bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Relaxation on Glucose Tolerance in Non-insulin-dependent Diabetes
Authors: Surwit Richard S , Feinglos Mark N
Published: March 2007

Twelve patients with non-insulin-dependent diabetes mellitus were hospitalized on a clinical research ward under identical conditions. A 3-h glucose tolerance test and an intravenous insulin tolerance test were performed on each patient. Half of the patients werethen given 5 days of progressive relaxation training after which all patients were retested while treated patients practiced relaxation. Relaxation was found to significantly improve glucose tolerance without affecting insulin sensitivity or glucosestimulated insulinsecretory activity.
Serum Lipids and Lipoproteins in Insulin-dependent Diabetic Subjects During High-Carbohydrate, High-Fiber Diet
Authors: Taskinen Marja Riitta , Nikkilä Esko A , Ollus Anneli
Published: March 2007

The response of blood glucose and serum lipids and lipoproteins to a high-carbohydrate, high-fiber, low-fat diet was assessed in 10 insulin-dependent diabetic subjects. The diet contained approximately 60% of calories as carbohydrate (CHO) and 20% as fat. The patients were followed for 2 wk in a metabolic ward and subsequently for 4 wk at home without changing insulin dosage. During this 6-wk period, the fasting blood glucose fell from 10.6 ± 1.1 to 8.9 ± 1.3 mmol/L (NS); HbA1 fell from 11.7 ± 0.5 to 11.0 ± 0.7% (P < 0.05). Serum total triglyceride and very-low-density lipoprotein levels remained unchanged. After 2 wk in the ward on a high-CHO diet, total cholesterol fell by 15% (P < 0.01), LDL cholesterol by 16% (P < 0.001), and HDL cholesterol by 10% (P < 0.05). The fall of HDL cholesterol was due to a decrease of HDL3 cholesterol only. After the 4-wk home period on a high-CHO diet, the observed lipoprotein changes were reversed. Heparin-releasable adipose tissue LPL activity was not influenced by a high-CHO diet. In conclusion, a high-carbohydrate, high-fiber, low-fat diet did not deteriorate the diabetic control, and it had no unfavorable effects on serum lipids or lipoproteins.
Diets for Insulin Pump and Multiple Daily Injection Therapy
Authors: Grinvalsky Maryanne , Nathan David M
Published: March 2007

The role of diet in achieving and maintaining normalized blood glucose control in type I diabetic patients using insulin pumps or multiple daily injection (MDI) regimens is not well defined. We describe herein dietary guidelines that have proved effective in the management of such patients over 3 yr. The guidelines stress the importance of a careful dietary history, the regularity and consistency of diet during the preliminary adjustment period, the establishment of a variable insulin dosage schedule based on meal size and content as well as blood glucose, the appropriate treatment for hypoglycemia, and dietary adjustments for exercise. While insulin pump and MDI therapy may ultimately provide increased flexibility in certain aspects of dietary therapy, the diet must be carefully controlled if these innovative modes of insulin delivery are to succeed.
Self Glucose Monitoring: A Comparison of the GLucometer, Glucoscan, and Hypocount B
Authors: Nelson Jill D , Woelk Mary A , Sheps Sam
Published: March 2007

Three reflectance meters available in Canada for glucose self monitoring were assessed for accuracy and reliability in determining capillary blood glucose compared with venous serum glucose assayed by the laboratory hexokinase method and to capillary whole blood glucose determined by the glucose-oxidase method on a YSI (Yellow Springs Instrument, Yellow Springs, Ohio). The readings with all three meters correlated with serum glucose rather than with whole blood glucose. The Ames Glucometer (Ames Division, Miles Laboratories, Rexdale, Ontario, Canada) was found to have the best predictive value over the full range of serum glucoses from 30 to 399 mg/dl. The Lifescan Glucoscan (Lifescan Inc., Mountainview, California), although reading satisfactorily in the range 30–180 mg/dl, significantly underestimated the capillary glucose at values > 180 mg/dl. The Hypoguard Hypocount B (Hypoguard Ltd., Suffolk, England) on the other hand read consistently high in the range 30–99 mg/dl but read satisfactorily over the range 100–399 mg/dl. All three methods, however, had inherent limitations that must be taken into account in their clinical application.
Timolol Treatment After Myocardial Infarction in Diabetic Patients
Authors: Gundersen Torstein , Kjekshus John
Published: March 2007

In diabetic patients long-term treatment with timolol after myocardial infarction was related to a reduction in overall mortality, total cardiac death, sudden death, and nonfatal reinfarction, compared with patients in a placebo group. The analyses were based on 99 diabetic patients in the Norwegian timolol multicenter study. The dosage of timolol was 10 mg twice daily and the follow-up period was 12–33 mo (mean: 17 mo). When analyzing all randomized patients, there were 14 deaths in the placebo group and 6 deaths in the timolol group, a reduction of 62.8% (P < 0.05). The number of nonfatal reinfarctions was 10 in the placebo group and 2 in the timolol group, a reduction of 82.7% (P < 0.05). With regard to inclusion rate, side effects, withdrawals, and timolol-related reduction in mortality and reinfarction, the diabetic patients basically behaved like nondiabetic patients. The data were analyzed retrospectively and should be confirmed by a prospective study. The study also indicates that long-term treatment with timolol may induce slight carbohydrate intolerance.
The Importance of Intensive Supervision in Determining the Efficacy of Insulin Pump Therapy
Authors: Nathan David M
Published: March 2007

The role of intensive supervision in the success of insulin pump programs was examined in six type I diabetic subjects utilizing a crossover protocol. The highly motivated volunteers who had attained euglycemia during intensive supervision had a significant increase in plasma glucose and hemoglobin A1c concentrations during the period when supervision by the medical team and frequency of self blood glucose monitoring decreased. Intensive supervision is a critical feature in ensuring maximal efficacy of insulin pump therapy. The importance of such supervision may be even greater in less motivated and adherent patients.
Overnight Metabolic Control with Pulsed Intermittent Versus Continuous Subcutaneous Insulin Infusion
Authors: Levy-Marchal Claire , Albisser A Michael , Zinman Bernard
Published: March 2007

Subcutaneous insulin pumps deliver insulin both as a premeal bolus and as a continuous basal rate. It has been shown that the effect of the basal component is primarily to maintain normoglycemia overnight, but it is not known whether an intermittent pulsed infusion would achieve similar metabolic control. Six type I diabetic subjects (19–31 yr) were studied for 2 wk. Glycemic control was maintained by premeal injections of regular insulin with subcutaneous infusion overnight. A constant basal flow rate of insulin was delivered either continuously or intermittently as pulses spaced at 30-, 60-, and 120-min intervals. With each type of infusion, given in a randomized order, plasma glucose levels at 0600 h were: 81 ± 12, 89 ± 11, 102 ± 14, and 94 ± 13 mg/dl (mean ± SEM), respectively. These values are not significantly different and remained stable until 1000 h. In addition, the hormonal responses (immunoreactive glucagon and “free” insulin levels) and metabolite levels (lactate, pyruvate, 3-hydroxybutyrate, alanine, and glycerol) were the same with continuous and pulsed insulin. These findings are in keeping with the expected kinetics for subcutaneously injected insulin. They may be of considerable interest for the design of smaller and more efficient subcutaneous insulin infusion pumps and demonstrate the wide physiologic limits for subcutaneous basal insulin replacement.
The Effects of Blood Glucose Testing Versus Urine Sugar Testing on the Metabolic Control of Insulin-Dependent Diabetic Children
Authors: Carney Robert M , Schechter Kay , Homa Mari , Levandoski Lucy , White Neil , Santiago Julio
Published: March 2007

Glycosylated hemoglobin A1c was measured in 43 insulin-dependent diabetic children before and after training in blood glucose testing. These measurements were compared with those obtained from a group of matched controls who tested urine sugars for the same period. Mean HbA1c measurements for the blood glucose testing group were significantly improved at 6 mo after training in blood glucose testing, and were significantly lower than those measured in the urine sugar testing group. However, HbA1c levels in the blood glucose testing group were well above levels for nondiabetic persons, and were generally higher than those reported for adult insulin-dependent diabetic persons following training in blood glucose testing. Explanations for this difference were considered. It was noted that 81% of the trained children accepted and continued to use blood glucose testing for at least 9 mo after training.
Adolescent Diabetes Mellitus: Parent/Child Perspectives of the Effect of the Disease on Family and Social Interactions
Authors: Ahlfield Janet E , Soler Norman G , Marcus Spencer D
Published: March 2007

To investigate the perceived effects of adolescent diabetes mellitus on family and social interactions from the children's and parents' perspectives, 50 teenagers with diabetes were studied: 21 from a private practice and 29 from a diabetes camp. Children and parents answered separately a specially prepared questionnaire dealing with daily life situations; the adolescents also responded to the Firo B questionnaire. On corresponding questions agreement between the responses of children and parents varied from as high as 86% to as low as 30%. Questions referring to the effect of diabetes on scholastic performance, concentration, and social life were associated with poor agreement. No correlation was found between the measure of agreement between parents and children on various responses and glycosylated hemoglobin determinations. The adolescents' perspectives were clearly influenced by sex and age of onset of diabetes. Female compared with male adolescents perceived significantly less effect from diabetes on scholastic performance and concentration, and the age of onset of their diabetes affected the measure of agreement with parents. In their responses to the Firo B questionnaire female diabetic adolescents differed significantly from norms in 2 of the 6 subscales measured, unlike male adolescents, whose scores were similar to those of norm groups. Male diabetic adolescents felt the most effect from diabetes on social life, scholastic performance, and concentration when they had developed the disease between 9 and 12 yr of age. Although the parents of this subgroup of adolescents underestimated these feelings, in general, parents of male and female diabetic adolescents perceived more effect from diabetes than their children.
Meeting the Problems of First-Generation Insulin Infusion Pumps: Clinical Trial of a New Miniature Infuser
Authors: Bending Jeremy J , Pickup John C , Keen Harry , Rothwell Denis , Sutherland Ian A
Published: March 2007

We designed and constructed a new miniature, open-loop insulin infusion pump specifically to overcome the problems of many first generation insulin infusers. Special features are small size, adjustable volumetric basal infusion rate, rapid electronically mediated prandial insulin boosts, facility for doubling and halving the basal infusion rate and/or prandial delivery, and alarms for low battery state, motor over-run, stoppage, and control circuit malfunction. The infuser takes a specially designed syringe prefilled with short-acting insulin, sufficient in most diabetic patients for at least 7 days treatment with 100 U/ml insulin. To test clinical efficacy nine insulin-dependent diabetic patients received continuous subcutaneous insulin infusion (CSII) with the new infuser for periods up to 6 mo. Four patients previously CSII-treated with a first-generation pump and five who were new to CSII achieved and maintained the expected degree of near-normoglycemia. There were no pump breakdowns and a questionnaire completed by patients during the study confirmed ease and simplicity of operation and an appreciation of the advantages of the new pump compared with one widely used first-generation infuser.
A Multicenter Placebo-controlled Clinical Trial of Oral Metoclopramide in Diabetic Gastroparesis
Authors: McCallum Richard W , Ricci Dominick A , Rakatansky Herbert , Behar Jose , Rhodes James B , Salen Gerald , Deren Julius , Ippoliti Andrew , Olsen Harvey W , Falchuk Kenneth , Hersh Theodore
Published: March 2007

40 patients with diabetic gastroparesis. Results of a 3-wk double-blind study indicate that metoclopramide at a dosage of one 10-mg tablet four times daily reduced nausea, vomiting, fullness, and early satiety and improved meal tolerance better than placebo. Statistically significant differences were noted for nausea and postprandial fullness. Mean gastric emptying assessed by radionuclide scintigraphy was significantly improved in the metoclopramide-treated group when compared with their baseline result. Metoclopramide is an effective agent for improving the upper gastrointestinal motor function in diabetic patients with gastroparesis.
Adherence to IDDM Regimens: Relationship to Psychosocial Variables and Metabolic Control
Authors: Schafer Lorraine C , Glasgow Russell E , McCaul Kevin D , Dreher Mark
Published: March 2007

Thirty-four adolescents (ages 12–14 yr) with IDDM completed a questionnaire assessing regimen adherence over the previous week and psychosocial measures potentially related to adherence. Four aspects of the IDDM regimen were studied: insulin injections, dietary patterns, glucose testing, and exercise. Psychosocial variables included (1) Social Learning Theory measures of diabetes-specific family behaviors and barriers to adherence and (2) more general measures of family interaction. Glycosylated hemoglobin levels were predicted accurately (R = 0.68) from a combination of three adherence measures. The psychosocial measures were not directly related to metabolic control, but they were associated with adherence. Degree of adherence to one aspect of the IDDM regimen was not related to adherence to other aspects of the regimen and different psychosocial variables predicted adherence to different regimen components. The diabetes-specific measures were generally more predictive of adherence than were the more global measures. Implications and limitations of this cross-sectional, correlational study were discussed.
Assessment of a New Visual Test Strip for Blood Glucose Monitoring
Authors: Marshall S M , Alberti K G M M
Published: March 2007

We have compared the performance of the newly available blood glucose test strip, Visidex (Ames Division, Miles Laboratories Ltd., Stoke Poges, Slough, United Kingdom), designed for visual reading, with that of the already available BM-Test-Glycemie 20–800 [Boehringer Mannheim Corporation (London) Ltd., Lewes, East Sussex, United Kingdom]. The new test strip proved slightly less accurate over a wide range of blood glucose values and was less precise at normal and high glucose values. The color of the Visidex faded more rapidly on storage and errors in timing of the blood strip reaction caused greater inaccuracies. At present BM-Test-Glycemie 20–800 remains the visual glucose test strip of choice, although even with this strip there was a wide scatter of values when used by patients.
Carotid Artery Disease in NIDDM Diabetes
Authors: Chan Anthony , Beach Kirk W , Martin Donald C , Strandness D Eugene
Published: March 2007

A prospective study of 135 controls, 286 non-insulin-dependent diabetic patients, and 31 subjects with an elevated fasting plasma glucose was performed to assess the prevalence of high-grade carotid artery stenosis. The carotid artery evaluation was performed using an ultrasonic duplex scanner. When those patients with an elevated fasting plasma glucose and non-insulin-dependent diabetes were considered together, the prevalence was 8.2% as compared with 0.7% for the controls (P = 0.0007). Those risk factors found to be significantly related to the higher prevalence of carotid disease in the combined groups of patients included age, ratio of systolic blood pressure to diastolic blood pressure, plasma cholesterol, and cigarette smoking. These findings may be an explanation for the greater incidence of stroke in patients with diabetes mellitus.
Teledyne Sleep Sentry: Evaluation in Pediatric Patients for Detection of Nocturnal Hypoglycemia
Authors: Hansen Karla A , Duck Stephen C
Published: March 2007

Twenty-four insulin-dependent diabetic pediatric subjects were studied for 1444 nights for detection of nocturnal hypoglycemia with the Teledyne Sleep Sentry (Teledyne Avionics, Charlottesville, Virginia): a wristwatch-like unit that measures absolute changes in skin temperature and decreases in galvanic skin resistance, indicators of hypoglycemia. The device detected 42 of 46 recognized hypoglycemic episodes. One hundred fifty alarms were sounded without evidence of hypoglycemia, probably due to night sweating. Twenty-five percent of the subjects experienced unacceptable cutaneous reactions, presumably due to metallic iontophoresis.
Fournier's Syndrome in a Ketoacidotic Diabetic Patient After Intrascrotal Insulin Injections Because of Impotence
Authors: O'Dell Kevin , Shipp Joseph
Published: March 2007

Fournier's syndrome is a necrotizing fasciitis most commonly confined to the male genitalia with high morbidity and mortality rates. The salient features are (1) sudden explosive illness in the midst of apparent health; (2) rapid necrosis and sloughing of tissues of the scrotum and penis; (3) absence of an obvious cause; (4) a mixed bacteriologic picture; and (5) gangrene affecting the whole thickness of the scrotal skin, but not the underlying testes. With the propensity toward life-threatening infections in patients with diabetes, it is surprising that Fournier's syndrome is not more common in suboptimally treated diabetic patients. This report is to illustrate the recognition and treatment of Fournier's syndrome in a patient with diabetes. Also, it must be emphasized that the explosive course of the disease process begins with a benign-appearing, epididymitis-like picture. Prompt recognition followed by prompt surgical debridement and appropriate antibiotic therapy along with surgical wound closure is necessary to reduce morbidity and mortality. The present case is unusual for the following reasons: (1) necrosis of the testicles requiring orchiectomy; (2) extensive spread of gangrene beyond the genitalia; and (3) the route of infection, which appeared to be intrascrotal injections of insulin in a vain attempt to cure impotence.
An Approach to the Prevention of Blindness in Diabetes
Authors: Herman William H , Teutsch Steven M , Sepe Stephen J , Sinnock Pomeroy , Klein Ronald
Published: March 2007

Diabetic eye disease is the leading cause of new cases of legal blindness in American adults under the age of 65 yr. Diabetic persons are at risk for visual loss due to diabetic retinopathy, glaucoma, and cataracts. Better understanding of the natural histories of these complications and recent advances in treatment have provided a rationale for developing an approach to prevent visual loss. This approach requires that diabetic patients who are at high risk for visual loss, and not under the care of ophthalmologists, be systematically screened, referred, and treated.
Carbohydrate Metabolism in African Women with Twin Pregnancy
Authors: Moodley S P , Jialal I , Moodley J , Naicker R S , Marivate M
Published: March 2007

Carbohydrate metabolism was evaluated in 21 twin pregnancies and in 21 women with singleton pregnancies. The groups were matched for age, weight, parity, and period of gestation. A 100-g oral glucose tolerance test was performed on all 42 subjects. No significant differences in venous plasma glucose responses were found between singleton and twin pregnancies. The only significant difference between the insulin responses of the two groups was a lower plasma insulin concentration at 60 min in the twin group (P < 0.03).
Pathophysiology of Beta Cell Failure After Prolonged Remission of Insulin-dependent Diabetes Mellitus (IDDM)
Authors: Drucker Daniel , Zinman Bernard
Published: March 2007

The pathophysiology of beta cell failure in IDDM has not been well documented. Islet cell responsiveness (C-peptide and glucagon) to oral glucose (OGTT), intravenous glucose (IVGTT), and arginine infusion was studied sequentially in a 24-yr-old nonobese patient with IDDM in prolonged remission interrupted by an episode of diabetic ketoacidosis and followed by a second transient (6 mo) partial recovery of beta cell function. The earliest abnormality in glucose tolerance was demonstrated with the IVGTT (K = 0.77) although OGTT (F, 101: ½ h, 177; 7 h, 211; 1 ½ h, 144; and 2 h, 111 mg/dl) and glucagon responses to glucose and arginine were normal. With the development of abnormal OGTT, glucagon failed to suppress with hyperglycemia although basal levels were not elevated. With the development of frank clinical diabetes, C-peptide did not respond to oral or i.v. glucose although stimulation in response to arginine infusion was still possible. Basal glucagon concentrations were now elevated. Thus, the failing beta cell shows a progressive deterioration in its responsiveness to various secretagogues in a sequential manner (i.v. glucose followed by oral glucose and then i.v. arginine). Abnormalities in glucagon secretion can be demonstrated early in the development of abnormal oral glucose tolerance. With more precise elucidation of the etiology of diabetes, it may be possible to intervene therapeutically in diabetic individuals who experience a remission in order to prevent further deterioration in beta cell function.
Intensified Insulin Therapy in the Type I Diabetic Adolescent: A Controlled Trial
Authors: Schiffrin Alicia D , Desrosiers Micheline , Aleyassine Hassan , Belmonte Mimi M
Published: March 2007

The effects of continuous subcutaneous insulin infusion (CSII), intensified conventional therapy (ICT), and a combination of CSII and ICT (CSII-ICT) on metabolic control were compared in a group of twenty type I diabetic adolescents who had previously failed to respond to twice-daily injections and home glucose monitoring. A marked improvement in control was observed when mean glycemia and glycosylated hemoglobin A1 (HbA1) were compared with conventional therapy (CT). In the course of CSII, a lower HbA1 (P < 0.05) and mean capillary blood glucose (CBG) (P < 0.04) were observed than during ICT and CSII-ICT. Acceptability of CSII was greater that of ICT and CSII-ICT, with 50% of the patients opting for this therapy at the end of the 1-yr trial. The marked improvement of control observed under CSII for the group as a whole was maintained after 6 mo of completion of the study. Thus, it appears that in type I diabetic adolescents CSII is more effective and acceptable than ICT and CSII-ICT.
Recurrent Use of Disposable Syringe-Needle Units in Diabetic Children
Authors: Aziz Shahid
Published: March 2007

Fourteen insulin-dependent diabetic children reused their disposable syringe-needle units an average of 6.3 times per needle. Between uses, the needle was wiped with alcohol and stored in the refrigerator. There were no infections reported during the study for an average duration of 94 days. Dullness of the needle was the major reason for changing to a new one. Recurrent use of disposable needles for insulin injections appears safe in childrenand may be advised. It will help decrease some of the high cost of the daily care of a person with diabetes.
Changes in Blood Protein Glycosylation During a Diabetes Summer Camp
Authors: Strickland Alva L , McFarland Kay F , Murtiashaw Martha H , Thorpe Suzanne R , Baynes John W
Published: March 2007

To evaluate changes in glycemic control during a 2-wk diabetes summer camp program, fasting plasma glucose (FPG), glycosylated hemoglobin (GHb), and glycosylated serum protein (GSP) levels were measured in a group of 36 children at the beginning and end of camp. Average FPG and GHb were unchanged during the 2-wk period, but the average decrease in GSP (7%) was significant (P < 0.005). The results of this study indicate that a measurable improvement in diabetic control occurred in some children during the 2-wk summer camp program.
Insulin Pharmacokinetics
Authors: Binder Christian , Lauritzen Torsten , Faber Ole , Pramming Stig
Published: March 2007

Where adjustments of diet, physical activity, and dosage of insulin are well known to diabetologists and diabetic patients, present-day knowledge of factors of importance to the pharmacokinetics of insulin is frequently ignored. The pharmacokinetics of insulin comprise the absorption process, the distribution including binding to circulating insulin antibodies, if present, and to insulin receptors, and its ultimate degradation and excretion. The distribution and metabolism of absorbed insulin follow that of endogenous insulin. The distribution and metabolism cannot be actively changed, except in the case of circulating insulin antibodies, which in rare cases also may cause insulin resistance. The use of insulin preparation of low immunogeneity will avoid or reduce this course of variation in action. The absorption process, the detailed mechanisms of which are still unknown, is influenced by many variables where some can be controlled, thereby reducing the intrapatient variability in insulin absorption, which may reach 35%, causing a corresponding metabolic lability. Besides the known differences in timing among different preparations, the size of dose, the injected volume, and the insulin concentration are determinants of absorption role. Fortuitous injection technique contributes to variance, as do changes in blood flow of the injected tissue. This may be induced by changes in ambient temperature, exercise of injected limb, or local massage. Regional differences are also due to differences in blood flow. Serum insulin peaks may peak up to 1 h after injection of soluble insulin into the thigh versus into the abdominal wall. Local degradation of insulin seems of less importance but may, in rare cases, be the cause of high insulin “requirements.” Available evidence is reviewed and the importance of implementing the consequences in the daily care of the insulin-treated patient is emphasized.
Decreased Skin Wrinkling in Diabetes Mellitus
Authors: Clark Charles V , Pentland Brian , Ewing David J , Clarke Basil F
Published: March 2007

Skin wrinkling, which may be dependent on peripheral autonomic innervation, was assessed in 100 normal and 42 diabetic subjects using a temperature-controlled water bath with immersion of the hands for 30 min. Markedly decreased skin wrinkling was observed in diabetic subjects and in manual workers, but did not correlate with cardiovascular tests of autonomic function, control, type or duration of diabetes, or diabetic complications. The cause of decreased skin wrinkling in people with diabetes is unexplained.
Metabolic Response to Fasting Exercise in Adolescent Insulin-Dependent Diabetic Subjects Treated with Continuous Subcutaneous Insulin Infusion and Intensive Conventional Therapy
Authors: Schiffrin Alicia , Parikh Sagar , Marliss Errol B , Desrosiers Micheline M
Published: March 2007

The metabolic effects of moderate exercise in the fasting state were examined in 12 insulin-dependent diabetic adolescents treated with continuous subcutaneous insulin infusion (CSII) or intensive conventional therapy (ICT). Six patients received their usual afternoon dose the evening before the study and six received their usual infusion rate during exercise. Insulin was injected subcutaneously in the abdominal wall. Exercise was performed on a bicycle ergometer for 45 min at 50% maximum oxygen consumption. Resting plasma glucose values during both CSII (114 ± 18 mg/dl, P < 0.02) and ICT (136 ± 30 mg/dl, P < 0.01) were higher than normal (77 ± 11 mg/dl). Diabetic patients receiving CSII showed a sharp decrease in glycemia after 45 min of exercise (77 ± 18 mg/dl, P < 0.02). In contrast, in patients receiving ICT and in control subjects plasma glucose did not change during exercise or recovery. Insulin levels decreased significantly during exercise in the control subjects while there was no change in plasma free insulin levels during exercise in the diabetic subjects. Profiles of intermediary metabolites in response to exercise were similar in all groups with no significant differences in resting values between diabetic subjects and controls. Continuous subcutaneous insulin infusion provides near-normoglycemia in the insulin-dependent diabetic adolescent. However, with the basal insulin infusion rate necessary to achieve near-normal fasting blood glucose levels, moderate exercise in the postabsorptive state may result in hypoglycemia with CSII.
Hypoglycemia due to Serum-Complexed Insulin in a Patient with Diabetes Mellitus
Authors: Albert Stewart G , Popp Dennis A
Published: March 2007

A 28-year-old woman with insulin-dependent diabetes mellitus presented with a “hyperlabile” state of hyperglycemia and ketoacidosis alternating with hypoglycemia. Measurements of total and free insulin levels suggested that the clinical syndrome may have been due to antibody binding of insulin. Equilibrium analysis of insulin binding to the patient's serum demonstrated two classes of anti-insulin activities. The first class was of high affinity (dissociation constant ≈10−9 M) and low capacity (150 μU/ml). At low total serum insulin concentrations, most of the circulating insulin was bound to the high-affinity binding activity, and the patient presented with hyperglycemia or ketosis. The second class of insulin binding activity had a lower affinity (dissociation constant ≈5 × 10−7 M). The insulin that was bound to this low-affinity serum substance still maintained biologic activity in vivo. Isophane insulin (NPH) had a markedly prolonged serum half-life, which resulted in delayed hypoglycemia. Serum insulin complexes—that is, bound insulin—may not be “inactive” but may contribute to total insulin action. A determination of insulin activity, not only free insulin levels, may help explain hypoglycemia in selected patients with diabetes mellitus.
Reimbursement Issues in Diabetes
Authors: Sinnock Pomeroy , Bauer Deborah Wright
Published: March 2007

Third-party reimbursement for outpatient education services and for new health care technologies in diabetes is an issue of concern to educators, administrators, and others in the diabetes health care system. Reimbursement for outpatient education has been obtained from 11 Blue Cross/Blue Shield plans in nine states, six commercial insurance companies in four states, Medicare in five states, and Medicaid in one state. Despite these successes, third-party payers still must be approached on an individual basis. We review approaches taken by different states and diabetes control programs and make recommendations on how to request third-party reimbursement for outpatient education services. Third-party reimbursement of diabetes-related technologies/services and equipment is found to be dependent on the type of coverage the individual has, the state in which he or she is located, and the item or procedure covered. Many third-party payers do not have stated policies on reimbursement of a particular piece of equipment such as the insulin pump, or they do not have consistent, well-communicated standards for determining coverage.
A Prospective Study to Evaluate the Benefits of Long-Term Self-Monitoring of Blood Glucose in Diabetic Children
Authors: Mann Nicholas P , Noronha Julia L , Johnston Derek I
Published: March 2007

The benefits of self-monitoring of blood glucose (SMBG) in diabetic children have beenassessed in an 18-mo prospective study by comparison of two groups, one receiving intensive education (N = 20) and the other, education combined with SMBG(N = 19). Regular home visits were made with all children during which attempts were made to optimize diabetes control. Mean blood glucose levels in the SMBG group showed a downward trend throughout the study; however, values at baseline (11.7mmol/L) were not significantly different from those at completion of the study (10.8 mmol/L). Hemoglobin Alc levels showed a seasonal fluctuation, but values at thebeginning and end of the study were nearly identical to each other in both groups. The SMBG group showed a reduction in the number of hospital admissions for stabilization of control and for ketoacidosis (P < 0.04).
Continuous Subcutaneous Insulin Infusion and Postprandial Exercise in Tightly Controlled Type I (Insulin-Dependent) Diabetic Patients
Authors: Trovati Mariella , Carta Quirico , Cavalot Franco , Vitali Sara , Passarino Gabriella , Rocca Giuseppe , Emanuelli Giorgio , Lenti Gianfranco
Published: March 2007

The aim of this study was to investigate the influence of short-term submaximal postprandial exercise on plasma glucose concentrations in tightly controlled insulin-dependent diabetic patients treated by means of continuous subcutaneous insulin infusion (CSII). Two hours after breakfast, five diabetic patients and five healthy control subjects followed this protocol: 30 min of mild exercise, 30 min rest, 30 min of moderate exercise, 150 min rest. Serial determinations of plasma glucose, free insulin, and growth hormone (GH) were made. Similar control studies without exercise were also performed. In the diabetic patients, analysis of variance and covariance did not reveal any significant difference between the 2-h postbreakfast concentrations of plasma glucose and free insulin and postexercise values. A significant GH increase was observed after the exercise periods. Plasma glucose and insulin concentrations throughout the exercise study were not significantly different from the control study concentrations. Plasma free insulin concentrations of the diabetic patients were higher than the concentrations of healthy subjects. We conclude that CSII-treated, tightly controlled, insulin-dependent diabetic patients performing short-term mild and moderate exercises 2 and 3 h after breakfast do not have a high risk of hypoglycemia in spite of mild hyperinsulinemia.
Autonomic Neural Dysfunction in Recently Diagnosed Diabetic Subjects
Authors: Pfeifer Michael A , Weinberg Clare R , Cook Daniel L , Reenan Andrew , Halter Jeffrey B , Ensinck John W , Porte Daniel
Published: March 2007

Because onset of autonomic neural dysfunction in the diabetic syndrome has not been well established, sensitive and quantitative measures of autonomic nervous system (ANS) function were made in 19 non-insulin-dependent (NIDD) and 14 insulin-dependent (IDD) recent-onset diabetic subjects. The known duration of diabetes mellitus in the NIDD subjects was ≤ 12 mo. The duration in the IDD subjects was ≤ 24 mo. RR-variation during beta adrenergic blockade (an index of an ANS reflex involving the cardiac parasympathetic nervous system [PNS] pathway) was smaller than that of control subjects in both NIDD (P < 0.001) and IDD subjects (P < 0.01). This PNS abnormality was not likely to be due to volume depletion since acute volume depletion induced by furosemide in six normal subjects (1608 ± 105 ml, mean ± SEM) did not change RR-variation. Dark-adapted pupil size after topical PNS blockade (an index of iris sympathetic nervous system [SNS] activity) was also smaller in both groups of diabetic subjects (NIDD, P < 0.01; IDD, P < 0.05). Pupillary latency time (an index of an ANS reflex involving iris PNS pathway) was prolonged in the NIDD subjects (P < 0.005) but was not significantly altered in the IDD subjects. Thus, it would appear that the ANS is impaired soon after the diagnosis of diabetes mellitus. We hypothesize that early impairment of the ANS is common in IDD and NIDD subjects. This finding is consistent with the hypothesis that abnormal carbohydrate metabolism is an important factor in the etiology of diabetic autonomic neuropathy.
Verbal Fluency and Naming Performance in Type I Diabetes at Different Blood Glucose Concentrations
Authors: Holmes Clarissa S , Koepke Kathleen M , Thompson Robert G , Gyves Peter W , Weydert Joy A
Published: March 2007

The effect of serum glucose alterations on selected verbal skills was examined in a group of diabetic men between 18 and 35 yr of age. An artificial insulin infusion system was used to set and maintain glucose concentrations during testing at each of three levels: hypoglycemia (55 mg/dl), euglycemia (110 mg/dl), and hyperglycemia (300 mg/dl). Subjects were used as their own controls, with performance at euglycemia serving as the comparison standard. A double-blind crossover design was employed as described in Holmes et al. (see ref. 14). Results showed significantly disrupted naming or labeling skills at hypoglycemia, with a trend toward poorer performance at hyperglycemia. During hypoglycemia, rate of responding was slowed from 6% to 18%, compared with euglycemic performance, but accuracy was not impaired. In contrast, word recognition skills were not affected by deviations in glucose. These performance effects were not correlated with duration of disease except for one of the five tests administered. This one exception, on the most difficult task, was less notable than the general finding of no relation between disease duration (from 6 mo to 17.5 yr) and test performance. Thus, in addition to considering long-term consequences of blood glucose alterations, clinicians and diabetic patients may wish to consider acute neuropsychological consequences of disrupted euglycemia.
Diabetic Complications and Their Relationships to Risk Factors in a Japanese Population
Authors: Ishihara Masaki , Yukimura Yaichiro , Yamada Takashi , Ohto Ken , Yoshizawa Kunio
Published: March 2007

The relationship between diabetic complications and age, sex, duration, mode of therapy, body weight, control of blood glucose, blood pressure, and serum triglyceride and cholesterol was analyzed in a population with non-insulin-dependent diabetes in Japan. The prevalences of complications in the subjects varied from 6.5% for cerebrovascular strokes to 85.1% for sclerotic changes in retinal vessels; 35.8% of the patients had diabetic retinopathy and 19.8% had proteinuria. Univariate and multivariate analyses revealed that control of diabetes (blood glucose, mode of therapy, and duration) was closely correlated with retinopathy and proteinuria. However, blood glucose did not correlate with coronary insufficiency or cerebrovascular strokes. These macrovascular complications were related to aging and blood pressure. The data suggested that not only good glycemic control but also sufficient antihypertensive therapy was necessary for treating diabetic patients. The coefficient of determination of the risk factors was calculated for each diabetic complication. Except for sclerotic changes in retinal vessels, the coefficients were too small to fully explain the development of diabetic complications, especially for macrovascular diseases. The current data suggest that susceptibility of the individual patients to the diabetic complications is an important determinant.
Clinical Utility of Nonenzymatically Glycosylated Blood Proteins as an Index of Glucose Control
Authors: Schleicher Erwin D , Gerbitz Klaus D , Dolhofer Roswitha , Reindl Erich , Wieland Otto H , Edelmann Edmund , Haslbeck Manfred , Kemmler Wolfgang , Walter Helmut , Mehnert Helmut
Published: March 2007

This study compares the utility of nonenzymatically glycosylated serum proteins (lys-GSP) to glycosylated hemoglobins (HbAla−c) as control indices of glucose homeostasis in patients with IDDM. The diagnostic value of lys-GSP was also examined in patients with non-insulin-dependent diabetes mellitus, in subjects with impaired glucose tolerance, and in two patients with insulinoma. The intraindividual fluctuation of lys-GSP in normoglycemic subjects is very small, resulting in an interindividual range of 3.0 ± 0.3 lysine-bound glucose/mg protein (x¯ ± SD, N = 52). HbA1a−c with a normal range of 6.4 ± 0.9% (N = 52) shows greater variability. In IDDM there is no overlap of lys-GSP levels between the normal and the diabetic range at the 95% confidence level. In patients treated with an open-loop insulin delivery system failure of normalization of the glucose balance was clearly discernible by an elevation of GSP. In contrast, in about 40% of the patients with incomplete glycemic control the HbA1a−c levels fell within the normal range. The utility of lys-GSP for diagnosis of diabetes is compared with the results of 60 oral glucose tolerance tests. Two patients suffering from insulinoma displayed decreased lys-GSP values. From these results it appears that determination of lys-GSP represents a more sensitive parameter for long-term control than HbA1a−c and is suitable for monitoring even small fluctuations of blood glucose.
A Four-year Prospective Trial of Unmeasured Diet In Lean Diabetic Adults
Authors: Gallagher Anne M , Abraira Carlos , Henderson William G
Published: March 2007

Fifty-one adult male outpatients at or below ideal body weight (IBW) with no history of weighing more than 15% over IBW in the past 5 yr and no more than 25% in the past 15 yr were randomly assigned to a traditional calorically defined exchange-type diet (EXCH) or an unmeasured diet emphasizing avoidance of refined sugar and balance of food consumption throughout the day. All but 4 patients were insulin treated. With the exception of one patient in each group, all patients were classified as having type II diabetes. Subjects were followed in a single-blind design for 4 yr in the Diabetes Outpatient Clinic every 3 mo. The average mean fasting glycemia (FBS), coefficient of FBS variation, number of reported hypoglycemic reactions, mean fasting serum triglyceride and cholesterol levels, and mean total daily insulin dosage were similar in both groups. Each patient's mean daily caloric intake did vary over time, but there was no difference in mean caloric intake between diet groups. There was a significant correlation between a patient's mean FBS rating and his serum triglyceride level: patients with lower mean FBS had a significantly lower mean triglyceride level than patients with higher FBS. Overall body weights remained stable throughout the study. However, there was a significant difference in the number of patients in the EXCH group whose actual weight was 3% or more above IBW on 50% or more of their visits. The unmeasured diet group had a significantly greater number of patients whose actual weight was at IBW during the study. There was no relationship between FBS and changes from IBW. In the EXCH group only subjects who increased their weight over initial levels had lower FBS values than patients who reduced from initial weight. It is concluded that individuals without history of obesity before the diagnosis of diabetes mellitus can continue to regulate their weight without a precise caloric prescription. All of the parameters studied suggest that a calorically defined exchange diet might be as effective as an unmeasured diet in the conventional long-term treatment of the lean adult diabetic patient.
Nephropathy in Indian Patients with Non-insulin-dependent Diabetes in the Young
Authors: Jialal I , Rajput M C , Asmal A C , Joubert S M
Published: March 2007

In 85 patients diagnosed as having non-insulin-dependent diabetes in the young (NIDDY), 6 were found to have nephropathy. The duration of diabetes ranged from 2 to 17 yr; 5 of the 6 patients had retinopathy as evidenced by fluoroscein angiography (3 with proliferative changes). All 6 patients had a 24-h urinary protein excretion >0.5 g and a glomerular filtration rate <80 ml/min. Serum β2-microglobulin levels were increased in all 6 patients, while only 3 had increased serum creatinine levels.
A Family Development Approach to Studying Factors in the Management and Control of Childhood Diabetes
Authors: Newbrough J R , Simpkins Celeste G , Maurer Helen
Published: March 2007

The study of family factors that relate to diabetes management and metabolic control is crucial because of the family's central role in this management. Four sequential phases of diabetes management are specified in this review: (1) the pre-onset stage; (2) the onset, crisis stage; (3) the accommodation stage; and (4) the stabilization stage. Each stage can be expected to influence the following stage. Thus, each is important to later management of the condition. No theory of family functioning provides a satisfactory framework for understanding the complex relationships between family development and diabetes. The Peabody Family Development Model is introduced as a more complex and systematic way of understanding the stages of management and the long-term view of the individual and family development. Individual and family are acting and reacting, and at the same time, coping with outside influences while moving from one life stage to the other. Historic factors of family and community influence one's view of the world and, consequently, the way regular routines are carried out. Individual characteristics influence individual behavior at any given point in time. The model has at its core a stress-support paradigm, and has an ecologie frame of reference. Behavior is a result of all preceding factors, and information processed is fed back into the system. The Peabody Family Development Model is a way to organize a variety of information on family functioning and to specify how it might relate to the Control of diabetes in children.
Social Learning Intervention to Promote Metabolic Control in Type I Diabetes Mellitus: Pilot Experiment Results
Authors: Kaplan Robert M , Chadwick Michele W , Schimmel Leslie E
Published: March 2007

Patients with type I, or insulin-dependent, diabetes mellitus (IDDM) must comply with a complex behavioral regimen to control their diabetes. Compliance is often poor in teenage patients who are adversely influenced by peers. During a diabetes summer school, we randomly assigned 21 IDDM patients to one of two groups. One group participated in daily social-learning exercises designed to improve social skills and the ability to resist peer influence. The second group spent an equal amount of time learning medical facts about diabetes care. Four months after the intervention, hemoglobin A1 was significantly lower in the social skills intervention group. A variety of variables were significantly correlated with good metabolic control. These included self-reported compliance with a diabetes regimen and attitudes toward self-care. Unexpectedly, variables correlated with poor diabetes control included social problem-solving ability and satisfaction with social support.
The Evaluation of a Pocket Computer as an Aid to Insulin Dose Determination by Patients
Authors: Chanoch Laurence H , Jovanovic Lois , Peterson Charles M
Published: March 2007

A small and inexpensive computer was programmed to assist patients in making decisions regarding insulin delivery using constant subcutaneous infusion systems. Insulin dosage was based on gender, pre- and postprandial blood glucose, between-meal blood glucose, patient weight, time of day, and when appropriate, the carbohydrate content of food ingested. The system was self-adjusting based on postprandial and fasting blood glucose levels. A developmental phase in which the computer program was refined was undertaken with five highly trained type I patients using an insulin infusion pump. Then, based on the suggestions made by these patients, a final program was used by these same five patients for 1 mo. Computer-assisted insulin delivery resulted in lower mean blood glucose (162 versus 130 mg/dl) and hemoglobin A1c (7.2% versus 5.8%) values when compared with precomputer values. In addition, there was a significant increase in the frequency of blood glucose testing during the computer-assisted periods in that patients monitored their blood glucose 4.9 times per day during the physician-alone period whereas a mean of 7.5 glucose tests were performed during the computer-assisted periods. Patient response to the concept was overwhelmingly favorable. These studies demonstrate that computer-assisted insulin-delivery decision making is feasible, acceptable to patients already accustomed to pump use, safe, effective, and may provide a savings in terms of professional time.