and 140 g complex CHOs. There was a high and linear correlation between total amount of insulin delivered to restore blood glucose values and amount of CHO consumed: 12.1 ± 1.3 to 31.2 ± 5.2 U insulin were needed for 116 ± 16 to 198 ± 24 min. However, neither the time lapse between the beginning of meal intake and blood glucose increase nor the peaking time for blood glucose variation were significantly different between meals. We suggest that some of the data obtained in this study might be useful in programming an open-loop insulin-infusion system.
Urinary Excretion of Angiotensin Converting Enzyme in NIDDM Patients With Nephropathy
Authors: Hosojima Hiroyuki , Miyauchi Eiji , Morimoto Shinpei
Published: March 2007

Twenty-four-hour urinary excretion of angiotensinconverting enzyme (ACE) was investigated in relation to that of albumin and β2-microglobulin (β2M) in 25 noninsulin- dependent diabetes mellitus (NIDDM) patients without nephropathy, 13 NIDDM patients with incipient nephropathy, 18 NIDDM patients with overt nephropathy, and 14 nondiabetic subjects. NIDDM patients without nephropathy and nondiabetic subjects were similar in albumin, β2M, and ACE excretion. NIDDM patients with incipient nephropathy had elevated albumin excretion (P < .01) and similar (β2M and ACE excretion compared with nondiabetic subjects. On the other hand, NIDDM patients with overt nephropathy had elevated albumin, β2M, and ACE excretion compared with nondiabetic subjects (P < .01). In all NIDDM patients studied, a positive correlation was found between ACE excretion and albumin excretion (r = 0.76, P < .001) or β2M excretion (r = 0.52, P < .01). These data suggest that elevated ACE excretion in NIDDM patients with overt nephropathy may be reflective of renal tubular damage.
Clinical Significance of Insulin Antibodies in Insulin-Treated Diabetic Patients
Authors: Van Haeften Timon W
Published: March 2007

The prevalence and titers of insulin antibodies in insulin-treated patients have markedly decreased, mainly as a consequence of the improvements in the purity of insulin preparations and to a lesser degree because of the changes of species of insulin (human insulin). However, numerous patients still produce antibody levels that may alter insulin pharmacokinetics, leading to higher postprandial blood glucose levels and to an increased risk for delayed hypoglycemia. Although the effects of antibodies on long-term glycemic control are less clear, the metabolic consequences of altered pharmacokinetics are clinically evident in patients in whom near normoglycemia is the goal and who are treated predominantly with short-acting insulin. Lipoatrophy and immunological insulin resistance, which are also antibody-induced phenomena, have become rare. Whether pregnancies in diabetic mothers with antibodies carry an increased risk for serious or fatal complications is not clear; neonates of these mothers are probably at increased risk for neonatal hypoglycemia.
Five-Year Follow-Up Study on Plasma Insulin Levels in Newly Diagnosed NIDDM Patients and Nondiabetic Subjects
Authors: Niskanen Leo K , Uusitupa Matti I , Sarlund Helena , Siitonen Onni , Pyörälä Kalevi
Published: March 2007

A representative group of middle-aged (45- to 64-yr-old) patients with non-insulin-dependent diabetes mellitus (NIDDM) (n = 133; 70 men, 63 women) were examined at the time of diagnosis and 5 yr afterward for metabolic control and insulin response to oral glucose; 144 nondiabetic control subjects (62 men, 82 women) were similarly examined twice between 5-yr intervals. At the 5-yr examination, 56 of the diabetic patients (36 men, 20 women) were on diet therapy only, 60 (27 men, 33 women) received oral antidiabetic drugs, and 5 were treated with insulin. The metabolic control of diabetic patients was poor at the time of diagnosis and 5-yr examination. Fasting plasma insulin levels were higher in diabetic patients than in control subjects both at baseline (23 ± 2 vs. 14 ± 1 mU/L, P < 0.01, for men; 26 ± 2 vs. 15 ± 1 mU/L, NS, for women) and 5-yr examination (19 ± 1 vs. 16 ± 2 mU/L, NS, for men; 29 ± 5 vs. 15 ± 1 mU/L, P < 0.05, for women). The frequency of insulin deficiency in diabetic patients based on a postglucagon (1 mg i.v.) C-peptide level <0.60 nM was 3.3% at the 5-yr examination, indicating that true insulin deficiency was uncommon during the first years after diagnosis of diabetes in middle-aged subjects.