bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Diabetes during Surgery with Glucose—Insulin—Potassium Infusion
Authors: Husband D. J. , Thai A. C. , Alberti K. G. M. M.
Published: July 2009

One hundred and twenty‐eight surgical operations in diabetic patients have been studied to assess the effectiveness, under routine clinical conditions, of a management regimen based on the use of glucose—insulin—potassium infusion (GIK). Forty‐four non‐insulin‐dependent diabetic (NIDDM) and 41 insulin‐dependent diabetic (IDDM) patients received GIK. Mean blood glucose on the day of operation was 9.3±S.D. 2.2 mmol/l in NIDDM and 8.9±2.3 mmol/l in IDDM patients. Acceptable control on the day of operation (defined as mean blood glucose 5–12 mmol/l without hypoglycaemia) was achieved in 70 (82%) patients. Eleven of 15 failures were attributable to incorrect implementation of the protocol. Though 16 units Soluble insulin/500 ml 10% glucose (0.32 units/g glucose) was needed in 61% of patients, 26% required a higher and 13% a lower dose. Plasma potassium concentration did not change after 24 h of GIK infusion, but sodium concentration fell (136±5 to 132±5 mmol/l; p < 0.01), with 12 of 32 patients having post‐operative values < 130 mmol/l. Forty‐three NIDDM patients undergoing minor surgery were managed without insulin, and acceptable control was achieved in 40 (93%). We conclude that the regimen described is a satisfactory routine means of managing diabetes during surgery, but that optimal results depend on careful monitoring with appropriate alteration of therapy.
Experience of Continuous Subcutaneous Insulin Infusion in the Outpatient Management of Diabetic Teenagers
Authors: Knight G. , Boulton A. J. M. , Ward J. D.
Published: July 2009

Of forty‐five adolescent diabetic patients offered continuous subcutaneous insulin infusion (CSII) as part of a large feasibility study, 13 (28.9%) initially chose the treatment, but only 4 out of 11 who actually started CSII continued for one year (64% discontinuation rate). In contrast 30.4% of adults approached chose CSII, and 32% had discontinued after one year. Improvement in glycaemic control was poor, and clinical problems were more common in pump‐treated teenagers than in adults. CSII does not appear to be a therapeutic solution for adolescents having difficult management problems.
Death of a Beta Cell: Homicide or Suicide?
Authors: Bottazzo Gian Franco
Published: July 2009

Based on the 1985 R. D. Lawrence Lecture delivered by the author at the Spring Meeting of the Medical and Scientific Section of the British Diabetic Association, Oxford, March 1985, and up‐dated for the Diaz‐Cristobal Lecture delivered at the XII Congress of the International Diabetes Federation, Madrid, September 1985. The Lecture was delivered in a judicial courtroom style which has been followed in the edited transcript. The reader is invited to join the Jury.
Frequency of Daytime Biochemical Hypoglycaemia in Insulin‐treated Diabetic Patients: Relation to Daily Median Blood Glucose Concentrations
Authors: Thorsteinsson B. , Pramming S. , Lauritzen T. , Binder C.
Published: July 2009

The frequency and distribution of daytime biochemical hypoglycaemia (capillary blood glucose concentration below 3 mmol/l) was assessed in type 1 diabetic patients on conventional twice daily insulin therapy (n = 79) and on continuous subcutaneous insulin infusion (n = 20). Patients collected and mailed to the hospital blood for seven‐point blood glucose profiles. For both treatment regimens the frequency of biochemical hypoglycaemia on individual days was inversely related to the median blood glucose concentration in a curvilinear manner (p < 0.001). Hypoglycaemia was more frequent pre‐prandially than post‐prandially (p < 0.01), and was evenly distributed during the day in patients on continuous subcutaneous insulin infusion. In patients on conventional therapy, however, pre‐lunch hypoglycaemia was four times more frequent than pre‐breakfast or pre‐dinner hypoglycaemia (p < 0.0001).
Chlorpropamide Lowers Serum and Lipoprotein Cholesterol in Insulin‐Dependent Diabetes
Authors: Seviour P. W. , Teal T. K. , Richmond W. , Elkeles R. S.
Published: July 2009

Changes in serum lipids and lipoproteins were examined during eight weeks chlorpropamide therapy in eight C‐peptide negative, insulin‐dependent diabetic patients (mean age 40 years, mean onset of diabetes 20 years). Chloropropamide was found to have a generalized cholesterol lowering effect (progressive significant fall in mean total cholesterol, LDL‐C, HDL‐C, and HDL3‐C) with no significant change in the ratio of high‐density lipoprotein to low‐density lipoprotein cholesterol which was independent of insulin secretion.
Paradoxical Platelet Behaviour in Diabetic Ketoacidosis
Authors: Campbell R. R. , Foster K. J. , Stirling C. , Mundy D. , Reckless J. P. D.
Published: July 2009

Thrombotic events may occur in patients who present with severe uncontrolled diabetes or with diabetic coma. As a possible explanation for this, platelet function was investigated at presentation with diabetic ketoacidosis and during treatment in 10 patients. Concentrations of the platelet‐specific proteins, platelet factor 4 (PF4) and betathromboglobulin (betaTG) were elevated and fell towards normal with treatment. Despite evidence of increased aggregation in vivo, platelets from subjects with ketoacidosis were insensitive to adenosine 5′‐diphosphate (ADP), sensitivity increasing with correction of ketoacidosis. Platelets from ketoacidotic diabetics were initially insensitive to the anti‐aggregatory action of prostacyclin (PGI2) and became normal with treatment. Initial blood glucose concentrations correlated with log10 ADP concentrations (r = 0.72, p < 0.01) and with log10 PGI2 ID50 (the PGI2 concentration required to half‐inhibit ADP‐induced aggregation) (r = 0.66, p < 0.025). Glucose concentrations throughout the 2‐week study period correlated with all log10 ADP concentrations (r = 0.32, p < 0.005) and all log10 PGI2 ID50 concentrations (r = 0.51, p < 0.001). The decrease in ADP sensitivity in ketoacidosis, paradoxical in view of the evidence of increased in vivo platelet aggregation, may result from an acquired platelet storage pool deficiency.
Diabetic Pregnancy following Renal Transplantation
Authors: Grenfell A. , Bewick M. , Brudenell J. M. , Carr J. V. , Parsons V. , Snowden S. , Watkins P. J.
Published: July 2009

Renal transplantation for diabetic nephropathy prolongs survival and the return of fertility makes pregnancy possible. We describe a successful pregnancy in a 38‐year‐old diabetic renal transplant recipient despite blindness, gangrenous toes, cardiac impairment, and both sensory and autonomic neuropathy. Renal function remained stable throughout the pregnancy which was complicated by supine hypertension, postural hypotension and increasing proteinuria. Fetal distress and increasing proteinuria precipitated delivery by Caesarian section at 29 weeks of a female infant weighing 1.1 kg. Following delivery, hypertension improved, gangrene resolved, proteinuria decreased, and renal function remained stable. Pregnancy in long‐standing diabetic patients with renal transplants, although hazardous, may be successful yet the maternal morbidity and mortality makes them inadvisable.
Semantics of Insulin
Authors: Ege H.
Published: July 2009

The lack of a stringent terminology and a well‐defined vocabulary for insulin and related subjects has been a deterrent to solving many of the problems encountered when using insulin in pumps. The same word is sometimes used to describe a number of different phenomena or the same phenomenon is referred to by different words. Thus the word ‘insulin’, meaning the substance, the protein hormone, is commonly used as a synonym for an ‘insulin formulation’ for the treatment of diabetes. The ‘insulin dimer’ can be the covalent or the non‐covalent dimer, two very different substances. ‘Isoelectric precipitation’ is often mistaken for ‘fibrillation’ and both are referred to as ‘aggregation’ or ‘polymerization’. The word ‘crystal’ is being used as a synonym for ‘particle’, and determination of ‘the content of insulin’ by HPLC is sometimes called a ‘bioassay’. The nature and consequences of these pitfalls are discussed, and advice is given on how to avoid them.
Abnormalities of Granulation Tissue and Collagen Formation in Experimental Diabetes, Uraemia and Malnutrition
Authors: Yue D. K. , Swanson B. , McLennan S. , Marsh M. , Spaliviero J. , Delbridge L. , Reeve T. , Turtle J. R.
Published: July 2009

The formation of granulation tissue and collagen was studied in rats made diabetic with streptozotocin. Granulation tissue was harvested from the inside of steelmesh cylinders implanted in the back of diabetic and control animals. Four weeks after implantation there was a reduction in the quantity of granulation tissue and its collagen content in diabetic animals compared to controls. Rats with renal failure or malnutrition but no diabetes also formed less granulation tissue but in these animals the content of collagen in the granulation tissue was normal. These results suggest that the decrease of collagen, but not granulation tissue, in diabetes is a relatively specific phenomenon which was not due to the toxic effects of streptozotocin as the changes were prevented by insulin treatment. The hydroxyproline/proline ratio of diabetic collagen was found to be normal, excluding defective hydroxylation of proline as an important factor in the reduction of collagen in diabetes. Treatment with an aldose reductase inhibitor did not prevent the abnormalities of granulation tissue and collagen in diabetes, making it unlikely that increased activity of this enzyme played an important pathogenetic role. The observed reduction of granulation tissue mass and collagen content in diabetes may be important factors in the impairment of wound healing in diabetes.
Abnormal Platelet Aggregation in Chronic Symptomatic Diabetic Peripheral Neuropathy
Authors: Jennings P. E. , Dallinger K. J. C. , Nightingale S. , Barnett A. H.
Published: July 2009

Both diabetic nephropathy and retinopathy result from microangiopathic processes although there is controversy as to whether this is true for neuropathy. Increased platelet aggregation has been reported in diabetics with nephropathy and retinopathy. The presence of increased platelet aggregation in diabetics with neuropathy could be due to the other coincident microvascular complications. We have, therefore, studied in vitro platelet aggregation in 10 diabetics with chronic symptomatic neuropathy but no other complications, 10 with neuropathy and severe retinopathy, 17 with retinopathy alone, and 23 diabetics with no complications. Increased platelet aggregation to adenosine diphosphate (ADP) and adrenaline was seen in diabetics with neuropathy alone (peak responses 85.0 ± 5.5% and 82.9 ± 6.2%, respectively) when compared with uncomplicated diabetics (peak response 74.9 ± 10.1%, p < 0.005, and 74.3 ± 12.5%, p < 0.01, respectively). The increased platelet aggregation in the patients with neuropathy alone was similar to that found in the diabetics with severe retinopathy. We conclude that increased platelet aggregation is associated with established microangiopathy and is also present in otherwise uncomplicated patients with neuropathy, and this may have pathogenic and therapeutic implications.
A District Screening and Treatment Service for Diabetic Retinopathy
Authors: Mayon‐White V. A. , Jenkins L. M. , Knight A. H.
Published: July 2009

A District Screening and Treatment Service for diabetic retinopathy using diabetic clinic staff is described. From 1978 to 1984 a total of 1195 diabetics entered the screening programme in a district with a population of 136 700. From 1982, when laser treatment became available locally, the average number of patients from the district requiring treatment for the first time per year was 14.0 for proliferative retinopathy and 11.3 for maculopathy. The laser was also used to treat patients from two other districts and the results of treatment from all three districts are reported. Regression of new vessels was achieved in 86% of 72 patients with proliferative retinopathy but 12 of these were also seen at the regional eye centre. Visual acuity was the same or better in 79% of the 104 eyes in 76 patients treated for maculopathy. Effective treatment can be given by a trained hospital practitioner at district level. This reduces demands on the regional centre but good liaison is necessary for difficult cases.
Asian Diabetes in Britain: A Clinical Profile
Authors: Nicholl C. G. , Levy J. C. , Mohan V. , Rao P. V. , Mather H. M.
Published: July 2009

The clinical features of large unselected groups of Asian (401) and European (491) patients attending a diabetic clinic were compared. The prevalences of symptomatic ischaemic heart disease, hypertension, retinopathy, and lens opacities were similar in the two groups, despite the shorter known duration and the relative youth of the Asian patients. Pedal pulses were more often absent in Europeans, whereas in the age‐group 20–64 years, ankle and knee reflexes were more often unobtainable in Asians. The degree of adiposity was similar in the two groups, but was less in Asian males than females. A first‐degree diabetic relative was reported more commonly in Asians than in Europeans. These findings are important in relation to the exceptionally high prevalence of diabetes recently described in the Southall Asian community.
Duration of Non‐insulin‐dependent Diabetes and Development of Retinopathy: Analysis of Possible Risk Factors
Authors: Jarrett R. J.
Published: July 2009

Thirty men aged 44–73 years were followed from the stage of impaired glucose tolerance ‐ detected in the Whitehall Survey ‐ to the diagnosis of diabetes and for a minimum of 3 years after. Eight men developed diabetic retinopathy during follow‐up after diagnosis, the minimum time from diabetes diagnosis being 59 months. The only significant difference between the groups with and without retinopathy was in the time from screening to diagnosis of diabetes ‐ mean 45.3 and 71.5 months, respectively. Of baseline variables, mean systolic and diastolic blood pressure levels were substantially higher in those who subsequently developed retinopathy, though the differences were not statistically significant (p>0.05).
Prospective Survey of Re‐used Plastic Syringes for Diabetics
Authors: McLaren E. H. ,   Strathclyde Diabetic Group
Published: July 2009

In a 1 year prospective survey of the safety and economy of re‐used plastic insulin syringes 9843 syringes were used 93 867 times with one possible injection site infection. On average syringes were used 5.7 days before changing. Re‐use of plastic syringes would produce an annual saving of about #15 per patient when compared with glass syringes.
Diabetes Mellitus and Fournier's Gangrene
Authors: Archer M. I.
Published: July 2009

A case is described in which Fournier's gangrene was the presenting feature of diabetes mellitus and in which extensive subcutaneous emphysema prevented the use of spinal anaesthesia for debridement. In the literature four cases have been reported in which Fournier's gangrene was the presenting feature in patients with diabetic ketoacidosis. Diabetes may predispose to a form of Fournier's gangrene in which subcutaneous gas formation is marked, though subcutaneous emphysema to the degree described in this case has not previously been reported in this condition. Diabetes mellitus and subcutaneous emphysema must be sought in patients with Fournier's gangrene as both may have a profound influence on management.
Failure of Improved Glycaemic Control to Reverse Diabetic Autonomic Neuropathy
Authors: Thomas's St ,   Diabetic Study Group
Published: July 2009

A prospective trial was conducted in 20 insulin‐treated diabetic patients with established autonomic dysfunction to test the effect of a 2‐year improvement in glycaemic control. On entry, the patients aged 34.6 ± 10.8 years (mean ± SD), duration 20.2 ± 10.4 years, had evidence of poor control (HbA1 > 9.5% on at least two consecutive tests, and at least one abnormality in the 11 different neuropathic function tests used. These included four of pupillary function, six of cardiovascular function and one of vibration sensitivity. The method used to improve control was conventional insulin treatment combined with home monitoring of blood glucose and regular adjustment of insulin dosage under the supervision of a diabetic specialist nursing sister. The HbA1 level on entry was 13.0 ± 0.7% (mean ± SEM) which fell to 10.4 ± 0.4% at 3 months and to 9.3 ± 0.4% at 24 months. The neuropathy tests were performed at 0, 3, 6, 12, 18, and 24 months and significant changes were recorded in five. These changes (in two pupillary and three cardiovascular tests) all indicated worsening function which exceeded that explicable by aging. One cardiovascular test showed slower rates of deterioration in patients achieving the greatest improvements in control. It was concluded that a prolonged period of improved control failed to reverse established autonomic dysfunction of diabetes.
Do Diabetics Remember all They have Been Taught? ‐ A Survey of Knowledge of Insulin‐dependent Diabetics
Authors: Germer S. , Campbell I. W. , Smith A. W. M. , Sutherland J. D. , Jones I. G.
Published: July 2009

A questionnaire survey of 182 insulin‐dependent diabetics aged 12–73 years attending a District General Hospital outpatient clinic revealed limitations in the understanding of their disease, with gaps in their knowledge on most aspects of diabetic management, including simple metabolic details, use of insulin, hypoglycaemic reactions, effects of exercise and illness, urine testing, and diet. Only 4 patients (2%) answered all 34 questions correctly and only 27 (15%) answered 11 key questions accurately. The total number of ‘knowledgeable’ patients who achieved a score of at least 28 in all, including 9 or more key questions correct, was 96 (53%). The degree of knowledge of our patients was unrelated to age, duration of diabetes, place of original diabetic education or degree of diabetic control as measured by blood glucose or HbA1 levels.
Microalbuminuria in Elderly Hyperglycaemic Patients and Controls
Authors: Damsgaard Else Marie , Mogensen Carl Erik
Published: July 2009

Detailed examination was performed in 1781 subjects with occult fasting hyperglycaemia (FH), 211 known diabetics (KD), and their corresponding non‐diabetic controls (80 CFH, 216 CKD), all found by screening of a well‐defined population aged 60–74 years. All but one FH and 90% of KD could be classified as non‐insulin‐dependent diabetes mellitus (NIDDM) when evaluated by a glucagon‐C‐peptide test. Urine excretion of albumin and β2‐microglobulin and the creatinine clearance were examined over 1 hour in the resting state. The results show that elderly non‐diabetics have a wide range of albumin excretion rates. Occult fasting hyperglycaemia is associated with increased albuminuria not detectable by conventional tests for urinary proteins in males, whereas females do not have increased microalbuminuria. Known NIDDM is associated with increased albuminuria in both sexes indicating a sex difference in the threshold for albuminuria only in subjects with occult fasting hyperglycaemia. The albumin/β2‐microglobulin excretion ratio indicates that the higher albumin excretion rates associated with occult fasting hyperglycaemia and known NIDDM are of glomerular origin.
The Relationship Between Autonomic Neuropathy and Urinary Sodium and Albumin Excretion in Insulin‐Treated Diabetics
Authors: Winocour Peter H. , Dhar Hanka , Anderson David C.
Published: July 2009

There is evidence to suggest that renal function may alter in the presence of autonomic neuropathy. Albumin excretion rate (AER) and sodium excretion rate (NaER) in timed daytime (erect) and night‐time (supine) urine collections were assessed in 20 insulin‐treated diabetics with and in 20 without established autonomic neuropathy, matched for age, sex, duration of diabetes, diabetic control, and systolic blood pressure. All patients were free of proteinuria on albustix testing and had normal serum levels of urea and creatinine.

AER based on daytime and pooled 24‐hour collections was higher, but not significantly so, in the group with autonomic neuropathy. The nocturnal AER on the other hand was significantly elevated in the group with autonomic neuropathy (p<0.02) as was the nocturnal urine volume (p<0.01) and sodium excretion rate (p<0.05). The corrected nocturnal albumin/creatinine ratio was likewise greater in this group (p<0.02). These findings suggest that autonomic neuropathy can independently affect renal function and that nocturnal renal haemodynamics and glomerulotubular balance may be deranged in insulin‐treated diabetics with autonomic neuropathy.
Influence of Metabolic Control of Insulin‐dependent Diabetes on Plasma Nucleotide Levels (cAMP, cGMP) During Bicycle Exercise
Authors: Kuzmits R. , Schernthaner G.
Published: July 2009

Plasma concentrations of cyclic nucleotides (cAMP, cGMP) were measured before and during bicycle exercise in 8 well‐controlled (mean pre‐exercise blood glucose 5.3 mmol/l; HbA1 8.6%) and 8 moderately controlled (mean pre‐exercise blood glucose 12.2 mmol/l; HbA,1 10.8%) patients aged 18–32 years with insulin‐dependent diabetes mellitus (IDDM) and in a group of non‐diabetic control subjects matched for age and sex. Pre‐exercise plasma cAMP concentrations and the rise with exercise were similar in all study groups. Significantly lower resting cGMP levels were found in well‐controlled IDDM patients (3.5 ± 0.3 pmol/ml, mean ± SEM) compared to controls (5.6 ± 1.1 pmol/ml; p <0.05) and moderately controlled IDDM patients (5.6 ± 1.0 pmol/ml; p <0.05). By contrast, plasma cGMP levels increased during exercise in the diabetics but not in the controls. These findings indicate a significant difference in responses of plasma cGMP to exercise between IDDM patients and controls.
Glycosylated Haemoglobin in Uraemia
Authors: Paisey R. , Banks R. , Holton R. , Young K. , Hopton M. , White D. , Hartog M.
Published: July 2009

Glycosylated haemoglobin (GHb) was measured in 71 patients with stable chronic renal failure by the thiobarbituric acid (TEA) reaction and by agar gel electrophoresis. Nineteen patients were diabetic. Of the non‐diabetics, 22 were treated conservatively (including 8 children), 15 by maintenance haemodialysis, and 15 by continuous ambulatory peritoneal dialysis. GHb measured by both methods correlated with postprandial blood glucose levels. There was a significant discrepancy between the two methods only in patients with serum urea concentrations greater than 30 mmol/l, mean ± SD, (6.8 ± 2.6% vs 8.2 ± 2.5% for TBA and electrophoresis, respectively). This difference, Δ GHb, correlated with serum urea, serum creatinine, and serum bicarbonate, but after logistic regression of results from all 71 patients only serum urea was associated with Δ GHb. Lower haemoglobin and GHb and high fetal haemoglobin concentrations in the haemodialysis group suggested increased haemolysis in these patients. Measurement of GHb by the TBA method and by agar gel electrophoresis remain useful indicators of hyperglycaemia in patients with mild, stable chronic renal failure.
Aortic Stiffness in Insulin‐dependent Diabetics: An Echocardiographic Study
Authors: Thordarson H. , Thorgeirsson G. , Helgason T.
Published: July 2009

To assess the aortic stiffness (AS) in young (15–35 year old) insulin‐dependent diabetics without manifestations of atherosclerotic disease or hypertension, M‐mode echocardiography was used to measure relative changes in aortic diameter expressed as

Aortic strain = Diameter change/Diastolic diameter x 100%

Aortic stiffness can be calculated from the formula AS = Pulse pressure/Aortic strain. Fifty‐seven diabetics were investigated, 31 men (aged 23.6 ± 5.6 years, mean ± SD) and 26 women (aged 25.7 ± 6.4 years).

There were 26 healthy controls with similar blood pressure, 14 men (aged 25.0 ± 5.5 years) and 12 women (aged 24.6 ± 7.1). The AS in diabetic men was 14 ± 8.0 (mean ± SD) compared to 3.6 ± 0.7 in controls (p<0.001). In diabetic women the AS was 5.8 ± 3.1 compared to 4.3 ± 1.3 in controls (p<0.05). Diabetic men also had much stiffer aortas than diabetic women (p<0.001). There was a linear correlation between AS and duration of diabetes in men (R= 0.70; (p<0.001). For females no such correlation was found, the AS frequently being within the range of the controls in spite of long duration of the disease. In males there was a significant correlation between AS and retinopathy (R = 0.49; p<0.01) and an inverse correlation with HDL‐cholesterol/total cholesterol ratio (R = 0.51; p<0.01). In diabetic females AS was significantly greater in smokers (7.0 ± 3.7) than in non‐smokers (4.2 ± 2.2; p<0.01). In neither sex were there significant correlations between AS and post‐prandial blood glucose, HbA1c, triglycerides or total cholesterol.

The results show that AS frequently increases at a young age in insulin‐dependent diabetics, especially males, who on average double the stiffness increment every 7.5 years of the disease.
Retinal Haemorrhages and Papilloedema due to Benign Intracranial Hypertension in a Pregnant Diabetic
Authors: Wheatley T. , Clark J. D. A. , Edwards O. M. , Jordan K.
Published: July 2009

A case of benign intracranial hypertension associated with generalized oedema is reported in a normotensive pregnant patient with long‐standing insulin‐treated diabetes mellitus. Following treatment with bed rest, chlorthalidone and dexamethasone the condition resolved and a healthy infant was delivered. This condition, not previously reported in a diabetic pregnancy, must be differentiated from other causes of bilateral optic nerve abnormalities associated with retinal haemorrhages and oedema, including diabetic retinopathy, diabetic optic neuropathy, accelerated hypertension and cerebral mass lesions. Treatment is required to prevent permanent visual impairment due to pressure on the susceptible optic nerve of the diabetic patient and to avoid the metabolic consequences to both mother and fetus of poor nutritional intake due to nausea.
Neutral Insulin Solutions Physically Stabilized by Addition of Zn2+
Authors: Brange J. , Havelund S. , Hommel E. , Sørensen E. , Kühl C.
Published: July 2009

Commercial neutral insulin solutions, all of which contain 2–3 zinc atoms per hexameric unit of insulin, have a relatively limited physical stability when exposed to heat and movement, as for example in insulin infusion pumps. Physical stabilization of neutral insulin solutions has been obtained by addition of two extra Zn2+per hexamer of insulin. This addition stabilizes porcine and human neutral solutions equally well and does not affect the chemical stability of the insulin. The stabilization is probably obtained by a further strengthening of the hexameric structure of insulin, so that the formation of insoluble insulin fibrils (via the dissociation into the insulin monomer or dimer) is impeded or prevented. The addition of an extra 2 Zn2+has been shown to be without influence on the insulin immunogenicity in rabbits or on the rate of absorption after subcutaneous injection in diabetic patients. It is concluded that neutral insulin solution can be physically stabilized by addition of extra Zn2+without affecting other qualities of the insulin preparation including chemical stability, immunogenicity, and duration of action after injection.
The Effects of Diabetes and Autonomic Neuropathy on Parotid Salivary Flow in Man
Authors: Lamey P‐J. , Fisher B. M. , Frier B. M.
Published: July 2009

Stimulated parotid salivary flow studies were performed on 20 non‐diabetic subjects and on 30 patients with insulin‐dependent diabetes mellitus who had been screened for autonomic neuropathy using tests of cardiovascular reflexes. Electrical gustometry was performed to detect the taste threshold.

The stimulated parotid salivary flow rates of diabetics with no autonomic neuropathy or early parasympathetic autonomic dysfunction alone were similar to those of non‐diabetic subjects. Diabetic patients with established parasympathetic autonomic neuropathy had significantly higher salivary flow rates as did those with combined sympathetic and parasympathetic neuropathies. Taste thresholds did not correlate either with the duration of the diabetes or with the presence of autonomic neuropathy.

The cause of the increased salivary flow associated with diabetic autonomic neuropathy is unclear. It may represent the removal of a neural inhibitory mechanism which modulates salivary flow, or the effects of long‐standing diabetes on salivary secretion.
Physical Activity, Glucose Tolerance, and Diabetes Mellitus: the Whitehall Study
Authors: Jarrett R. J. , Shipley M. J. , Hunt R.
Published: July 2009

In the Whitehall Study, 6 672 men aged 40–64 years completed a questionnaire concerning leisure time physical activity and had a capillary blood glucose measurement on a sample taken 2 h after a 50 g glucose load. An activity score was calculated by grouping subjects into three broad categories: inactive, moderately active, and active. In both univariate and multiple regression analysis no significant association between blood glucose level and activity score could be found.

There were 49 previously diagnosed non‐insulin‐dependent diabetic men and 25 men with 2 h blood glucose levels exceeding 11.1 mmol/l. The proportion of men in each of these groups did not differ significantly between the three activity categories.

In a 1:10 sub‐sample (n = 1 650) of the whole Study population there was no relationship between glucose tolerance distribution and a measure of energy expenditure (kcal/kg body weight).

In this population there is no evidence for relationship between glucose tolerance or non‐insulin‐dependent diabetes and reported leisure time physical activity, or between glucose tolerance and energy expenditure.
Effect of Strict Metabolic Control on Regulation of Subcutaneous Blood Flow in Insulin‐dependent Diabetic Patients
Authors: Kastrup J. , Mathiesen E. R. , Saurbrey N. , Nørgaard T. , Parving H.‐H. , Lassen N. A.
Published: July 2009

The effect of 10 weeks of improved metabolic control on the impaired autoregulation of the subcutaneous blood flow was studied at the level of the lateral malleolus in eight long‐term insulin‐dependent diabetic patients with clinical microangiopathy. Blood flow was measured by the local 133‐Xenon washout technique. Mean arterial blood pressure was reduced by a maximum of 23 mmHg by elevating the limb above heart level and elevated to a maximum of 65 mmHg by head‐up tilt; in the latter position venous pressure was kept constantly low by activation of the leg muscle vein pump (heel raising). Improved metabolic control was achieved using either continuous subcutaneous insulin infusion or multiple insulin injections. The blood glucose concentration declined from (median) 12.7 to 6.8 mmol/l and the HbA1c level from 10.1 to 7.5% during strict metabolic control (p<0.01 and p<0.01, respectively). The slope of the subcutaneous blood flow autoregulation curves during poor metabolic control (median: 11.6% per 10 mmHg, range: 8.0–30.5% per 10 mmHg) was not significantly different from the slope values during improved metabolic control (13.4% per mmHg, 10.1–24.4% per mmHg). No association was demonstrated between the impaired autoregulation of subcutaneous blood flow and the metabolic parameters.

Our results indicate that improved metabolic control for 10 weeks has no effect on the impaired autoregulation of subcutaneous blood flow in long‐term insulin‐dependent diabetic patients with clinical microangiopathy.
Platelet Aggregation and Coagulation Factors in Insulin Dependent Diabetics With and Without Microangiopathy
Authors: Dallinger K. J. C. , Jennings P. E. , Toop M. J. , Gyde O. H. B. , Barnett A. H.
Published: July 2009

Abnormalities of platelet aggregation and coagulation have been reported in insulin dependent diabetes mellitus (IDDM), although there is controversy concerning their relationship to microangiopathy. We have studied platelet function and haemostasis in 55 patients with IDDM, 23 without, 14 with mild (background retinopathy) and 18 with severe (proliferative retinopathy, or background retinopathy plus proteinuria) complications. Studies were done on 2 occasions 8 weeks apart and the results compared with 28 control subjects. There was evidence of increased in vivo platelet aggregation in the diabetic group v controls shown by raised values of beta‐thromboglobulin (61 ± 42, mean ± SD, v 18 ± 14 μg/ml, p<0.001), platelet factor 4 (62 ± 76 v 14 ± 11 μg/ml, p<0.01), and platelet micro‐aggregates (20 ± 16 v 12 ± 11%, p<0.01). There was no significant difference in fibrinogen and fibrinopeptide A levels, nor in ‘in vitro’ tests of platelet aggregation between the groups. Dilute whole blood clot lysis time was increased in the diabetic group v controls (6.4 ± 2.6 v 4.8 ± 0.5 hours, respectively, p<0.001). Subjects with severe complications had significantly increased platelet micro‐aggregates when compared to those without complications (23 ± 16 v 16 ± 11%, p<0.05) and increased dilute whole blood clot lysis time (7.0 ± 2.8 v 6.0 ± 2.5 hours, p<0.05).

We conclude that patients with IDDM show increased intravascular platelet aggregation which is more severe in those with microangiopathy.
Comparison of Glycaemic Control in Diabetic Patients Treated with Morning or Evening Human Ultratard Insulin
Authors: Edsberg B. , Dejgaard A. , Kühl C.
Published: July 2009

To investigate whether morning or evening injection of a long‐acting insulin preparation (Ultratard HM, Novo) affects the glycaemic control in insulin‐dependent diabetic (IDDM) patients, 24‐hour blood glucose and plasma free insulin profiles were obtained in nine C‐peptide negative IDDMs after one daily injection of insulin Ultratard HM either before breakfast (0800 h) or at 2200 h during the preceding 14 days.

There was a tendency towards higher plasma free insulin levels and lower blood glucose values from 0100 h to 1300 h when Ultratard HM insulin was injected at 2200 h as compared to the morning injection. There was, however, only a significant difference between the corresponding plasma free insulin values at 1200 h, and blood glucose levels did not differ significantly at any time point investigated. The number of blood glucose values below 3 mmol/l in the study periods was 6 when insulin Ultratard HM was injected at 2200 h as opposed to 2 when insulin was given at 0800 h, but this difference was not significant.
The Effects of One Month High Fructose Intake on Plasma Glucose and Lipid Levels in Non‐insulin‐dependent Diabetes
Authors: McAteer E. J. , O'Reilly G. , Hadden D. R.
Published: July 2009

The effects of a high fructose diet on the control of blood glucose and serum lipids were studied in 10 non‐insulin‐dependent diabetic patients (mean age 64.4 years, mean duration of diabetes 5.6 years). Comparison was made following 28 days on the usual diabetic diet and 28 days during which 25% of the usual carbohydrate was substituted with fructose. There was no change in mean (± SEM) fasting plasma glucose (on usual diet 9.2 ± 0.5 mmol/l, on fructose diet, 9.1 ± 0.4 mmol/l), but there was a fall in mean plasma glucose levels at 30, 60, and 120 min in a 75 g OGTT following the fructose diet. There was no significant change in fasting lipids: on usual diet mean serum cholesterol 5.8 ± 0.2 mmol/l, on fructose diet 5.6 ± 0.2 mmol/l; serum triglyceride, on usual diet 1.3 ± 0.1 mmol/l, on fructose diet 1.3 ± 0.1 mmol/l; HDL cholesterol on usual diet 1.4 ± 0.1 mmol/l, on fructose diet 1.4 ± 0.1 mmol/l. Mean body weight did not vary significantly between the two diets. Incorporation of fructose into the diabetic diet may lower post‐prandial glucose levels without disturbing serum lipids.
Prevalence of Insulin‐Dependent Diabetes Mellitus in Asian Children
Authors: Samanta A. , Burden A. C. , Jones G. R. , Woollands I. G. , Clarke M. , Swift P. G. F. , Hearnshaw J. R.
Published: July 2009

A survey was conducted in 1984–85, within Leicester City boundaries, which contains 64 535 children below the age of 15 years (20 267 Asian and 44 268 White Caucasian) to ascertain the prevalence of insulin‐dependent diabetes mellitus (IDDM) using a central register maintained for the changeover to U‐100 insulin, diabetic health visitor index cards, hospital admissions of diabetic children, and individual registers maintained by us. Overall prevalence per thousand for children aged 0–15 years was 0.54 for Asian and 0.99 for White Caucasians; for ages 10–15 years they were 0.97 and 1.87, and for ages 0–9 years, 0.31 and 0.18, respectively. This was not statistically different at the 5% level.

Ours is the first population based study of its kind in Asian children, and challenges the view that there is a large difference in the prevalence of IDDM between Asians and White Caucasians. A wider analysis of this observation incorporating a large population base is suggested.
Diabetic Pregnancy Managed with Intraperitoneal Insulin
Authors: Fonseca V. A. , Menon R. K. , O'Brien P. M. S. , Fernando O. N. , Stephen R. , Dandona P.
Published: July 2009

A woman with insulin‐dependent diabetes (IDDM) and resistance to subcutaneously injected insulin conceived while being treated with intraperitoneal (i.p.) insulin administered through a recently developed subcutaneous peritoneal access device (SPAD). She continued on this regimen during the pregnancy and at 37 weeks was delivered of a normal baby by Caesarian section. During her pregnancy, she had 2 episodes of infection of the SPAD, which were rapidly controlled by local instillation of antibiotics. Her diabetes remained under excellent control (HbA1: 7.3–7.5%) throughout her pregnancy. This case demonstrates that in such patients i.p. administration of insulin through a SPAD is a feasible mode of management during pregnancy.
Pregnancy after Vitrectomy for Proliferative Diabetic Retinopathy
Authors: Young L. B. , Steel J. M. , West C. P. , Chawla H. B.
Published: July 2009

A 26‐year‐old female with insulin‐dependent diabetes of 16 years duration had a vitrectomy for a dense non‐resolving vitreous haemorrhage. Two months later she became pregnant. She delivered a healthy baby and despite the known adverse effects of pregnancy on retinopathy no deterioration occurred in visual acuity or in retinal appearance.
Continuous Subcutaneous Insulin Infusion in Children
Authors: de Beaufort C. E. , Bruining G.J.
Published: July 2009

Insulin‐dependent diabetes mellitus usually presents in childhood. Since it is generally accepted that persisting metabolic derangements contribute to the development of microand macrovascular complications, a primary aim of the management of children with diabetes is to achieve near normalization of metabolism. In adults continuous subcutaneous insulin infusion (CSII) has been used to optimize control. Despite a reluctance amongst paediatricians to use CSII in children, several studies with pumps have been performed in adolescents. The results of these studies are contradictory with respect to acceptability and achieved metabolic control. Thus, some authors report a near normilization of blood glucose concentrations, whereas others only find a temporary improvement. Patient selection seems to account for many of these differences. This suggests that methods ought to be developed to predict success or failure of CSII in a particular adolescent patient. For diabetic toddlers with their age‐specific problems CSII may be a therapy of choice. So far, good acceptability and improved metabolic control are reported in this group. More studies are needed to confirm this. It is important that the diabetic clinic as well as the patient is organized to a high standard before starting CSII. Home blood glucose measurements, education, and a 24‐h telephone service are essential factors for the management of diabetic children, treated conventionally or with CSII.
Low Dose Guar in a Novel Food Product: Improved Metabolic Control in Non‐insulin‐dependent Diabetes
Authors: Peterson D. B. , Ellis P.R. , Baylis J. M. , Fielden P. , Ajodhia J. , Leeds A. R. , Jepson E. M.
Published: July 2009

Sixteen non‐insulin‐dependent diabetic patients, mean age 60 years (range 47–69 years) and duration of diabetes 9 years (2–20 years), completed a randomized cross‐over study of three 6‐week periods separated by 2‐week intervals to minimize carry‐over effects, in which their usual bread was replaced by either control bread, guar bread (100 g guar/kg wheat flour), or control bread plus a guar granulate. The mean (± SEM) intake of guar taken in bread was 7.6 ± 0.7 g/day (range 3.1–14.3 g/day). The granulate was taken in a dose of 5 g twice daily which provided 8.3 g guar/day. Significant reductions were found in glycosylated haemoglobin after guar bread (11.5 ± 0.8% to 10.7 ± 0.8%; p< 0.02) and after guar granulate (11.2 ± 0.8% to 10.6 ± 0.7%; p<0.05) compared with control bread. Total cholesterol was also reduced significantly after both guar bread and guar granulate (p<0.01, p<0.02), the changes being due to LDL‐cholesterol. Dietary intakes and body weight did not change. No significant side‐effects were reported; 14 subjects found guar bread more palatable than guar granulate but 8 preferred the granulate for its convenience. We conclude that a lower than convential dose of guar can be effective and palatable. The incorporation of guar into food increases its metabolic benefits and palatability.
Long‐Term Organ Culture of Large Numbers of Human Fetal Pancreata: Analysis of Their Insulin Secretion
Authors: Tuch B. E. , Turtle J. R.
Published: July 2009

Cultured human fetal pancreas has been transplanted into diabetic man in an attempt to cure the metabolic disorder. However, the capacity of large numbers of these organs to secrete insulin in organ culture has not been reported previously. This report sets out the characteristics of 321 human fetal pancreases of gestational age 12–20 weeks obtained over a period of 34 months, 295 of these being maintained in organ culture. Average insulin secretion was constant at 2.22 ± 0.35 mU/plate/day over a 90‐day period, the maximal duration of culture possible. Explants were lost because of infection or reduced insulin secretion.

Practical guidelines for obtaining and maintaining viable explants in culture were established as follows:

Insulin secretion had to be greater than 0.1 mU/plate/day. Secretory rates of this order were associated with a positive insulinogenic response to theophylline.

Prostaglandin induction, suction curettage, and hysterotomy were equally suitable as methods of termination of pregnancy.

The pancreas had to be obtained within 4 hours of termination of pregnancy.

The tissue had to be diced into explants within a further 4 hours.
Measurement by Epigastric Impedance of Gastric Emptying in Diabetic Autonomic Neuropathy
Authors: Gilbey S. G. , Watkins P. J.
Published: July 2009

Changes in impedance across the epigastrium form the basis of a new non‐invasive method of assessing gastric emptying of liquids. The apparatus is simple to use at the bedside and, in conjuction with conventional investigations, is of value in diagnosing gastroparesis in patients with diabetic autonomic neuropathy and symptoms of recurrent vomiting. We measured gastric emptying of liquids in 22 diabetics aged 33.4 ± 9 years (mean ± SD) with severe symptomatic autonomic neuropathy (mean heart rate variability 4.9 ± 2.2 SD beats/min), and 15 normal controls. Median ‘half emptying’ time in the diabetics with autonomic neuropathy was prolonged overall but it was not always abnormal (12.25 min, range 6.5‐>30 compared to 8.0 min, range 3–17; p<0.01). Results in five diabetics with symptoms of recurrent vomiting corresponded with those using conventional radiological methods, confirming gastroparesis in three instances and excluding it in two. The effect of metoclopramide was also studied and was shown to accelerate gastric emptying in some but not all of the patients. Assessment of gastric emptying using the impedance method assists in establishing the diagnosis of gastroparesis and is of value for repeated measurements.
Screening for Diabetes in Pregnancy: Is a random blood glucose enough?
Authors: Jowett N. I. , Samanta A. K. , Burden A. C.
Published: July 2009

It has been suggested that a single random blood glucose measurement, timed in relation to food, can be used to determine those women needing a formal oral glucose tolerance test for the detection of gestational diabetes. One hundred and ten pregnancies have been screened to compare the results of a formal oral glucose tolerance test with timed venous plasma glucose measurements taken throughout the day. At the suggested thresholds of 6.1 mmol/l (within 2 h of eating) and 5.6 mmol/l (at greater than 2 h of food), random blood glucose testing is specific and excludes most normal women. However, the sensitivity of the test is low, and the majority of those with impaired glucose tolerance would be missed. Random blood glucose measurement is not a sufficiently sensitive method for detecting gestational diabetes as presently defined.
Abnormal Cerebrovascular Carbon Dioxide Reactivity in People with Diabetes
Authors: Griffith D. N. W. , Saimbi S. , Lewis C. , Tolfree S. , Betteridge D. J.
Published: July 2009

Cerebral blood flow was measured both under conditions of normocapnia and hypercapnia in 22 diabetic patients and 20 normal control subjects, using either the intravenous 133Xe method or the closely comparable 133Xe inhalation method. While 19 out of 20 control subjects responded appropriately to hypercapnia with an increase in flow, eight of the diabetic patients failed to respond normally, this difference being significant (p = 0.03). Those manifesting an abnormal response included young, insulin‐dependent patients with a short duration of diabetes and no clinical evidence of complications.
Plasma Immunoreactive Somatostatin is Elevated in Diabetic Ketoacidosis and Correlates with Plasma Non‐esterified Fatty Acid Concentration
Authors: Binimelis J. , Webb S. M. , Serrano J. , Codina M. , Corcoy R. , Perez A. , Peinado M. A. , Puig M. , de la Torre W. , Serrat J. , Gomez J. A. , Casamitjana R. , de Leiva A.
Published: July 2009

In experimental diabetes and after the administration of β‐hydroxybutyrate and non‐esterified fatty acids (NEFA), an increase in circulating immunoreactive somatostatin (IRS) has been described. Both ketones and NEFA are raised in diabetic ketoacidosis. Therefore, we decided to investigate 10 patients in diabetic ketoacidosis by measuring, on admission and throughout the initial 24 hours of therapy, circulating levels of IRS, β‐hydroxybutyrate, acetoacetate, triglycerides, blood glucose, pH and NEFA. Fluids and insulin were administered IV following a previously established protocol. Nine patients showed abnormally high levels of circulating IRS. When compared with a group of controlled insulin‐dependent diabetic patients, basal IRS was high (111 ± 15 vs 28 ± 3 pmol/l), and remained elevated for at least 24 h despite clear improvement of metabolic status. On admission we also found elevated levels of NEFA (1.04 ± 0.2 mmol/l), triglycerides (4.7 ± 1.1 mmol/l), β‐hydroxybutyrate (22.1 ± 4mmol/l), and acetoacetate (4.8 ± 1.1 mmol/l). A significant correlation was found initially between IRS and NEFA (p<0.01). We conclude that circulating IRS is high in most cases of diabetic ketoacidosis. The mechanism behind this hypersomatostatinaemia could be related to the abnormalities of lipid metabolism which occur in diabetic ketoacidosis.