bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study of the Activity of Biosynthetic Human Insulin and Pork Insulin Using the Glucose Clamp Technique in Normal Subjects
Authors: Massi-Benedetti M , Burrin J M , Capaldo B , Alberti K G M M
Published: March 2007

The activity of biosynthetic human insulin (BHI) has been compared with that of pork insulin using the glucose clamp technique in normal subjects. After a baseline period, insulin was infused at 0.02 U/kg/h for 2 h, then 0.032 U/kg/h for 2 h, and finally 0.05 U/kg/h for 2 h. Glucose was clamped at baseline values using a glucose-controlled insulin infusion system (Biostator) and the amount of glucose infused to maintain normoglycemia calculated for each insulin dose for the two insulins. C-peptide levels decreased with both insulins, suggesting suppression of endogenous insulin secretion. Serum insulin levels attained were the same for both insulins. There were no significant differences in either total glucose infused or glucose infused during the last 30 or 60 min at each insulin dose for the two insulins. Intermediary metabolite responses to the infusion of the two insulins were similar. We conclude that in normal human beings, BHI shows identical metabolic activity with pork insulin.
Biologic and Immunologic in Vivo and In Vitro Studies with Biosynthetic Human Insulin
Authors: Federlin Konrad , Laube Heinrich , Velcovsky Hans Georg
Published: March 2007

A preliminary study was performed to estimate the effect of biosynthetic human insulin (BHI) produced by the Eli Lilly Company in comparison with purified pork insulin (PPI) from the same manufacturer. Immunologic studies were done using an intradermal skin test with both insulins and in vitro studies binding with sera containing preformed antibodies against bovine and pork insulin. The studies were undertaken in eight healthy volunteers aged 24–31 yr. Insulin was given subcutaneously in an amount of 0.1 U/kg and 3 days later intravenously in an amount of 0.03 U/kg injected slowly over 1 min. Blood glucose, insulin, C-peptide, and growth hormone were measured at different times between 0 and 360 min. It was shown that BHI and PPI behaved similarly in lowering blood glucose, suppressing C-peptide, and increasing growth hormone via hypoglycemic action. After s.c. injection, BHI was found to reach higher serum concentrations after 60 min than PPI. Correspondingly, the blood glucose curve was significantly lower after BHI than after PPI. This difference was not observed after the i.v. application of both forms of insulin.
Comparison of Biosynthetic Human Insulin and Pork Insulin in the Gerritzen Test
Authors: Weinges Kurt , Ehrhardt Manfred , Enzmann Franz
Published: March 2007

Biosynthetic human insulin (BHI) produced by recombinant DNA technology has been proven to be identical to pancreatic human insulin. It differs from pork insulin in one carboxy-terminal amino acid of the B-chain, where alanine substitutes for threonine. This leads to a higher hydrophilicity and usually lowers the tendency of insulin molecules to aggregate. To study its biologic effect in man, the Gerritzen test was applied. BHI regular (10 IU) or purified pork insulin (PPI) (10 IU) was injected subcutaneously to evaluate the insulin action profile. The time course of plasma glucose levels under both BHI and PPI did not significantly. BHI seems to lower the blood glucose somewhat faster during the first 30 min and, during the late phase, somewhat less than pork insulin. In general, for both BHI and PPI, the onset of action occurs within 15 and 30 min; after 60 min, plasma glucose levels drop by 44.3% for BHI and by 40% for PPI. The plasma glucose minimum was reached about 2 h after injection; therefore, the slope of the plasma glucose fall after 60 min was only marginal. The minimum levels were steady over about 1.75 h. At 2.5 h postinjection plasma glucose rose gradually and reached starting levels after about 7 h. BHI was as well tolerated in the intradermal skin testing as were pork insulin and a placebo solution.
Comparison of the Biologic Activity of Biosynthetic Human Insulin and Natural Pork Insulin in Juvenile-onset Diabetic Subjects Assessed by the Glucose Controlled Insulin Infusion System
Authors: Klier M , Kerner W , Torres A A , Pfeiffer E F
Published: March 2007

To assess the biologic activity of biosynthetic human insulin (BHI) synthesized by Escherichia coli, six insulin-dependent juvenile-onset diabetic subjects were studied with BHI and natural pork insulin, by means of the glucose controlled insulin infusion system (GCIIS). First, after an overnight normalization of blood glucose levels, the 24-h insulin requirement was determined while the patients were consuming a diet of 30 kcal/kg. Then, the amount of glucose necessary to maintain normal blood glucose levels during a 5-h intravenous infusion of BHI and pork insulin, respectively, was assessed. Both studies demonstrate that in the insulin-dependent diabetic subject, BHI is at least as effective as natural pork insulin and may, therefore, be useful for the treatment of insulin-dependent diabetes mellitus.
Immediate-Type Allergy Against Insulin Itself: Clinical and Immunologic Studies on a Diabetic Patient with Insulin Intolerance
Authors: Schernthaner G , Ludwig H , Jarisch R , Bruneder H
Published: March 2007

In this report clinical and immunologic data of a female diabetic patient with immediate-type allergy against insulin preparations of different species, including pancreatic human insulin, biosynthetic human insulin and semisynthetic human insulin are described. The determination of insulin-specific antibodies showed relatively high IgE-antibody titers in contrast to low IgG-antibody concentrations, which is in accordance with the assumption that the ratio of IgE- to IgG-insulin antibodies is important in the outcome of clinically manifest allergic reactions. Negative results for cutaneous delayed-type insulin hypersensitivity and for stimulation of lymphocyte blastogenesis exclude type IV immunopathogenic reaction in this insulin-allergic patient. Preliminary data suggest that inherited individual factors–such as DR2, DR3 positivity in this diabetic individual–might predispose diabetic patients to insulin allergy.
Receptor Binding Properties and Biologic Activity In Vitro of Biosynthetic Human Insulin
Authors: Keefer Linda M , Piron Marie AgnÈs , De Meyts Pierre
Published: March 2007

The interaction of biosynthetic human insulin with human cultured lymphocytes, human circulating erythrocytes, and isolated rat fat cells was examined. The binding of the biosynthetic insulin to human cells was identical to that of native human or pork insulins, with respect to affinity, kinetics of association and dissociation, negative cooperativity, and downregulation of lymphocyte receptors. The biosynthetic insulin also had equal potency in stimulating the incorporation of [3H]-glucose into the lipids of isolated rat fat cells. These data suggest that the structure of the biosynthetic insulin has been integrally reconstituted.
Insulin Binding, Biologic Activity, and Metabolism of Biosynthetic Human Insulin
Authors: Olefsky Jerrold M
Published: March 2007

Insulin binding to receptors, insulin action, and cellular insulin metabolism were studied using biosynthetic human insulin (BHI). The results demonstrated that this insulin preparation binds to receptors with full binding potency and also exerts normal biologic activity to stimulate adipocyte glucose oxidation and glucose transport. Furthermore, following initial binding to adipocyte receptors, BHI is internalized and degraded in a manner indistinguishable from purified pork insulin (PPI). Thus, these results demonstrate that BHI has full biologic activity, is metabolized normally, and should produce the full insulin effect when administered to diabetic patients.
Programming of Insulin Delivery with Meals During Subcutaneous Insulin Infusion
Authors: Chisholm Donald J , Kraegen Edward W , Zelenka Guido S
Published: March 2007

The serum insulin elevation after subcutaneous (s.c.) infusion of 10 U of neutral regular insulin given over 5 or 30 min has been examined in normal subjects to find a delivery profile that would simulate the normal serum insulin response to a meal. Endogenous insulin release, assessed by measurement of C-peptide, was suppressed by an i.v. infusion of 1 U/h neutral regular insulin, beginning 60 min before the s.c. administration and continuing throughout the study. The increment in serum insulin levels after the 5-min s.c. infusion reached a peak of 62 ± 9.5 mU/L at 45 min, and the rate of elevation of insulin levels closely approximated the normal insulin response to a 50-g, 500 kcal mixed meal. The increment in serum insulin levels with the 30-min s.c. infusion reached a peak of 41 ± 1.4 mU/L at 75 min. The incremental insulin response up to 180 min (area under the curve) after the 5-min s.c. infusion was 30% greater than the response to the 30-min infusion. On the basis of these studies, we conclude that insulin delivery for meals during s.c. insulin infusion need not be initiated before the meal, but should be given over a period of approximately 5 min or less. Further study is required to delineate the effects of concentration, local degradation, and rate of delivery on entry of s.c. insulin to the vascular system.
The Family Medical History: Assessing Patient Understanding of Diabetes Mellitus
Authors: Doody Rachelle S , Grose Nellie P
Published: March 2007

In this preliminary study, we attempted to determine whether diabetic subjects with a positive family medical history for diabetes have a better understanding of their own disease (ie., of its course, treatment, and genetic characteristics) than diabetic subjects without diabetes in their histories. We interviewed 50 diabetic subjects and scored their responses to determine their understanding of diabetes in general and in their own cases in particular. The data were analyzed using the Student's t test and chi-square analysis. Overall, patients with positive histories did not have significantly higher understanding than patients with negative histories. However, if patients had extensive exposure to the affected relative, or if tht relative was a spouse or a parent, the patients' understanding was significantly higher (P < 0.05). Educational level, age, and duration of diabetes did not affect patients' understanding. The data suggest that the family medical history can be a valuable teaching model, once we redefine it so as to reconcile patient concepts about illness with physician concepts of disease.
Chylomicronemia Syndrome in Diabetes Mellitus
Authors: Chait Alan , Robertson H Thomas , Brunzell John D
Published: March 2007

Lipemic plasma with marked elevations of plasma triglyceride levels (3221 ± 1590 mg/dl) and fasting chylomicronemia was observed in nine patients with uncontrolled non-insulin-dependent diabetes mellitus. Every case had hypertriglyceridemic relatives, suggesting that the very high triglyceride values seen resulted from the coexistence of diabetes with a familial form of hypertriglyceridemia. A number of clinical and biochemical features observed in the diabetic patients and also in a group of nondiabetic controls with comparable degrees of hypertriglyceridemia suggests that these manifestations are related to high plasma triglyceride levels rather than to the diabetes per se. Chronic abdominal pain, mental confusion, and memory loss improved with lipid-lowering therapy and clearing the plasma of chylomicrons. Pulmonary function tests, red cell 2,3-diphosphoglycerate, and hemoglobin oxygen affinity were normal; the mild hypoxemia observed is believed to be an artifact. It is suggested that a syndrome due to chylomicronemia can occur in uncontrolled non-insulin-dependent diabetic patients, who in addition have a familial form of hypertriglyceridemia. To prevent manifestations of this syndrome in these patients, specific lipid-lowering therapy may be required in addition to control of their diabetes.
Progressive Retinopathy with Improved Control in Diabetic Dwarfism (Mauriac's Syndrome)
Authors: Daneman Denis , Drash Allan L , Lobes Louis A , Becker Dorothy J , Baker Lester M , Travis Luther B
Published: March 2007

We report four children aged 11–18½ yr first seen 7–14 yr after the diagnosis of insulin-dependent diabetes. At presentation, all had marked short stature, two had hepatomegaly, and the older three had delayed adolescence. They had been severely underinsulinized. Initial funduscopy demonstrated only occasion microaneurysms in two children and a single intraretinal hemorrhage in another. The youngest was normal. Improved control required large increases in insulin dosage. Growth rate improved significantly and hepatomegaly regressed. Puberty progressed rapidly in two older patients with poor final height. Paradoxically, with improved control, retinopathy progressed rapidly with appearance of multiple microaneurysms, nerve fiber layer infarctions, intraretinal microangiopathic changes, hemorrhages, exudates, and macular edema in all the patients and severe proliferation changes in three. One child with proliferative retinopathy in both eyes developed vitreous hemorrhage and blindness in one eye. Two required panretinal photocoagulation with no further progression of their retinopathy. These rapidly progressive retinal changes remain unexplained. We advise caution when correcting metabolic derangements of diabetic patients who have been poorly controlled for a prolonged period.
A Comparison Study of Blood Glucose Test Strips
Authors: Worth Richard C , Harrison Kevin , Anderson John , Johnston Desmond G , Alberti K George M M
Published: March 2007

Blood glucose test strips provide a convenient and rapid method for estimation of blood glucose. They can be read either by eye against a color scale or in a reflectance meter. This study compares the performance characteristics of the principal test strips available. When read visually, the BM Glycemie 20–800 (Chemstrip bG) strip was shown to be more accurate than the Dextrostix strip. Comparison of the meter systems showed Reflotest-Glucose to be more accurate and precise than Dextrostix. This was because the Reflotest system was read closer to the endpoint of color development and because there was less subsequent color fade than with the Dextrostix system. Reflotest-Glucose and Reflotest-Hypoglycemie developed colors that were stable for at least 2 days after completion of the test. However, when using a reflectance meter the Reflotest system required two strips to cover the important range of blood glucose.
Reduced Albuminuria During Early and Aggressive Antihypertensive Treatment of Insulin-dependent Diabetic Patients with Diabetic Nephropathy
Authors: Parving Hans-Henrik , Andersen Allan R , Smidt Ulla M , Friisberg Birgit , Svendsen Per Aa
Published: March 2007

Urinary albumin excretion rate (radial immunodiffusion), glomerular filtration rate (GFR) (single-shot 51Cr-EDTA technique), and arterial blood pressure (BP) were measured in 12 juvenile-onset, insulin-dependent diabetic patients with persistent proteinuria (> 0.5 g/day) due to diabetic nephropathy. Mean age of the patients was 30 yr. All patients had a diastolic blood pressure ≥95 mm Hg. Metoprolol, hydralazine, and furosemide or thiazide were used as antihypertensives. During the 12-mo treatment period, BP decreased from 151/104 to 133/85 mm Hg (P < 0.001), the urinary albumin excretion rate diminished from 1447 to 613 μg/min (P < 0.005), and GFR declined from 96 to 89 ml/min/1.73 m2 (P < 0.01). A linear relationship between mean blood pressure and the logarithm of the albuminuria was found (r = 0.48, P < 0.01). Arterial hypertension is an early feature of diabetic nephropathy in young insulin-dependent patients. Early and aggressive treatment of that condition decreases albuminuria, probably due to reduced intraglomerular filtration pressure. Whether sustained reduction in arterial blood pressure to near-normal levels during several years also reduces the rate of decline in GFR in diabetic nephropathy remains to be established.
Plasma Glucose and Insulin After Fructose an High-Fructose Corn Syrup Meals in Subjects with Non-insulin-dependent Diabetes Mellitus
Authors: Akgün Suat , Ertel Norman H
Published: March 2007

The impact on plasma glucose of 35 g of fructose or an equicaloric amount (43.75 g) of high-fructose corn syrup (HFCS) (as part of a 400-calorie meal) was measured in six patients with non-insulin-dependent diabetes mellitus (NIDDM). Blood samples were collected periodically at all points for all patients for 3 h for plasma glucose (PG) and insulin (IRI) determinations. The mean peak PG increment was higher after the HFCS meal (66.5 mg/dl) than after the fructose meals (45.5 mg/dl). When increase in the mean plasma glucose concentration (Δ PG) after the fructose meals were compared with the Δ PG after the HFCS meals, there was statistical significance at 15 min (P < 0.02) and 30 min (P < 0.05). The total areas under the 3-h curves of mean Δ PG showed a highly significant (P < 0.001) difference between the fructose meal (5601 planimetry U) compared with the HFCS meal (8023 planimetry U). Mean changes in IRI after meals with either sweetener were comparable. These findings suggest that fructose is superior to HFCS as a sweetening agent in patients with NIDDM.
The Reduction in Symptoms of Diabetic Patients After Treatment in Diabetic Clinics
Authors: Bulpitt C J , Shaw K M , Clifton Pamela , Bloom Arnold
Published: March 2007

One hundred and seventy-six patients who were newly referred to two diabetic clinics completed an initial questionnaire and a second questionnaire 1 yr later. Over the 1-yr period the average 2-h postprandial blood sugar was reduced from 13.8 to 8.8 mmol/L. The questionnaire included 33 questions on symptoms, and four symptoms improved by more than 10%: increased thirst (reduced by 29%), dry mouth (reduced by 24%), pruritus (17%), and weakness in the limbs (10%). No symptom was increased by more than 7%. The changes in five symptoms were significantly related to the changes in blood sugar observed, the improvement in symptoms being associated with reductions in blood sugar. These results are contrasted with newly referred hypertensive patients in whom marked improvements in symptoms were not observed and an increased frequency of certain symptoms was observed owing to drug side effects.
Autonomic Nervous Function in Asymptomatic Diabetic Patients with Signs of Peripheral Neuropathy
Authors: Göran Sundkvist
Published: March 2007

Fifty-two long-term diabetic patients without symptoms of autonomic neuropathy and 31 age-matched healthy controls were tested for autonomic neuropathy by deep breathing, Valsalva maneuver, and an orthostatic test on tilt table. The deep breathing and the orthostatic tests showed significant parasympathetic impairments in patients with signs of peripheral neuropathy. The Valsalva maneuver, which also mainly reflects parasympathetic: function, was disturbed in patients with peripheral neuropathy, but only in those with a very long duration of diabetes. Parasympathetic neuropathy was closely correlated with peripheral neuropathy. However, five patients showed signs of parasympathetic neuropathy but not of peripheral neuropathy. Thus, parasympathetic neuropathy can appear before peripheral neuropathy. On the contrary, sympathetic denervation, as shown from the blood pressure reaction to tilting, only appeared in patients with peripheral neuropathy.
Reversal in the Seasonal Clustering of Diabetes in Multiplex Families
Authors: Miller Alice Penrose , Rich Stephen S , Barbosa Jose
Published: March 2007

We studied attributes of diabetic sib pairs in 138 insulin-dependent multiplex families. Within multiply affected families, there is a large subset of siblings diagnosed only a year or less apart in whom the usual seasonal variation for diabetes is reversed. Furthermore, we confirm that affected sibs tend to cluster for onset of disease. The clustering, however, is limited to those sibs younger than 20 yr. These diabetic patients cannot be categorized by HLA type, and a common environment may play a major role in the development of insulin-dependent diabetes.
Nutritional Management of Pregnancy Complicated by Diabetes: Historical Perspective
Authors: Ney Denise , Hollingsworth Dorothy R
Published: March 2007

The important role of diet in the management of pregnancies complicated by diabetes has been recognized since the nineteenth century. In this historical review we have traced the evolution of the diabetic diet from the pre-insulin era, when diabetic pregnancies were not only rare, but accompanied by high maternal mortality and fetal loss to 1981, when the nutritional management of carbohydrate intolerance during gestation is again raising provocative questions. Our recent understanding of diabetes as a heterogeneous syndrome, the 1979 dietary guidelines of the American Diabetes Association (ADA), and the 1980 revised Recommended Dietary Allowances (RDA) for pregnant and lactating women are summarized as representative of the current approach to the nutritional management of diabetic pregnancies. Many questions remain unanswered. These include the hundred-year-old debate concerning the optimal amount of carbohydrate in the diabetic diet, the possible beneficial role of large amounts of dietary fiber, and the nagging concern about total caloric intake in type I insulin-dependent diabetes mellitus (IDDM) versus type II non-insulin-dependent diabetes mellitus (NIDDM) pregnant diabetic women. We suggest that nutritional counseling during gestation in the future may need to be more highly individualized as metabolic distinctions between different types of patients with carbohydrate intolerance are more clearly delineated.
Hyperglycemia and Plasma Lipid Levels: Covariations in Insulin-dependent Diabetes
Authors: Sosenko Jay M , Breslow Jan , Miettinen Olli S , Gabbay Kenneth H
Published: March 2007

Longitudinal relationships of plasma lipids with parameters of blood glucose control were studied in 124 young insulin-dependent diabetic patients who had multiple, simultaneous determinations of these parameters during a 1-yr period. Fluctuations in hemoglobin A1, a cumulative measure of blood glucose control, correlated with fluctuations in total cholesterol (r = 0.19, P < 0.001) and low-density lipoprotein-cholesterol (r = 0.17, P < 0.001). Similarly, fluctuations in fasting blood glucose correlated with those in total cholesterol (r = 0.20, P < 0.001), very low-density lipoprotein-cholesterol (r = 0.13, P = 0.002), and total triglyceride (r = 0.23, P < 0.001). These data indicate covariation between plasma lipid and blood glucose control parameters and suggest that poor blood glucose control contributes to the excess risk of coronary heart disease in insulin-dependent diabetes mellitus.
The Hypertensions of Diabetes
Authors: Christlieb A Richard
Published: March 2007

Patients with diabetes mellitus may have any one of several forms of hypertension. These include essential hypertension, systolic hypertension of three varieties, the hypertension associated with diabetic nephropathy (“diabetic hypertension”), and the hypertension associated with neuropathy (supine hypertension with orthostatic hypotension). Because there are differences in the hypertensive mechanisms in each of these hypertensions, the use of antihypertensive medications should be tailored to the type of hypertension present. In this review, the rationale for treating hypertension in the diabetic will be discussed, the mechanisms of action and potential side effects of antihypertensive drugs peculiar to the diabetic will be outlined, and specific antihypertensive therapy programs based on the mechanisms involved in producing each of the hypertensions will be detailed.
Erogress Toward a Potentially Implantable, Enzyme-Based Glucose Sensor
Authors: Gough David A , Leypoldt John K , Armour Jon C
Published: March 2007

Our efforts toward the development of a potentially implantable, enzyme-based glucose sensor have concentrated on understanding in sufficient detail the most important component, the enzyme-containing membrane. We describe here some features that this membrane must have to operate as a constituent of a chronically implanted sensor. A model of reaction and diffusion within the membrane is outlined and methods of membrane characterization are reviewed.
Glucose Sensor Characteristics for Miniaturized Portable Closed-Loop Insulin Delivery: A Step Toward Implantation
Authors: Oberhardt Bruce J , Fogt Eric J , Clemens Anton H
Published: March 2007

An implantable glucose sensor must be free of baseline and sensitivity drift. To our knowledge, a driftfree glucose sensor with fast response time is not currently available. We are therefore proposing a miniature extracorporeal glucose sensor with access to the vascular system as a practical step toward implantation. This sensor could use existing technology to form the basis of a patient-wearable closed-loop system.
Development and Present Status of an Electrocatalytic Glucose Sensor
Authors: Richter G J , Luft G , Gebhardt U
Published: March 2007

For the determination of glucose in body fluids the electrocatalytic sensor seems to be quite favorable, particularly for long-term intracorporeal operation. The measuring response is disturbed by the fluctuating concentrations of interfering substances that are present in body fluids. However, the disturbance can be for the most part controlled, as shown in the case of amino acids. Their marked influence on glucose oxidation is suppressed at a membrane-covered sensor electrode by using a potential step method.
Noninvasive Glucose Monitoring of the Aqueous Humor of the Eye: Part I. Measurement of Very Small Optical Rotations
Authors: Rabinovitch B , March W F , Adams Robert L
Published: March 2007

We have described the concept of using the aqueous humor glucose as a measure of the blood glucose concentration, with a view to developing a noninvasive glucose monitor for diabetic individuals. We have conceived of a scleral lens that houses a light source, polarizers, other electro-optic units, and a light detector, and which measures the optical rotation of the aqueous humor continuously. We have built an optical bench mock-up of the glucose sensor and assessed the limits of its capabilities. We have described a physical method, employing the Faraday effect, that modulates the incident light and uses a compensator to introduce a feedback mechanism giving a null-point technique capable of measuring extremely small rotations with an accuracy of 0.4 s of arc. We have used this and have measured the optical rotations of glucose solutions from 0.02 to 0.1%, and have demonstrated linearity in both cases. Miniaturization of the technique is discussed.
Studies on the Relationship Between Insulin Concentrations and Insulin Action
Authors: Fineberg S Edwin , Schneider Stephen H
Published: March 2007

The relationship between insulin concentrations and insulin effects was assessed using a 30-min steadystate perfusion of insulin across the human forearm and a 90-min recovery period in 17 normal men. During perfusion, calculated insulin increments in forearm arterial plasma insulin were 87 ± 4 (group I), 161 ± 17 (group II), and 333 ± 55 μU/ml (group III), respectively. Measured venous insulin increments were 33 ± 4, 66 ± 6, and 231 ± 27 μU/ml. During perfusion, venous and arterial increments were linearly related (r = 0.88, P < 0.001). With discontinuation of perfusion, venous increments of insulin became undetectable after 15 min in groups I and II, and after 30 min in group III. Of the total microunits of insulin perfused, 46.0 ± 11.0%, 45.3 ± 9.4%, and 36.5 ± 4.8%, respectively, remained unaccounted for 90 min after perfusion. Effects of insulin on arteriovenous differences of FFA and potassium persisted throughout the recovery period, with peak effects occurring after perfusion for all groups. Estimated interstitial insulin levels in the three groups fell below 10 μU/ml by 45, 60, and 90 min after perfusion, respectively. Although peripheral tissues had a significant capacity to sequester insulin, the persistence of biologic effects was not consistent with increased concentrations within the interstitial spaces. Effects of insulin upon glucose waned first, followed by effects upon potassium and then lipolysis.
Sorbitol Concentration in the Plasma and Erythrocytes of Diabetic Subjects
Authors: Somers Guido , Depoorter Ivan , Sener Abdullah , Malaisse Willy J
Published: March 2007

Sorbitol content of plasma and red blood cells is increased in diabetic subjects, and it correlates with plasma glucose concentration. Rapid changes in plasma glucose concentration, either during normalization or impairment of glucose homeostasis, are paralleled by equally rapid changes in plasma or erythrocyte sorbitol content. At variance with a recent proposal, it is concluded that the measurement of sorbitol in red cells is not a reliable indicator of either long-term blood glucose levels or sorbitol accumulation in those tissues in which such an accumulation participates in the pathogenesis of degenerative Complications.
Insulin Responses to Glucose in Non-insulin-dependent Diabetic Subjects With and Without the Chlorpropamide-Alcohol Flush: Effect of Salicylate and Naloxone
Authors: Hershon Kenneth S , Bierman Edwin L , Bruzzone Carole M , Ensinck John W
Published: March 2007

We examined the role of endogenous opiates and/or prostaglandins on the abnormal insulin secretion characteristic of some non-insulin-dependent diabetic subjects. A group of chlorpropamide-alcohol flush positive (CPAF +) and a group of flush negative (CPAF −) non-insulin-dependent subjects were compared as to their pancreatic beta-cell responses to intravenous glucose tolerance tests before and after sodium salicylate infusion, and before and after naloxone infusion. There was no difference in mean insulin secretion (either first or second phase) between CPAF+ versus CPAF− groups. Both groups increased their insulin secretion with salicylate infusion, and both had a small decrease with naloxone infusion. There was no correlation between chlorpropamide-alcohol flushing and beta-cell response tO glucose.
Parental Perceptions of the Psychological Adjustment of Children with Diabetes and Their Siblings
Authors: Lavigne John V , Traisman Howard S , Marr Thomas J , Chasnoff Ira J
Published: March 2007

This study examined the psychological adjustment of children with diabetes and their siblings. Data were collected for 41 diabetic children and their siblings between ages 6 and 11 yr who were followed in a large pediatric practice. The diabetic group was matched with 35 control children who were followed for routine pediatric care and their siblings. Diabetic families and the controls did not differ on divorce rate or level of marital adjustment. Behavior problems were measured through the use of the Achenbach Behavior Checklist for both sexes separately at the 6–11 and 12–16-yr-old age levels. Diabetic boys, aged 6–11 yr, were higher than nondiabetic boys on internalizing and externalizing symptom scales, particularly on measures of schizoid tendencies, obsessive compulsive symptoms, hyperactivity, and aggression. Neither female patients, male siblings, nor female siblings in the 6–11-yr-old age group differed from controls on emotional adjustment. Among the 12–16-yr-old males, diabetic patients were higher on internalizing symptoms than male siblings and their controls. Male siblings tended to be lower than diabetic patients and controls on school performance. Social class differences may have contributed to the differences at the 12–16-yr age levels. Female subjects in the 12–16-yr-old age group did not differ on measures of adjustment. Level of control was unrelated to patients' or siblings' adjustment, but behavioral symptoms tended to increase for male diabetic patients with length of illness, and tended to decrease for male siblings. Results are interpreted according to social class effects and sex differences.
Limited Joint Mobility of the Hand in Type I Diabetes Mellitus
Authors: Starkman Harold , Brink Stuart
Published: March 2007

Limited joint mobility (LJM) of the hand was present in 32 of 100 subjects, aged 3–22 yr, with type I diabetes mellitus. Prevalence of LJM was independent of age and sex, but increased with duration of diabetes, with peak occurrence in individuals who had diabetes for more than 5 yr (P < 0.005). In ageand duration-matched pairs of control and LJM subjects (N = 31), there was no significant correlation of LJM with insulin type, insulin allergy, family history of arthritis, or growth retardation. There was also no correlation with “control parameters” including number of episodes of hypoglycemia and ketoacidosis, degree of ketonuria or mean glucose, hemoglobin A1, fasting triglyceride, or cholesterol value.
Need for Residential Treatment for Children with Diabetes Mellitus
Authors: Rosenbloom Arlan L
Published: March 2007

Specialists in childhood diabetes in North America were queried about the need for residential facilities for their patients with recurrent hospitalizations and school deficits due to family coping problems. Of 132 respondents, 115 indicated a need for 5–12% of their patients, a total of 530, close to the estimate of 600 based on the number of places available for Danish, Dutch, and German children.
Diabetes and Pregnancy in South Carolina: Prevalence, Perinatal Mortality, and Neonatal Morbidity in 1978
Authors: Wheeler Frances C , Gollmar Charles W , Deeb Larry C
Published: March 2007

Through retrospective analysis of vital records and hospital discharge data, this study examines the prevalence of diabetes in pregnancy and diabetes-related perinatal mortality and neonatal morbidity in South Carolina in 1978. Diabetes was observed in 5.9/1000 deliveries. Diabetic natality rates for whitesand nonwhites were 5.1/1000 and 6.9/1000, respectively. In comparison with comprehensive screening programs, these rates suggest that more than half of all diabetic pregnancies in South Carolina are unrecognized. The overall diabetic perinatal mortality rate was 102 deaths/1000 deliveries, in contrast to the nondiabetic perinatal mortality rate of 25 deaths/1000 deliveries. The risk of perinatal mortality is greater for nonwhites (153 deaths/1000 deliveries) and for women on insulin (182 deaths/1000 deliveries). One-fourth of the pregnancies among nonwhite women on insulin resulted in fetal or neonatal death. Observed neonatal morbidity was high, with respiratory distress syndrome, hypoglycemia, infections, and congenital anomalies the most frequent complications reported. Documentation of assessment for other common neonatal complications was limited
Short-Term Effects of a High-Fiber, High-Carbohydrate Diet in Very Obese Diabetic Individuals
Authors: Hoffman C Russell , Fineberg S Edwin , Howey Daniel C , Clark Charles M , Pronsky Zaneta
Published: March 2007

The short-term effects of a weight-maintenance diet high in fiber and carbohydrate (HFHC) was studied in seven very obese individuals with type II diabetes mellitus. Such diets contained 68% of kcal as carbohydrate and total fiber content of 81 g (in contrast to 42% and 28 g during baseline). Fasting glucose concentrations, summed glucose concentrations, and 24-h glucosuria were unaffected in six of seven individuals. Fasting insulin levels decreased (– 6.0 ± 2.0 μU/ml, P < 0.05), but meal-stimulated insulin concentrations were not altered. Triglyceride and HDL cholesterol concentrations were also unaffected. Total cholesterol concentrations fell in four individuals whose initial values exceeded 200 mg/dl. Basal glucose production rates were similar in the obese diabetic subjects, in five nonobese normal subjects, and in one obese normal individual (2.05 ± 0.19 versus 2.63 ± 0.30 and 1.85 mg/kg/min for the obese normal individual) while on baseline diets, and did not change with HFHC. During isoglycemic hyperinsulinemic glucose clamp procedures (maintenance of basal glucose concentrations), 40 mU/m2/min was infused intravenously for 2 h. Glucose disappearance rates increased significantly in the normal-weight control subjects, but: did not increase during baseline diets in the obese type II diabetic subjects (4.65 ± 0.80 versus 0.68 ± 0.40 mg/kg/min). HFHC diet had no effect on glucose disappearance rates. Plasma insulin levels were 131.0 ± 11.0, 120.0 ± 11.0, and 120.0 ± 5.0 μU/ml during these studies. These studies indicate that short-term HFHC diets without caloric restriction were ineffective in improving glycemic control or lessening insulin resistance in very obese patients with type II diabetes
Some Characteristics of Steroid Diabetes: A Study in Renal-Transplant Recipients Receiving High-Dose Corticosteroid Therapy
Authors: Arner Peter , Gunnarsson Rolf , Blomdahl Sven , Groth Carl-Gustav
Published: March 2007

Risk factors and course of steroid diabetes were investigated in 145 renal-transplant recipients who were given a high-dose steroid regimen. Persistent steroid diabetes developed in 25% of the patients and transient diabetes in another 22%. When antidiabetic therapy was required, insulin had to be given in 50%. The incidence of steroid diabetes correlated with steroid dose, age, body weight, and diabetes heredity but not with abnormal glucose tolerance or with another complication of steroid therapy, posterior-pole lenticular cataract. There was no association with HLA-A and B antigens. Thus, steroid diabetes is a frequent complication of high-dose corticosteroid therapy and is similar to type II diabetes. However, it often requires insulin therapy.
A Randomized Clinical Trial Comparing Behavior Modification and Individual Counseling in the Nutritional Therapy of Non-insulin-dependent Diabetes Mellitus: Comparison of the Effect on Blood Sugar, Body Weight, and Serum Lipids
Authors: Rabkin Simon W , Boyko Evelyn , Wilson Allan , Streja Dan A
Published: March 2007

To determine whether a group behavior modification approach might be preferable to individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus, 40 adults younger than 65 yr of age with diabetes mellitus who were not receiving insulin were randomized to either a program of individualized dietary review and recommendations or a program of group meetings aimed at controlling the signals leading to overeating and noncompliance with a diabetic dietary regimen. Statistically significant (P < 0.05) decreases in body weight, sum skin-fold thickness, fasting serum glucose, and serum triglycerides but not LDL-C or HDL-C were observed. The individual counseling group had a greater amount of weight loss than the behavior modification group. There were no significant (P < 0.05) differences between the two groups with respect to the biochemical outcome variables. Patient characteristics assessed at entry—namely anxiety, internal versus external locus of control and perceived disease severity, and compliance with advice—were significantly associated with weight loss in the behavior modification group while only the latter index was of value in the individual counseling group. Thus, our use of these programs does not identify a clear advantage of either approach in the nutritional therapy of non-insulin-dependent diabetic patients.
Registered Nurses' Knowledge About Diabetes Mellitus
Authors: Scheiderich Sandra D , FreiBaum Carol N , Peterson Leona M
Published: March 2007

Level of knowledge was tested in 137 volunteer registered nurses in three hospitals in the Midwest. A 34-item multiple choice Diabetes Knowledge Test (DKT) was developed by the first author (S.D.S.) working with a panel of expert nurse diabetes educators. Reliability using coefficient alpha was 0.61. Staff nurses obtained a meanvscore of 25.3, or 74% correct. Thirty-four nurses (25%) scored above 80% correct; 62 (45%) scored between 70% and 79% correct; and 41 (30%) scored below 70% correct. Higher-scoring nurses did well on items requiring use of exchange lists, but they missed items on physiologic actions of insulin, side effects of sulfonylureas, where insulin should be stored, and areas of the body suitable for injections of insulin. Nurses who scored below 60% on the test consistently missed items requiring use of exchange lists, effects of regular exercise and illness on blood glucose, and symptoms and causes of hypoglycemia and hyperglycemia. A strong trend (P = 0.055) was found for surgical nurses to score lower than medical unit nurses, and significant differences (P < 0.05) were found among scores between hospitals. Staff nurses employed in a hospital where clinical specialists also were employed to teach diabetic patients had the lowest scores of the three hospitals. Test content subareas should be developed in the future to test knowledge reliably about urine testing, use of oral medications, home blood glucose monitoring, effects of exercise, and Somogyi phenomenon. A curriculum for regular inservice should be developed for nurses to assure a high level of knowledge for patient teaching with diabetes patients.
Early-Morning Hyperglycemia in Diabetic Individuals Treated with Continuous Subcutaneous Insulin Infusion
Authors: Geffner Mitchell E , Frank Harrison J , Kaplan Solomon A , Lippe Barbara M , Levin Seymour R
Published: March 2007

Significant early-morning hyperglycemia was observed in insulin-dependent diabetic individuals who were otherwise well controlled while receiving a continuous subcutaneous insulin infusion (CSII) at standard doses. We measured the levels of the five key counterregulatory hormones (CRH) throughout the night for a total of 10 patient-nights in four such patients. No abnormalities in the patterns of glucagon, cortisol, growth hormone, epinephrine, or norepinephrine secretion were observed. Stepping up the daytime basal infusionrate in six affected patients before bedtime by 37.0 ± 7.5% and maintaining the increased infusion until breakfast significantly blunted this early-morning hyperglycemia without causing significant early nighttime hypoglycemia. Plasma glucose concentrations before breakfast averaged 106.8 ± 13.0 mg/dl after increase of the overnight basal infusion rate as compared with 269.8 ± 39.1 mg/dl while receiving a single basal rate over 24 h (P < 0.02). Thus, the “dawn phenomenon” may occur in patients receiving CSII by an unmodified algorithm and may be obviated by a carefully determined step-up in nocturnal basal infusion rate. The mechanism responsible for this phenomenon of increased early-morning insulin need remains to be elucidated.
Guar Gum and Glycemic Control of Pregnant Insulin-dependent Diabetic Patients
Authors: Kühl Claus , Mølsted-Pedersen Lars , Hornnes Peter J
Published: March 2007

The effect of a guar gum preparation on the glycemic control of 12 pregnant insulin-dependent diabetic patients was investigated. The study was performed on inpatients and lasted 3 wk (from week 32 of pregnancy and onward). Weeks 32 and 34 were control periods during which time the patients had their normal diet only. During week 33, the diet was supplemented with guar. The mean blood glucose level of week 33 was 14% lower than that of week 32 (P < 0.01) but equal to that of week 34. Mean fluctuations of blood glucose during individual days of the 3 wk were similar. The M-value declined significantly from week 32 to week 33, but the M-value of week 33 was not different from that of week 34. The average 24-h glycosuria declined by 63% from week 32 to week 33 (P < 0.05), whereas the values of weeks 33 and 34 were not significantly different. The mean daily insulin doses of weeks 32, 33, and 34 were similar. The results show that whereas admission of pregnant insulin-dependent diabetic women to a diabetes ward exerts a favorable influence on diabetes control, no further improvement is obtainable if the diet is supplemented with guar.
A Survey of Cognitive Functioning at Different Glucose Levels in Diabetic Persons
Authors: Holmes Clarissa Smith , Hayford John T , Gonzalez Jose L , Weydert Joy A
Published: March 2007

Cognitive functioning was assessed in diabetic patients during hypoglycemia (60 mg/dl), euglycemia/ control (110 mg/dl), and hyperglycemia (300 mg/dl). Blood glucose levels were set and maintained to within 4% of targeted levels by an artificial insulin/glucose infusion system (Biostator). Attention and fine motor skills, assessedby visual reaction time, was slowed at altered glucose levels. Performance was less impaired during hyperglycemia than hypoglycemia when a longer interstimulus interval was used,although it was still slower than normal. The time required to solve simple addition problems was increased during hypoglycemia, although reading comprehension was not affected. The possibility that some automatic brain skills are disrupted at altered glucose concentrations is discussed, while associative or inferential skills may be less affected.
Prevention of Congenital Malformations in Infants of Insulin-dependent Diabetic Mothers
Authors: Fuhrmann Kurt , Reiher Horst , Semmler Klaus , Fischer Friedericke , Fischer Michael , Glöckner Eberhard
Published: March 2007

From April 1977 to April 1981, 420 deliveries of infants of insulin-dependent diabetic women were performed in our department. Of the infants delivered, 23 had congenital malformations (5.5%). The malformation rate was 1.4% for infants of 420 nondiabetic women. Strict metabolic control was begun after 8 wk gestation in 292 of the diabetic women who delivered 22 infants with congenital malformations (7.5%). Intensive treatment was begun before conception in 128 diabetic women planning pregnancy. There was only one malformation in infants of this group (0.8%), a significant reduction from the anomaly rate in the late registrants (X2 = 7.84; P < 0.01). These observations indicate that reasonable metabolic control started before conception and continued during the first weeks of pregnancy can prevent malformations in infants of diabetic mothers.
Sugar Content of Selected Pharmaceuticals
Authors: Souney Paul F , Cyr Dale A , Chang Jacob T , Kaul Alan F
Published: March 2007

Medications may contain significant amounts of various sugars. Data provided by 67 manufacturers have been tabulated to provide specific qualitative and quantitative information on sugar content of selected drug products. Since diabetic individuals may tolerate various sugar forms differently, it is useful to know specific sugar forms and content present in medications. This listing should prove to be a convenient guide to clinicians caring for diabetic individuals.
The Prevalence of Diabetes Mellitus in a Traditional-Living Polynesian Population: The Wallis Island Survey
Authors: Taylor Richard J , Bennett Peter H , LeGonidec George , Lacoste Jacques , Combe Denis , Joffres Michel , Uili Roparti , Charpin M , Zimmet Paul Z
Published: March 2007

The prevalence of diabetes mellitus in the traditional-living population of Wallis Island was low and comparable with that found in other rural Polynesian societies. The diabetes prevalence was 1.9% in men and 3.5% in women; impaired glucose tolerance occurred in 5.0% of men and 8.4% of women. The prevalence of obesity was significantly greater in women than in men (37.4% versus 12%, respectively, were equal to or greater than 140% ideal weight). Subjects with diabetes tended to be more obese and less active than normal subjects, but these differences, although appreciable, were not usually statistically significant. The population engages in considerable physical activity, and this, along with the traditional diet, may be responsible for the relatively low diabetes prevalence.