bluuebunny/crossref_metadata_2025 huggingface dataset:
Need Stable Diabetics Mix their Insulins?
Authors: Roland J. M.
Published: July 2009

Ten insulin‐dependent diabetics taking twice‐daily mixtures of soluble and isophane insulin were studied in a double‐blind crossover trial to examine the effect on their glycaemic control of a fixed‐mixture preparation (containing either 50% soluble, 50% isophane or 30% soluble, 70% isophane) given in the same total dose as each patient's usual mixture. The mean (± S.E.M.) of eight daily blood glucose determinations when the patients' usual mixtures were pre‐mixed by the hospital pharmacy was 7.6±0.7 mmol/I, 7.8±0.8 mmol/I when the fixed‐mixture preparation was used and 8.0± 0.5 mmol/I when the patients drew up and mixed the insulins themselves. Individual glucose profiles on each of the three regimens expressed as mean modified log ‘M’ indices were 1.2 ± 0.14, 1.29 ± 0.16 and 1.37 ± 0.14, respectively. Thus, the patients studied were as well controlled on a fixed‐mixture preparation as on their usual ‘tailormade’ insulin regimens.
Growth Hormone Response to Hyperinsulinaemia in Insulin‐dependent Diabetics Comparison of Patients With and Without Retinopathy
Authors: Sharp P. S. , Foley K. , Vitelli F. , Maneschi F. , Kohner E. M.
Published: July 2009

Growth hormone levels were measured in glucose clamp studies on 13 insulin‐dependent diabetic patients with retinopathy and 9 age, sex, and weight matched patients without retinopathy. Four non‐diabetic subjects were used as controls. The glucose was kept constant at 12 ± 0.85 mmol/I (mean±S.D.) in the diabetic groups, and at 6 mmol/I in the non‐diabetic controls. Insulin was infused at sequential rates of 0.3, 1.0, and 10 mU/kg/min. Basal levels of growth hormone were not significantly different in those with and without retinopathy (5.7 ± 4.9, 9.4± 10.6 mU/I p = 0.21). Growth hormone levels were compared in each group during a 60 minute steady state period for each insulin infusion rate. At all 3 infusion rates, the diabetics with retinopathy produced a rise in growth hormone, while the non‐diabetics did not (1.24 ± 0.6 mU/I). The patients with retinopathy produced more growth hormone than those without at each infusion rate (12.2 ± 11.5 vs. 2.8 ± 5.1, p = 0.03; 10.6±11.1 vs. 1.6±1.7, p = 0.02; 19.7±20.6 vs. 4.2 ± 4.8, p = 0.03). These data confirm that insulin alone can stimulate growth hormone secretion in insulin‐dependent diabetics with retinopathy. Evidence is provided indicating that patients with retinopathy produce more growth hormone than those without.
Diabetes Outward Bound Mountain Course, Eskdale, Cumbria
Authors: Hillson Rowan M.
Published: July 2009

Following a successful first British Diabetic Association/Outward Bound Mountain Course in 1981, biannual courses were established for insulin‐treated diabetic patients. These mentally and physically demanding courses are intended to encourage young diabetic patients to take active exercise whilst learning how to manage their diabetes under varied conditions. Careful medical supervision and expert instruction with minute attention to safety and constant alertness for hypoglycaemia is essential. This paper details the experience gained during the first three courses.
A Fifteen‐month Double‐blind Cross‐over Study of the Efficacy and Antigenicity of Human and Pork Insulins
Authors: Home P. D. , Mann N. P. , Hutchison A. S. , Park R. , Walford S. , Murphy Moira , Reeves W. G.
Published: July 2009

The antigenicity and efficacy of semi‐synthetic human and pancreatic pork insulins have been compared in a double‐blind double cross‐over study in 96 insulin‐treated diabetic patients. Transfer from pork to human insulin was associated with a 1.2 ±0.5 mmol/l deterioration (p<0.05) in the fasting blood glucose level, while the opposite change caused a 1.1 ±0.5 mmol/l improvement (p<0.05). After 4 months treatment, glycosylated haemoglobin levels were lower on pork (11.1±0.3%) than on human (11.7 ±0.3% p<0.01) insulin. The incidence of hypoglycaemia was similar with the two insulins. IgG insulin antibody levels were identical after human insulin treatment (5.7 ±0.4 μg/l) compared to pork insulin treatment (5.9 ±0.5 μg/l). Patients with high levels of antibodies (>10 μg/l) showed a similar reduction in level when switched to either species of highly purified insulin. The deterioration in fasting blood glucose control is consistent with similar reports for biosynthetic human insulin and suggests, in the absence of changes in insulin antibody levels, a small but clinically significant pharmacokinetic difference between human and pork insulin.
Continuous Intraperitoneal Insulin Infusion in the Management of Severely Brittle Diabetes—A Metabolic and Clinical Comparison with Intravenous Infusion
Authors: Husband D. J. , Marshall S. M. , Walford S. , Hanning I. , Wright P. D. , Alberti K. G. M. M.
Published: July 2009

We report a comparison of continuous intraperitoneal insulin infusion (CIPII) and continuous intravenous insulin infusion (CIVII) in 6 diabetic patients in whom severe hyperglycaemia and ketoacidosis could not be prevented with subcutaneous or intramuscular insulin. In the short term both methods were equally effective in maintaining glycaemic control. Blood glucose, glycerol, and 3‐hydroxybutyrate levels were normal but lactate and pyruvate levels remained elevated with both treatments. Insulin requirements were significantly lower on CIPII than CIVII (70 vs 113 U/day, p<0.01). Intraperitoneal insulin delivery was associated with near physiological peripheral plasma insulin profiles in 3 patients. In the longer term CIVII was associated with frequent septicaemia and thrombosis, and was successful in preventing hospitalization for 6 months or more in only one patient. Despite technical problems with CIPII complications were less serious and hospital admission due to metabolic decompensation was prevented for 6 months or more in 3 patients. When subcutaneous insulin delivery is unsuccessful in the management of brittle diabetes, CIPII should be considered rather than CIVII because it is more likely to be successful and less likely to cause serious complications.
Newly Diagnosed, Insulin‐dependent Diabetes Mellitus in Elderly Patients
Authors: Kilvert A. , FitzGerald M. G. , Wright A. D. , Nattrass M.
Published: July 2009

Over a two‐year period 398 out of 1776 new referrals to a diabetic clinic were newly diagnosed diabetic patients aged 65 years and over. Initial treatment of this group was diet—122 (31%), diet plus oral hypoglycaemic agents—232 (58%) and diet plus insulin—41 (10%).

Sixteen (39%) of the group treated initially with insulin died within 3.5 years of diagnosis compared with 21% of the 345 patients treated with diet ±oral hypoglycaemic agents who were followed for this time. Twenty‐five patients treated initially with insulin survive but 8 have stopped insulin and are treated with diet ±oral hypoglycaemic agents, and a further 5 had a period of 6–24 months on oral therapy. Twelve patients have been treated with insulin continuously but of these only 3 are clearly insulin‐dependent. These data suggest that true dependence on insulin is uncommon in patients aged 65 years or over at diagnosis.
Pancreatic Cancer and Diabetes Mellitus
Authors: Morris D. V. , Nabarro J. D. N.
Published: July 2009

In a series of 6,500 patients with diabetes mellitus there were 37 cases of primary carcinoma of the pancreas which significantly exceeded the expected number for the patient years at risk in both males and females (p<0.01). There was no evidence that pancreatic cancer was more common in patients with long‐standing diabetes. The increased incidence of pancreatic cancer in diabetic patients is probably the result of patients presenting with the symptoms of diabetes as long as four years before the cancer becomes manifest. An underlying pancreatic tumour should be suspected when an elderly diabetic proves difficult to control and loses weight despite adequate treatment.
Evidence for a Central Abnormality in the Regulation of Growth Hormone Secretion in Insulin‐dependent Diabetes
Authors: Sharp P. S. , Foley K. , Kohner E. M.
Published: July 2009

To assess pituitary and hypothalamic function in diabetes, 100 μg growth hormone releasing factor 1–44 was administered to 10 normal subjects at fasting plasma glucose (5.2 ± 0.1 mmol/l, mean ± S.E.M.), 10 insulin‐dependent diabetics while euglycaemic (6.4 ± 0.3 mmol/l), and 10 while hyperglycaemic (13.1 ± 1.3 mmol/l). Six of the diabetics participated in both parts of the study. The normal subjects and euglycaemic diabetics produced similar peaks in growth hormone (118.2 ± 37.6 vs 105.2 ± 23.9 mU/l, p = 0.69). The peak growth hormone level was reached between 30 and 45 minutes in all the normal subjects, but varied between 15 and 75 minutes in the diabetics. While all normal subjects suppress their growth hormone response to releasing factor when hyperglycaemic, not all the diabetics did so, and the suppression did not reach statistical significance on comparison of euglycaemic and hyperglycaemic diabetics (105.2 ± 23.9 vs 64.7 ± 19.4 mU/l, p = 0.2). Comparison of results from those diabetics studied at both euglyaemia and hyperglycaemia again showed no significant difference (140.8 ± 30.9 vs 90.2 ± 27.7 mU/l, p = 0.22). These results suggest a central, possibly hypothalamic, abnormality to account for the disruption of growth hormone regulation in diabetes.
Pharmacokinetics of Human Insulin Zinc Suspension (Recombinant DNA) in Normal Man: A Comparison with Porcine Insulin Zinc Suspension
Authors: Frier B. M. , Sullivan F. M. , Mair Frances S. , Koch Isobel M. , Scotton Janet B.
Published: July 2009

A single dose crossover study in 10 fasting, non‐diabetic men compared the 24‐hour profiles of blood glucose, plasma insulin, and C‐peptide following a single subcutaneous injection of either human insulin zinc suspension crystalline (recombinant DNA), or highly purified porcine insulin zinc suspension (mixed), in a standard dose of 0.2 U/kg. Both insulins produced moderate hypoglycaemia within 3 hours which persisted for 24 hours after administration. The rate of fall of blood glucose was similar from 0–3 hours but was significantly lower after the porcine insulin at 4 and 7 hours (p< 0.05). Mean plasma insulin values were higher after porcine insulin between 2 and 6 hours (p< 0.05) and a biphasic pattern was observed following injection of both insulins. Plasma C‐peptide declined after each insulin was administered, and was significantly lower between 2 and 7 hours after porcine insulin.

The duration of the hypoglycaemic action of human crystalline insulin (recombinant DNA), assessed by blood glucose measurements and C‐peptide suppression, was equivalent to porcine insulin zinc suspension (mixed) (Monotard® MC, Novo) over 24 hours.
BM Strips: How Accurate are they in General Wards?
Authors: Hutchison A. S. , Shenkin A.
Published: July 2009

In order to test the accuracy of BM Test Glycemie 20–800 strips when used in general wards, simultaneous BM strip results were obtained for 183 emergency out‐of‐hours plasma glucose requests. The results were considered accurate if the value obtained by the Emergency Biochemistry Laboratory (using a Beckman II glucose analyser) was within one strip‐range on either side of the stated BM strip value. Fifty‐nine (32.2%) of the BM strip results were considered inaccurate by this definition, and in 22 of these inaccurate results the differences were large enough to have led to inappropriate management if this was based on the BM strip result alone.

The reasons for these inaccuracies are not clear, but it is suggested that improved training of ward staff and formal quality control schemes may help to improve results.
The Whitehall Study: Ten Year Follow‐up Report on Men With Impaired Glucose Tolerance With Reference to Worsening to Diabetes and Predictors of Death
Authors: Jarrett R. J. , Keen H. , McCartney P.
Published: July 2009

Two‐hundred and four men with a defined degree of impaired glucose tolerance derived from the Whitehall Survey and its pilot study were enrolled in a therapeutic trial and followed for ten years. For the first five years of the trial approximately half the group received 50 mg phenformin daily and the other half an identical placebo. For the whole ten years of the trial approximately half the group were recommended a diet in which carbohydrate intake was limited to 120 g/day, while the other half was recommended a qualitative limitation of sugar intake. 60 men (29.4%) worsened to diabetes during the follow‐up period. The major independent predictor of worsening was the baseline blood glucose level (glucose tolerance). High baseline plasma triglyceride levels and low baseline systolic blood pressure levels were also independent predictors of worsening, though of lower significance (0.01 <p<0.05). Obesity, measured as body mass index, was not a significant risk factor.

Thirty‐nine men died, with 19 deaths ascribed to coronary heart disease (CHD). Baseline blood pressure significantly predicted both all causes and CHD mortality. All causes mortality rates were higher in the less obese. Allocation to drug or diet therapy did not significantly affect mortality rates or the proportions worsening to diabetes.
Diagnostic Value of the Valsalva Ratio Reduction in Diabetic Autonomic Neuropathy: Use of an Age‐related Normal Range
Authors: Smith Shirley A.
Published: July 2009

A curvilinear age‐related normal range for the Valsalva ratio is presented. Application of this range was used to identify abnormalities in ratios obtained from 59 patients with diabetes mellitus aged 16–60 years. It was found that 35 had normal, 6 had borderline and 18 had abnormal results. Comparison with other autonomic function tests of the cardiovascular and pupillary systems showed that abnormalities of the Valsalva ratio correlated most highly with the sinus arrhythmia test results. Repeat measurements of ratios in healthy and diabetic subjects yielded coefficients of variation of 15.4% and 10.5% respectively.
Assay of Microalbuminuria using Gel Electroimmunoassay
Authors: Samuell C. T. , Walker B. J. , Smith R. F. , Dhar H. , Nelstrop G. A.
Published: July 2009

The possibility of using electroimmunoassay as a technique for assessing microalbuminuria in the diabetic population has been studied. The method was found to be precise (given inter‐batch coefficients of variation of 5.7% and 5.8% at levels of 16 mg/l and 23 mg/l respectively), showed adequate sensitivity, and produced results which correlated well (r = 0.971) with these obtained from a routine radioimmunoassay procedure. It is concluded that electroimmunoassay provides a reliable alternative to more sophisticated techniques in the non‐specialized laboratory dealing with only moderate numbers of specimens.
Diabetes Mellitus: Diagnostic Criteria
Authors: Teuscher A. , Jarrett R. J.
Published: July 2009

Recommendations of the European Diabetes Epidemiology Study Group (EDESG) concerning the Second Report of the WHO Expert Committee on Diabetes Mellitus (Technical Report Series 646 WHO Geneva 1980)
Computer Based Learning and Assessment for Diabetic Patients
Authors: Farrant Susan , Dowlatshahi Dawn , Ellwood‐Russell Magdeline , Wise P. H.
Published: July 2009

A comparatively inexpensive microcomputer‐based system of programmed diabetic instruction is described, matched to an interactive knowledge assessment questionnaire with or without prescriptive feedback. This provides an educational and assessment package for newly diagnosed and established diabetics, with additional analytical potential. The system is well accepted, demonstrates major areas of defective knowledge and allows cost‐effective handling of large numbers of patients.
Hospital Admissions of Diabetic Patients: Information from Hospital Activity Analysis
Authors: Williams D. R. R.
Published: July 2009

Hospital admissions data for 1981 reveal that, for the population of East Anglia, 1.6% of hospital bed days were attributed to diabetes mellitus as the principal cause for admission. Admissions for diabetes without complications or with ketoacidosis or other coma accounted for about 60% of bed days while the other specified complications of diabetes accounted for the remainder. Admissions with diabetes as a subsidiary diagnosis accounted for 2.6 times as many bed days as those for which the disease was the principal diagnosis. Ischaemic heart disease or cerebrovascular disease was recorded as principal diagnosis significantly more often than would be expected from the general population experience, particularly for female diabetics. On an average day, 5.6% of beds were occupied by diabetic patients. The diabetic population of East Anglia used, on average, 5.1 hospital bed days per person year compared with 1.1 days for the non‐diabetic population.
A Practical Guide to Basal and Prandial Insulin Therapy
Authors: Holman R. R. , Turner R. C.
Published: July 2009

Separating basal and meal‐related insulin requirements allows a systematic approach to subcutaneous insulin therapy. Simple guidelines for both the doctor and patient can cater for the spectrum of severity of diabetes. A non‐insulin‐dependent diabetic who, despite dieting, continues to have moderate fasting hyperglycaemia (6–10 mmol/l) may need only a basal insulin supplement, whereas a totally insulin‐dependent diabetic usually needs similar amounts of basal and meal‐related insulin. The likely insulin requirements of individual diabetics can be predicted, including the increased amounts required by obese patients. The algorithms have been developed using ultralente to provide the basal insulin requirement, but the principles and doses probably apply to other similarly long‐acting insulins or an insulin pump. The insulin doses can be easily altered for varying lifestyles, including night work, religious fasts or long distance aeroplane travel, and for temporary disturbances such as operations or intercurrent infections.
Diabetic Ketoacidosis due to Insulin Resistance Treated by Haemodialysis
Authors: Sheldon J. , Hollis P. R. , Trafford J. A. P. , Cook J. G. H.
Published: July 2009

A 14‐year‐old female patient with insulin resistance is reported in whom it appeared that initially insulin breakdown was unusually rapid. Subsequently there was in addition evidence of reduced insulin sensitivity. The rapidly increasing requirement of insulin (1600 units daily), given by continuous IV infusion, was dramatically reduced by haemodialysis, and was maintained subsequently. We suggest that insulin aggregates which may have blocked insulin receptor sites, causing insulin resistance, were removed by haemodialysis.
MEDIA REVIEW
Authors: Gale Edwin
Published: July 2009

Book reviewed in this article:

Review of the Freebies

Pancreatic Pathology Günter Klöppel and Phillipp U. Heitz (Eds).
Are the WHO Criteria for Hypertension Appropriate in Young Insulin‐dependent Diabetics?
Authors: Drury Paul L. , Tarn Anne C.
Published: July 2009

The WHO Criteria for Hypertension

Normal adult blood pressure is arbitrarily defined as a systolic pressure equal to or below 140 mmHg together with a diastolic (5th phase) equal to or below 90 mmHg.

Hypertension in adults is arbitrarily defined as a systolic pressure equal to or greater than 160 mmHg and/or diastolic (5th phase) equal to or greater than 95 mmHg.

The term ‘borderline hypertension’ is used to denote blood pressure values between the normal and the hypertensive ranges as described above.

The blood pressure levels at which hypertension can be defined for children vary with age, but precise levels are under review. Clearly values that would be regarded as hypertensive are lower in children than in adults.
The Course of Incipient Diabetic Nephropathy: Studies of albumin excretion and blood pressure
Authors: Christensen C. K. , Mogensen C. E.
Published: July 2009

With the aim of defining the transitional phase from normal or near normal albumin excretion to overt diabetic nephropathy, 23 male diabetics of more than 7 years' duration, below 40 years of age and a baseline urinary albumin excretion above 15 μg/ min but without clinical proteinuria (incipient diabetic nephropathy) were studied. For comparison 18 normals, 23 diabetics with normal albumin excretion and 10 patients with overt nephropathy were also examined. Diastolic blood pressure (DBP) was elevated to 88±9mmHg (mean±S.D.) compared to patients with normal urinary albumin excretion: 80±7 (S.D.) (2p=0.13%) but was below pressures in patients with overt diabetic nephropathy 109±15 (2p = 0.002%). Glomerular filtration rate (GFR) was elevated to 142±21 ml/min (mean±S.D.) compared to 132±9 in patients with normal urinary albumin excretion (2p=4.3%). Renal plasma flow (RPF) was not altered. Renal vascular resistance (RVR) was increased (0.200±0.035) compared to that of patients with normal urinary albumin excretion (0.180±0.025) (2p = 3.8%).

In a longitudinal study of 10 of the patients with incipient nephropathy, followed for 4.9 (Mean) years, urinary albumin excretion increased significantly during the observation period, the yearly increase rate being 19±22% (mean±S.D.). DBP increased from 84±9 to 93±13 (2p = 3.8%) in 6 patients followed for more than 4 years. A significant correlation was observed between DBP and the yearly percentage increase rate in urinary albumin excretion (r = 0.77, 2p = 0.9%) and between RVR and the yearly percentage increase rate in urinary albumin excretion (r = 0.80, 2p = 0.8%). Thus incipient diabetic nephropathy is associated with high GFR and with elevated blood pressure both of which may accelerate further renal damage.
Association of Glucose‐6‐Phosphate Dehydrogenase Deficiency with Diabetes Mellitus
Authors: Saeed Th. Kh. , Hamamy H. A. , Alwan A. A. S.
Published: July 2009

The prevalence of glucose‐6‐phosphate dehydrogenase (G6PD) deficiency was estimated in 318 diabetic patients using Beulter's fluorescent Spot test. A significantly (p<0.001) higher prevalence of G6PD deficiency was detected among diabetic patients (19.6%) as compared to controls (10.4%). The distribution of G6PD deficiency varied with age, sex, and duration of diabetes. Among diabetic men, the prevalence of deficiency was significantly higher than controls in both age groups; 40 years and below, and 41 years and above (p<0.005 and p<0.02, respectively). Among diabetic women, the significantly higher prevalence of deficiency was observed only in the young age group (p < 0.005), whereas the difference among the older age group was not significant (p>0.1). A significant increase in the prevalence of deficiency with increase in duration of diabetes was detected among men (p<0.05), but not in women. The results of the study suggest a positive association between G6PD deficiency and diabetes mellitus.
Glycaemic Effects of Bread and Marmalade in Insulin‐dependent Diabetes
Authors: Lean M. E. J. , Tennison B. R. , Williams D. R. R.
Published: July 2009

The glycaemic responses of 12 C‐peptide negative insulin‐dependent diabetics were studied following four breakfasts with different carbohydrate sources. Total energy content of the meals was the usual for each subject, carbohydrate supplying 55% and fat 32%. The meals comprised: wholemeal bread with margarine; white bread with margarine; marmalade made with sucrose, and cheddar cheese; and marmalade (22% of total energy) on wholemeal bread with margarine.

The study demonstrated powerfully that there were no statistically significant or clinically relevant differences between the meals in post‐prandial glucose peak elevation, or in incremental area under the blood glucose curve to 120 mins. On these grounds, sucrose, in amounts considered acceptable to the general population, need not be prohibited from diabetic diets.
Family Involvement and Metabolic Control of Childhood Diabetes
Authors: Standen P. J. , Hinde F. R. J. , Lee P. J.
Published: July 2009

To investigate the association between the family environment and metabolic control of childhood diabetes 20 diabetic children aged between 4 and 12 years with same‐sex healthy siblings and two cohabiting parents were selected. The parents were interviewed separately and completed questionnaires about their own and their spouse's involvement and shared activities with both children, diabetic management, and knowledge of and attitudes towards diabetes. They also completed the Moos Family Environment Scale (FES) which yields ten sub‐scales relating to different aspects of family functioning as did 20 sets of parents with age‐ and sex‐matched healthy children, who also completed questionnaires concerning their involvement and shared activities with their children. There were no differences between the families of diabetics and of controls in the extent to which either parent was involved with their children or in the attention each child received. Fathers of diabetic children differed from controls in their use of punishment and diabetic families were less achievement oriented. The degree of metabolic control (HbA, assessment at three‐monthly intervals) was related to parental involvement with the non‐diabetic child and to some aspects of the FES including parental incongruence.

These differences in family functioning suggest useful directions for possible intervention programmes.
Insulin Dependence: Problems with the Classification of 100 Consecutive Patients
Authors: Wilson R. M. , Van der Minne P. , Deverill I. , Heller S. R. , Gelsthorpe K. , Reeves W. G. , Tattersall R. B.
Published: July 2009

We have evaluated the clinical and immunogenetic features of 100 consecutive patients presenting to an adult diabetic clinic who were judged clinically to need insulin therapy but were not sufficiently ill to be admitted to hospital. Over this same period 15 newly diagnosed patients (aged 13–70 years) were started on insulin as in‐patients of whom ten were in ketoacidosis. The 100 out‐patients, aged 11–75 years at the time of starting insulin, were followed for at least a year. Fifty‐six had islet cell antibodies and/or were heterozygous for HLA DR3 and DR4 (Group A) whereas 44 had neither of these markers (Group B). Islet cell antibodies and/or DR3, DR4 heterozygosity were most common in the 70 patients diagnosed below the age of 40 years but were also found in older patients. Patients in Group A were significantly younger at diagnosis (29 vs. 43 years), had a shorter duration of symptoms (17 vs. 61 weeks), were more likely to have ketonuria, and had a lower random C‐peptide level at diagnosis (0.2 vs. 0.31 nmol/l). The two groups could not be distinguished by weight, haemogloblin A1 or blood glucose at diagnosis or by diabetic control or insulin dose after one year.

The National Diabetes Data Group (NDDG) definition of insulin dependence stresses the importance of HLA types and islet cell antibodies although we found their prevalence to be low in the 30 patients diagnosed over 40 years who clinically were indistinguishable from the younger patients. The NDDG definition is based on extrapolation from the features of diabetes in children and adolescents and is too restrictive for use over the whole range of newly presenting insulin‐requiring diabetes.
The Effect of Mixing Human Soluble and Human Crystalline Zinc‐suspension Insulin: Plasma Insulin and Blood Glucose Profiles after Subcutaneous Injection
Authors: Francis A. J. , Hanning I. , Alberti K. G. M. M.
Published: July 2009

The effect of mixing human soluble insulin with two newly developed formulations of human crystalline zinc‐suspension insulin was studied in two groups of 8 normal and 6 diabetic subjects. Mixing Human Actrapid with Human Ultratard and Humulin‐S with Humulin‐Zn, for 60s before subcutaneous injection, significantly blunted the rise in free insulin levels (p<0.05) and the onset of action of the short‐acting insulins (p<0.01). The loss of solubility that occurs on mixing these insulins, with the consequent loss of the rapid acting component, may diminish their therapeutic usefulness in the control of post‐prandial blood glucose.
Comparison of Oral Glucose Loading and Intravenous Glucagon Injection as Stimuli to C‐peptide Secretion in Normal Men
Authors: Small M. , Cohen H. N. , Beastall G. H. , MacCuish A. C.
Published: July 2009

In 10 healthy men, we have compared the respective effects of an intravenous injection of glucagon (1 mg) and an oral glucose load (75 G) in eliciting the release of C‐peptide and insulin from the pancreas. Serum C‐peptide and insulin concentrations increased respectively to median values of 190% and 500% at 6 minutes after glucagon injection, and to 344% and 794% at 30 minutes and 268% and 278% at 60 minutes following glucose ingestion. The oral glucose load was as effective as glucagon injection in testing beta cell function and was free from the unpleasant side effects (nausea, vomiting, syncope) commonly associated with glucagon. We conclude that oral glucose loading is probably the test of choice to elicit C‐peptide release when screening populations of normal subjects for adequacy of beta cell function.
Adverse Effect of Smoking on the Hyperaemic Response in Diabetic Patients and Control Subjects
Authors: Harrower A. D. B. , Duncan G. , Ward A. , Railton R. , Newman P.
Published: July 2009

In order to determine whether smoking had an adverse effect on the hyperaemic response, as measured by transcutaneous oximetry, matched groups of insulin‐dependent diabetic smokers and non‐smokers were compared both with each other and with similar matched groups of non‐diabetic control subjects. The hyperaemic response was also measured immediately, 1 hour and 24 hours after smoking a cigarette in five control subjects who smoked. The hyperaemic response was significantly lower in the diabetic smokers compared with the diabetic non‐smokers (p = 0.008) and in the control smokers compared with the control non‐smokers (p = 0.011). No other significant differences were found. In the five subjects studied at intervals after smoking the responses were variable and inconsistent. Smoking modifies the hyperaemic response and this must be taken into account in any investigation using such measurements.
Glycosylation of Maternal Hair and Cord Skin During Pregnancy in Diabetic and Non‐diabetic Women
Authors: Paisey R. B. , Lewin I. G. , Hopton M. , Frappel J. , Roland J. , Turner G.
Published: July 2009

A study of 15 insulin‐dependent diabetics (IDD), 4 gestational diabetics (GDM), and 21 non‐diabetic women was undertaken to assess non‐enzymatic glycosylation in maternal hair, cord skin, and cord blood. Glycosylation of maternal hair was stable from tip to root in controls. In the IDD group, levels were highest at the tip, but were significantly lower in the middle and scalp segment, (p<0.01), both tip and middle segments were higher than control values (p<0.01). In contrast, only the scalp segment of hair from the GDM group had a higher than normal level of glycosylation (p<0.01). Cord skin and cord blood glycosylation were significantly increased in the IDD group compared with normal (0.100±0.002 vs 0.074±0.008 μmol fructosamine/100 mg, p<0.01, and 0.160±0.002 vs 0.14±0.008, p<0.05, mean±S.E.M.), respectively. Only cord skin glycosylation was increased in the GDM group (0.116±0.003, p<0.01).

Thus near normal glycaemic control of maternal insulin‐dependent diabetes during pregnancy was associated with small but significant increases in cord skin glycosylation and a fall towards normal in maternal hair glycosylation which may provide a useful retrospective index of diabetic control.
Oesophageal Function in Diabetes Mellitus and its Association with Autonomic Neuropathy
Authors: Channer K. S. , Jackson P. C. , O'Brien I. , Corrall R. J. M. , Coles D. R. , Davies E. Rhys , Virjee J. P.
Published: July 2009

We have evaluated oesophageal function in 34 diabetics and in 16 non‐diabetic controls by a timed bolus transit method derived from dynamic oesophageal scintiscans (water transit time: WTT) and barium swallow. The diabetics were screened for autonomic neuropathy using standard cardiovascular responses and 10 patients were classified as abnormal. WTT was significantly prolonged in autonomic neuropaths compared with other diabetics (p<0.01) and controls (p<0.001). Abnormal peristalsis on barium swallow was seen more frequently in autonomic neuropaths (9/10) than in other diabetics (11/24, p<0.002). WTTs from all diabetic patients correlated with abnormal heart rate responses at rest (Rs = −0.49, p<0.005), on deep inspiration (Rs = −0.48, p<0.005), and on standing (Rs = − 0.39, p<0.025) but not with the Valsalva manoeuvre. A weaker correlation was found between the postural fall in blood pressure (Rs = 0.3, p<0.05).

Diabetics with autonomic neuropathy frequently have asymptomatic oesophageal dysfunction which may result from a vagal neuropathy in view of its association with abnormalities of vagally mediated cardiovascular responses.
Limited Finger Joint Mobility in Insulin‐dependent and Non‐insulin‐dependent Ethiopian Diabetics
Authors: Mengist M. , Abdulkadir J.
Published: July 2009

The prevalence of limited joint mobility (LJM) was studied in 110 insulin‐dependent (IDDM) and 190 non‐insulin‐dependent (NIDDM) consecutive Ethiopian African diabetics and 300 age‐ and sex‐matched controls at the Tikur Anbassa Teaching Hospital in Addis Ababa over a period of 18 months. Mean ages±S.D. of the IDDM, NIDDM, and controls were 35±9.9, 49.4±12.0, and 43.3±14.0 years, respectively. LJM was found in 44.5% of IDDM, 25.3% of NIDDM, and 6.7% of controls, being significantly commoner in IDDM than NIDDM (p<0.001) and in the diabetics than in controls (p< 0.001).

In IDDM those with LJM were significantly younger (p<0.05), had a higher prevalence of median fasting blood glucose (FBG) levels of 15 mmol/l and above (p<0.01), and retinopathy (p<0.05), but did not differ from those without LJM in duration of diabetes, or prevalence of neuropathy and nephropathy. In NIDDM those with LJM had a significantly longer duration of diabetes (p<0.005) and a higher prevalence of nephropathy (p<0.005), but did not differ from those without LJM in age at onset of diabetes, prevalence of neuropathy, and retinopathy or median FBG level.
ETHOPIA: Insulin Therapy: Problems in an African Country
Authors: Lester F. T.
Published: July 2009

Major problems of metabolic control are encountered in the 40% of Ethiopian diabetic patients who require insulin. Important contributory factors include the cost of insulin, its erratic supply, and difficulties with handling syringes and obtaining sterility. Economic and social factors also aggravate poor dietary control, a situation exacerbated by religious customs. Geographical and manpower problems contribute to the problem through unsatisfactory follow‐up arrangements.
Systolic Time Intervals in Adolescents with Insulin‐dependent Diabetes Mellitus
Authors: Northcote R. J. , Semple C. , Kesson C. M. , Ballantyne D.
Published: July 2009

Systolic time intervals were used to evaluate left ventricular performance in 20 diabetic adolescents with a mean age of 15.2 ± 2.2 years (range 9–17 years) and were compared with an age‐ and sex‐matched control group. Pre‐ejection period index (PEPI), left ventricular ejection time index (LVET±l), total electromechanical systole index (QS2I) and the PEP to LVET ratio were calculated at rest and following sustained isometric handgrip (SIHG). None of the diabetics had demonstrable microangiopathy or autonomic neuropathy. There was no significant difference in resting or post‐exercise heart rate, PEPI, LVETI or PEP/LVET ratio between the two groups. QS2I was significantly prolonged (p<0.05) at rest in the diabetics, but was not significantly different following SIHG.

These results indicate that cardiac contractility is not detectably abnormal in young diabetics, compared to their adult counterparts who may develop impaired myocardial performance.
Comparison of Serum Fructosamine with Glycosylated Serum Protein (Determined by Affinity Chromatography) for the Assessment of Diabetic Control
Authors: Lloyd D. R. , Nott M. , Marples J.
Published: July 2009

Glycosylated total protein (GTP) and glycosylated albumin (GALb) were measured in serum using aminophenylboronic acid affinity chromatography and the results were compared with those found using the fructosamine assay. The percentage GTP and GALb found by affinity chromatography correlated well with fructosamine values in the sera of a group of non‐diabetic and diabetic patients (fructosamine vs GTP, r = 0.91, p<0.001; fructosamine vs GALb, r = 0.91, p<0.001). Results of each method gave similar correlations when compared with the degree of diabetic control assessed by glycosylated haemoglobin (GHb) and fasting plasma glucose (FPG) (fructosamine vs FPG, r = 0.74, p<0.001; GTP vs FPG, r = 0.75, p<0.001; GALb vs FPG, r = 0.79, p<0.001; fructosamine vs GHb, r = 0.79, p<0.001; GTP vs GHb, r = 0.81, p<0.001; GALb vs GHb, r = 0.84, p<0.001). Both methods could equally discriminate between groups of non‐diabetics and diabetic patients (p<0.001) and showed similar temporal changes after starting insulin therapy.
Home Blood Glucose Monitoring in Non‐insulin‐dependent Diabetics: The Effect of Gliclazide on Blood Glucose and Weight Control, a Multicentre Trial
Authors: Shaw K. M. , Wheeley M. St. G. , Campbell D. B. , Ward J. D.
Published: July 2009

The efficacy of the sulphonylurea gliclazide was assessed in 229 non‐insulin‐dependent diabetics attending U.K. outpatient diabetic clinics. Patients inadequately controlled by diet alone or oral hypoglycaemic agents used reflectance meters to monitor their blood glucose. After a 4‐week run‐in, in those whose control remained unsatisfactory, gliclazide was either added to diet, or given in place of existing drugs. Patients continued home‐monitoring and were followed for 3 months. Gliclazide reduced mean random blood glucose in all groups, particularly those previously treated by diet alone or a first‐generation sulphonylurea. The patients improved in their ability to measure glucose at home and within 2 months a good correlation with laboratory measurements was found. Mean body weight was reduced, particularly in obese and elderly subjects and those treated previously with sulphonylurea drugs. Side effects were mild and only two patients were withdrawn for this reason.
Reversal of Insulin Resistance in Type 1 Diabetes following Initiation of Insulin Treatment
Authors: Gray R. S. , Cowan P. , Duncan L. J. P. , Clarke B. F.
Published: July 2009

The biological action and pharmacokinetics of insulin were assessed in nine type 1 (insulin‐dependent) diabetic patients before and after 3 months conventional insulin treatment, and in seven age and weight‐matched non‐diabetic controls, by means of the euglycaemic insulin clamp technique. The mean (± S.E.) metabolic clearance rate of insulin, when infused at 1 mU/kg/min, was similar in untreated and treated diabetic patients and in controls (22.7 ± 2.0, 19.3 ± 3.8, and 22.9 ± 3.3 ml/kg/min) but, when infused at 6 mU/kg/min, was greater (p<0.01 and <0.01) in untreated patients (18.0 ± 2.5 ml/kg/min) than in treated patients (11.5 ± 1.4 ml/kg/min) and controls (12.7 ± 1.3 ml/kg/min). Insulin‐mediated glucose disposal was reduced (p<0.01 and <0.01) at insulin infusion rates 1 and 6 mU/kg/min in untreated patients (18.5 ± 1.9 and 33.8 ± 4.5 μmol/kg/min) when compared with controls (35.8 ± 3.4 and 62.0 ± 4.7 μmol/kg/min) and was improved (p<0.01 and <0.01) following insulin treatment (36.1 ± 4.6 and 64.8 ± 4.2 μmol/kg/min). Daily insulin requirement fell by 33% following 3 months insulin treatment with improvement in mean HbA, from 16.3 ± 0.7 to 8.2 ± 0.4%, but without significant increase in endogenous insulin secretion. The ‘honeymoon phenomenon’, which has traditionally been attributed exclusively to resurrection of endogenous insulin release, may also be related to normalization of insulin action following institution of insulin treatment.
The Effect of Six Months Continuous Subcutaneous Insulin Infusion on Kidney Function and Size in Insulin‐dependent Diabetics
Authors: Christensen C. K. , Christiansen J. Sandahl , Christensen T. , Hermansen K. , Mogensen C. E.
Published: July 2009

Glomerular filtration rate (GFR), renal plasma flow (RPF), kidney volume, and urinary albumin excretion rate were measured in 24 insulin‐dependent diabetics, aged 29 ± 7 years (mean ± S.D.) of 8 ± 4 years duration, randomly allocated to either continous subcutaneous insulin infusion (CSII) (n = 12) or unchanged conventional insulin treatment (CIT) (n = 12). Glomerular filtration rate, renal plasma flow, and kidney volume were identical in the two groups at the start of the study, although significantly increased above normal values. During the 6 months CSII treatment a reduction of the GFR from 145 ± 21 to 132 ± 14 ml/min (2p = 2.4%) was seen, no change was observed in the CIT group while in both groups RPF and kidney volume remained unchanged. Urinary albumin excretion rate was normal or near normal in both groups and remained unchanged. Thus improved glycaemic control in insulin‐dependent diabetics studied before the onset of microalbuminuria is associated with improved (reduced) GFR. Nephromegaly does not improve with 6 months CSII treatment. Whether it would improve with more prolonged treatment is uncertain.
A Simple Diagnostic Test for Pupillary Abnormality in Diabetic Autonomic Neuropathy
Authors: Smith Shirley A. , Dewhirst Richard R.
Published: July 2009

A simple portable pupillometer using Polaroid photography has been developed for use in the diagnosis of diabetic autonomic neuropathy. The pupil diameter per cent (PD%), defined as the percentage of iris diameter to which pupil diameter had dilated in darkness, was measured from the instant colour prints. An age‐related normal range was constructed from measurements in 163 healthy subjects in whom PD% declined linearly by 3% per decade. The PD% was measured in 15 patients with automatic neuropathy and 12 were identified with abnormally low values indicating a failure of sympathetically mediated dilatation. Results were consistent with the standard television pupillometric technique and had the same high repeatability with a coefficient of variation of 3.2%.
The Effect of Residual Beta‐cell Function on the Development of Diabetic Retinopathy
Authors: Madsbad S. , Lauritzen E. , Faber O. K. , Binder C.
Published: July 2009

The effect of residual B‐cell function on retinopathy was evaluated in a cross‐sectional study of 533 insulin‐dependent diabetic patients (disease duration 0 to 45 years).

One hundred and fifty‐three patients with residual B‐cell function, as evaluated by stimulated plasma C‐peptide concentration, had lower prevalence of retinopathy than patients without B‐cell function. The patients with B‐cell function had a shorter duration of diabetes and were older at onset, but there was no difference in age at the time of the study.

When patients with similar duration of diabetes were compared, no differences in the degrees of retinopathy could be demonstrated between patients with and without B‐cell function.

These results indicate that residual B‐cell function does not protect against or delay the development of diabetic microvascular lesions.
Platelet Aggregation in Non‐insulin‐dependent Diabetes is Associated with Platelet Fatty Acids
Authors: Jones D. B. , Haitas B. , Bown E. G. , Carter R. D. , Barker K. , Jelfs R. , Turner R. C. , Mann J. I. , Prescott R. J.
Published: July 2009

Platelet aggregation was measured in 15 patients having non‐insulin‐dependent diabetes mellitus (NIDDM) at the time of diagnosis and after three months of dietary treatment. Mean fasting plasma glucose fell from 13.0 to 8.8 mmol/l (p<0.0002), glycosylated haemoglobin fell from a mean of 11.3% to 9.0% (p<0.005) and insulin levels fell from a mean of 17.5 to 13.8 mU/l (p<0.005). Platelet aggregation showed a variable response and did not correlate with plasma glucose, glycosylated haemoglobin or plasma insulin. Multiple linear regression analysis was carried out on the aggregation values against the biochemical variables and platelet phospholipid fatty acid levels following logarithm transformation. Platelet linolenic acid and eicosapentaenoic acid levels were significantly inversely associated with aggregation but the difference between the relationship at diagnosis and after three months was not statistically significant. The association between platelet w3 fatty acids and platelet aggregation suggest that dietary change aimed at increasing the proportions of these fatty acids might favourably influence vascular disease in NIDDM via an effect on platelet function.
Autonomic Neuropathy and Diabetic Foot Ulceration
Authors: Edmonds M. E. , Nicolaides K. H. , Watkins P. J.
Published: July 2009

Autonomic function was studied in three groups of insulin‐dependent diabetic patients. Heart rate changes during deep breathing and on standing were significantly less in 28 patients with a recent history of foot ulceration compared with 40 patients with peripheral neuropathy but without ulceration (p<0.001) and 54 patients without neuropathy (p<0.001). Sympathetic function was assessed in 36 of these patients from peripheral arterial diastolic flow patterns obtained by Doppler ultrasound measurements and expressed as the pulsatility index (PI). Patients with a history of ulceration (n = 10) showed considerably increased diastolic flow (Pl = 4.28 ± 0.53, mean ± S.E.M.) compared with 12 neuropathic patients with no history of ulceration (Pl = 7.80 ± 0.68, p<0.002) and 14 patients without neuropathy (Pl = 9.55 ± 0.89, p<0.002). Severely abnormal autonomic function occurs in association with neuropathic foot ulceration, but patients without ulcers have lesser degrees of autonomic neuropathy, thus a causal relationship has not been established.
Acceptability of High‐fibre Diets in Diabetic Patients
Authors: Geekie M. A. , Porteous J. , Hockaday T. D. R. , Mann J. I.
Published: July 2009

Twenty‐five diabetic patients were selected from Oxford Diabetic Clinics to assess their dietary compliance (Group A). All had been taught to follow diets rich in dietary fibre in which carbohydrate provided 50% of total energy. The results were compared with those obtained previously from a similar group of patients (Group B) all of whom had been instructed to follow a diet in which carbohydrate provided 40% of total energy. The patients of Group A had a significantly greater intake of carbohydrate (45.1% vs 34.7% of total energy) and dietary fibre (33.1 g vs 18.7 g) and a lower intake of fat (33.5% vs 42.1% of total energy) than the patients of Group B. The results of dietary assessment obtained from a third group of patients (Group C), who had been advised to follow a high‐fibre diet before the widespread availability of dietary teaching aids and recipe books, showed that carbohydrate and fat provided 37.5% and 41.0% of total energy, with a dietary fibre intake of 25.6 g. The results suggest that patients are willing and able to change their dietary habits towards a distribution of food constituents likely to improve diabetic control and reduce the risk of coronary heart disease when given enthusiastic instruction and support in diabetic clinics.