bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating a Learning Device for Juvenile Diabetic Children
Authors: James V Heston , Susan J Lazar
Published: March 2007

The purpose of this study was to determine if knowledge of diabetes could be increased through use of a learning device designed for insulin-dependent diabetic children, aged 7–12 yr. The instrument, consisting of a book and game, combines cognitive and affective elements to provide diabetic information and to reinforce and to evaluate this knowledge in subjects. Serial exposure to the instrument resulted in a significant increase in knowledge and retention of information in 26 experimental subjects. Five subjects receiving one teaching intervention showed an initial increase in knowledge, but without reinforcement, demonstrated minimal retention. Six control subjects, receiving no intervention, showed no increase in knowledge.
Insulin Allergy: Differences in the Binding of Porcine, Bovine, and Human Insulins with Anti-Insulin IgE
Authors: Kumar Dinesh
Published: March 2007

We investigated in vitro binding of insulins of various species sources (bovine, porcine, and human) with anti-insulin reaginic immunoglobulins (IgE) in 10 patients with systemic insulin allergy and in 5 nonallergic but insulin-resistant cases. Anti-insulin IgE had a higher avidity for bovine compared with porcine insulin in both groups. Avidity for bovine insulin was also significantly higher compared with human or desalanine porcine insulin in the insulin-allergic patients. These observations provide a rationale for using porcine insulin in the treatment of systemic insulin allergy.
Maturity-Onset Diabetes of the Young: An Illustrative Case for Control of Diabetes and Hormonal Normalization with Dietary Management
Authors: Lawson Virginia K , Young Ruth T , Kitabchi Abbas E
Published: March 2007

The efficacy of diet therapy used for one patient with the newly classified maturity-onset diabetes of the young (MODY) is reported. Using the conventional American Diabetes Association's food exchange system with appropriate caloric restriction, the patient's weight was reduced from 25% to 6% above ideal body weight in the 14-wk study. Results of three meal tolerance tests compared with a group of lean, normal subjects revealed a steady improvement from baseline and postprandial hyperglycemia, with concomitant normalization of the counterregulatory hormones as well as hemoglobin A1, free fatty acids, and subsequent euglycemia. This case demonstrates the effectiveness of dietary manipulation as the major therapy in MODY with obesity.
Nucleated Red Blood Cells and Artifactual Hypoglycemia
Authors: Macaron Chamel I , Kadri Adei , Macaron Zoubeida
Published: March 2007

A patient with chronic hemolytic anemia presented with an acute hemolytic crisis, a high count of nucleated red blood cells (NRBC), and artifactual hypoglycemia. Temporal events showed a parallel relationship between an increased number of nucleated RBCs and an excess in vitro consumption of glucose.
Pharmacokinetics of Biosynthetic Human Insulin and Characteristics of Its Effect
Authors: Bottermann P , Gyaram H , Wahl K , Ermler R , Lebender A
Published: March 2007

In the last 2 years we have developed1 a new method for determining insulin biologic activity with the help of the glucose-controlled insulin infusion system (GCIIS). Primarily this closed-loop system infuses insulin. But to prevent hypoglycemia, it can in addition, infuse glucose below a certain blood glucose minimum. This effect is used to reproduce insulin biologic activity. After subcutaneous injection of the insulin to be tested in healthy persons (not in insulin-dependent diabetic subjects), the blood glucose level falls, and this is checked by the counterregulatory glucose delivery from the apparatus. The time and intensity of glucose delivery from the GCIIS reflect the insulin effect, so that each insulin manifests its own particular biologic activity.
Biosynthetic Human Insulin: Effect in Healthy Men on Plasma Glucose and Non-Esterified Fatty Acids in Comparison with Highly Purified Pork Insulin
Authors: Viberti G C , Pickup J C , Keen H , Bilous R W , Mattock M , Jarrett R J , Glynne A , Rogers R
Published: March 2007

Biosynthetic human insulin (BHI) produced by recombinant DNA technology was administered subcutaneously and intravenously at two dose levels to two groups, each consisting of six normal men. Responses were compared with those for purified pork insulin (PPI) given by the same routes at the same dose levels to the same two groups. The glycemic response to the insulins was similar with a suggestion (seen both with intravenous and subcutaneous administration) that the glycemic depression with BHI was slightly greater at low dose and less at high dose. No significant difference between insulin types was found in the depression of non-esterified fatty acid (NEFA) concentrations, although significant differences between types with low-dose subcutaneous injection emerged during the later phases of the experiment. After termination of high-rate infusion with both insulins, NEFA concentrations rose more rapidly with some overshoot, suggesting that the rate and depth of blood glucose fall in these experiments might have triggered a brisker counterregulatory response. The small differences found between human and pork insulins, although in some cases significant, are unlikely to be of clinical importance.
Internalization of 125I-Insulin by IM-9 Cultured Human Lymphocytes: A Comparison Between A14-Monoiodo-Pork and Biosynthetic Human Insulin
Authors: Carpentier Jean Louis , Halban Philippe A , Renold Albert E , Orci Lelio
Published: March 2007

Human insulin synthesized from A- and B-chains separately produced in Escherichia coli from cloned genes was characterized by examining its interaction biochemically and morphologically with IM-9 cultured human lymphocytes. Biosynthetic human insulin (BHI) behaves similarly to pork insulin with respect both to its binding properties and to the rate and magnitude at which it is internalized by the cells.
Potency of Biosynthetic Human Insulin Determined In Vitro
Authors: Fussgaenger R D , Ditschuneit H H , Martini H , Lenardis H Wiebauer-De , Etzrodt H , Thun Ch , Ditschuneit H , Pfeiffer E F , Enzmann F
Published: March 2007

Biosynthetic human insulin (BHI) obtained from separately synthesized A- and B-chains by recombinant DNA technology with Escherichia coli fermentation was compared with human and pork insulin of high purity in vitro. Applying four biologic tests (glucose oxidation and glucose incorporation into the lipids by rat epididymal fat pads, inhibition of lipolysis, and ATP depletion of isolated fat cells) and three receptor assays (binding competition with human fat cells, IM-9 lymphocytes, and rat liver cell plasma membranes), we could not discern significant differences of the half-maximum response by these seven methods. The only variance occurred with the ATP-depletion assay. This method disclosed 10% greater maximum reversion of isoproterenol-induced ATP depletion by BHI when compared with pork insulin.
Factors Affecting the Educational Diagnosis of Diabetic Patients
Authors: Davis Wayne K , Hull Alan L , Boutaugh Michele L
Published: March 2007

An accurate determination of the educational needs of diabetic patients is based on a wide range of patient characteristics. In the development of an assessment instrument to determine the educational needs of patients, the relative importance of numerous patient characteristics was determined. A questionnaire was mailed to 1518 health professionals who are either members of the American Association of Diabetes Educators or community health nurses in the state of Michigan. Analyses of the responses to this questionnaire have provided information regarding the knowledge, psychosocial, and demographic characteristics of patients, which are thought to be important in an educational diagnosis. Questions to measure these identified characteristics will be incorporated into an instrument that will assess the educational needs of diabetic patients.
Receptor Depletion in Diabetes Mellitus: Correction with Therapy
Authors: Eaton R P , Galagan R , Kaufman E , Allen R C , Russell Linda , Miller Frank
Published: March 2007

This report describes two patients with diabetes mellitus, presenting with insulin resistance and depression of erythrocyte insulin receptor binding to less than one-third of normal. Scatchard analysis of the data was consistent with a depletion in insulin receptors in these poorly controlled diabetic patients. Therapy with tolbutamide and reduced insulin administration resulted in restoration of erythrocyte receptor binding, clinical resolution of the insulin resistance, and amelioration of hyperglycemia. These data suggest a role for transient depletion and/or dysfunction of cellular receptors of insulin activity in the evolution of insulin resistance in diabetes.
Algorithms for Adjustment of Insulin Dosage by Patients Who Monitor Blood Glucose
Authors: Skyler Jay S , Skyler Denise L , Seigler Deborah E , O'Sullivan Mary Jo
Published: March 2007

Patient self-monitoring of blood glucose is a useful adjuvant to diabetes therapy that facilitates improved glycemic control when used as part of an intensive diabetes management program that includes careful balancing of food intake, energy expenditure, and insulin dosage. This paper describes an approach by which patient-determined blood glucose measurements may be used to attain and maintain glycemic control. The patient is provided with a set of algorithms by which minor adjustments in a therapeutic routine may be made to achieve the desired control.
Self-Monitoring of Blood Glucose Without a Meter
Authors: Birch Kjeld , Hildebrandt Per , Marshall Michael O , Sestoft Leif
Published: March 2007

We studied the reliability of the Chemstrip system in the self-monitoring of blood glucose by diabetic patients. A total of 453 blood glucose values obtained by 38 diabetic patients using Chemstrip were compared with the glucose values of the same blood samples measured with a conventional laboratory method. We found a definite tendency at concentrations <320 mg/dl for patient-read Chemstrip values to be too low. Also, we found a wide range in laboratory values corresponding to a given patient-read Chemstrip value. However, a better agreement between Chemstrip and laboratory values was obtained when the Chemstrips were read by trained staff. We recommend, therefore, that the use of Chemstrip in the self-monitoring of blood glucose can be restricted to patients who have shown competence in the use of Chemstrip during prior testing.
Diabetic Management in Patients with Renal Failure
Authors: Amico Janet A , Klein Irwin
Published: March 2007

The management of diabetes in patients with renal disease requires understanding of the multiple changes in carbohydrate metabolism that accompany renal failure. A decrease in insulin requirements may occur due to changes in insulin clearance or insulin metabolism. With the onset of uremia, a peripheral resistance to insulin action develops that often requires increased insulin administration, and this resistance can be expected to improve with adequate dialysis. Hypoglycemia may occur as a result of decreased gluconeogenesis, excessive insulin action, or decreased caloric intake. Thus, the treatment of diabetes in the settings of renal failures involves anticipation of changes in insulin sensitivity and insulin dosages. An overall management plan that coordinates diet, insulin, and dialysis where appropriate is most likely to yield optimum diabetic care.
Plasma Lipids and Microangiopathy in Insulin-dependent Diabetes Mellitus
Authors: Eckel R H , McLean E , Albers J J , Cheung M C , Bierman E L
Published: March 2007

The relationship of plasma levels of high density lipoprotein (HDL) cholesterol, apolipoproteins A-I and A-II (the major apolipoproteins in HDL), low density lipoprotein (LDL) cholesterol, triglyceride, and glucose to microangiopathy was evaluated in 49 insulin-dependent diabetic subjects. Although the HDL cholesterol/LDL cholesterol ratio (a risk determinant for macroangiopathy) was lower in women with proteinuria, no other relationships between HDL cholesterol or the A apolipoproteins and renal microangiography were found. The only independent association between HDL and retinal microangiopathy was found in women, where an inverse correlation was found between the apo A-I/apo A-II ratio and the number of microaneurysms (rs = −0.561, P < 0.05). Men showed strong relationships of glucose, triglyceride, cholesterol, and LDL cholesterol to renal microangiopathy whereas women, in general, had stronger correlations of these variables with retinal microangiopathy. Thus, several alterations in lipoprotein cholesterol distribution and HDL composition are associated with diabetic microangiopathy. In addition, differences between sexes suggest that previously undescribed hormonal factors may influence the severity of this process.
Antibodies to Viruses and to Pancreatic Islets in Nondiabetic and Insulkin-dependent Diabetic Patients
Authors: Palmer Jerry P , Cooney Marion K , Crossley Jeannette R , Hollander Priscilla H , Aspli Christopher M
Published: March 2007

Autoimmunity is frequently involved in the pathogenesis of insulin-dependent diabetes, and viral infections have been implicated in some cases. We have investigated the possibility that islet cells and viruses share antigenic determinants with the result that antiviral antibodies would cross-react with islet cells. Antibody titers to Coxsackie B2, B3, B4, and B5, Influenza A and B, and mumps viruses were compared with islet cell antibody (ICA) titers in newly diagnosed insulin-dependent diabetic patients and in some diabetic patients followed prospectively for 1 yr postdiagnosis. Nondiabetic patients, with cultureproven Coxsackie B4 infections and large rises in Coxsackie B4 antibody titers, were evaluated for islet cell antibodies. No relationship between ICA and viral antibody titers was found either in diabetic or nondiabetic patients. We conclude that it is unlikely that islet cells and the viruses tested share antigenic determinants and other mechanisms relating viral infection and autoimmunity in insulin-dependent diabetes must be sought.
Family Characteristics of Diabetic Adolescents: Relationship to Metabolic Control
Authors: Anderson Barbara J , Miller J Philip , Auslander Wendy F , Santiago Julio V
Published: March 2007

This research compares the family environments of diabetic adolescents in good (HbA1c < 10), fair (10 ≥ HbA1c ≤ 14), and poor (HbA1c > 14) control. Fifty-eight adolescents diagnosed with type I diabetes and their parents (mothers) were independently assessed with structured interviews, the Moos Family Environment Scale, and adolescents also completed the Piers-Harris Children's Self-Concept Scale. As compared with adolescents in poor control, those in good control reported fewer diabetes-related symptoms and had less anxiety and a more positive self-concept. Well-controlled youths also reported more cohesion and less conflict among family members. More parents of well-controlled youths stated that family members were encouraged to behave independently. In addition, more parents of poorly controlled adolescents believed that diabetes had negatively affected the child's personality, physical well-being, schooling, and participation in activities away from home. These findings suggest a complex interplay between the diabetic adolescent's psychological and physical functioning, metabolic control, and the family environment.
Elevation of IgA Levels in the Non-insulin-dependent (Type II) Diabetic Patient
Authors: Gill Charles W , Stephen Bush W , Burleigh William M , Cooke-Gomes Deborah
Published: March 2007

Serum immunoglobulin (G, A, M) levels were performed on 66 patients with non-insulin-dependent (type II) diabetes mellitus (NIDDM). When compared with 30 age-matched normal controls and 32 hospitalized controls there was no significant difference between the mean IgG and IgM levels. The IgA levels were significantly higher (P < 0.005) in the diabetic group when compared with both control groups. This is true regardless of age, sex, duration of disease, and type of treatment (insulin/diet or oral hypoglycemic agents and/or diet). Thirty-six percent of the diabetic patients' IgA levels exceeded the mean ± 2 SD of the normal control group. There were no significant differences in immunoglobulin levels between insulin-treated and non-insulin-treated diabetic groups. Since diabetic patients may have a number of secondary diseases, attempts were made to correlate the most common of these (acute and/or chronic bacterial infections, hypertension, arteriosclerotic heart disease, and diabetic neuropathy) with elevated IgA levels. Only IgA levels of diabetic patients with infections versus diabetic patients without infections were significantly different (P < 0.05). However, IgA levels of uninfected diabetic patients remained significantly higher than those of normal controls (P < 0.005), hospitalized controls (P < 0.01), and hospitalized controls with bacterial infections (P < 0.005). Possible reasons for the isolated elevations of IgA are discussed.
Antibody Response to Pneumococcal Polysaccharides in Insulin-dependent Diabetes Mellitus
Authors: Lederman Michael M , Rodman Harvey M , Schacter Bernice Z , Jones Paul K , Schiffman Gerald
Published: March 2007

Twenty-one insulin-dependent diabetics and 11 healthy control children were immunized with polyvalent pneumococcal polysaccharide vaccine. Serum antibody to pneumococcal polysaccharides was measured by radioimmunoassay before and after immunization. Although there were some differences in type-specific antibody concentrations between diabetic and control subjects, the overall antibody concentrations preimmunization, 3–4 wk postimmunization, and 6–7 wk postimmunization were similar in both populations. In both groups antibody response to immunization correlated strongly with preimmunization antibody concentration. Among the diabetic subjects there was no correlation between antibody responses and duration of disease, insulin dose, or concentration of glycosylated hemoglobin. Insulin-dependent diabetic subjects have a serum antibody response to pneumococcal polysaccharides equivalent to that of controls, and in both populations the magnitude of the antibody response correlates with preimmunization antibody levels.
Diabetes in Kentucky
Authors: Leichter Steven B , Hernandez Carlos , Fisher Ansella , Collins Peggy , Courtney Anita
Published: March 2007

A state diabetes commission and university diabetes program in Kentucky jointly studied the social and economic impact of diabetes mellitus and its complications on the Commonwealth. This investigation revealed that diabetes was a more serious public health problem than previously supposed. Active, diagnosed diabetes afflicts 4.4% Kentucky's population. Less severe clinical and “borderline” forms of diabetes affect an additional 2.4%. Diabetes is especially prevalent in Appalachian regions and in rural, Western Kentucky. In contrast, its prevalence in Lexington, the second-largest city, is 2.7%, similar to the current, estimated national prevalence. Diabetes is the leading cause of hospitalization by disease, and costs approximately $98,800,000 to $135,000,000. Previous estimates of these social and economic losses were lower, partly because they failed to account for the impact of diabetic complications. An average of 5.23% of all hospitalized Kentuckians have diabetes. Specific services for diabetes care, including organized patient education programs, social or psychological counseling, and preventive foot care, were offered by less than 8% of accredited Kentucky hospitals. This study demonstrates the disparity between need and available services, particularly preventive services, for diabetes care in the health care system.
Effect of Acarbose on the 24-Hour Blood Glucose Profile and Pattern of Carbohydrate Absorption
Authors: Taylor Rodney H , Jenkins David J A , Barker Helen M , Fielden Hashmein , Goff David V , Misiewicz J J , Lee Donald A , Allen H Brian , MacDonald Garry , Wallrabe Horst
Published: March 2007

Acarbose (Bay g 5421) is a powerful α-glucoside hydrolase inhibitor of potential value in the treatment of diabetes and hypoglycemic dumping syndrome after gastric surgery. The extent of its use may be limited by symptoms produced by carbohydrate malabsorption. To minimize these, the action of low doses of acarbose on 24-h blood glucose profiles and hydrogen evolution have been studied on four ambulant volunteers on control diets, after exclusion of sucrose and also after addition of guar in an attempt to enhance the therapeutic effect. Replacement of dietary sucrose by starch abolished significant hydrogen evolution in the morning after low doses of acarbose but did not reduce its effectiveness in decreasing the mean three-meal blood glucose area by 41% (P < 0.002). Addition of hydrated guar to this diet reduced the mean three-meal glucose area after acarbose further by 72% (P < 0.001) but increased hydrogen evolution. The results suggest that acarbose will be both effective and acceptable given at low dose when the dietary carbohydrate is starch.
Enzymatic Glucose Electrodes
Authors: Guilbault George G
Published: March 2007

Enzymatic electrodes are described for the specific and sensitive determination of glucose in blood. The probes are based on the conversion of B-D-glucose by glucose oxidase chemically attached to the surface of a Pt electrode. The peroxide liberated is sensed by measurement of the current generated at +0.7 volts vs. S.C.E. The enzyme, chemically attached to pig intestine via glutaraldehyde coupling is quite stable for months, even at room temperature. Other glucose electrodes developed at the University of New Orleans, using Pt (measurement of the O2 consumed at −0.7 volts vs. S.C.E.) and I− probes are also described.
Possibility for an Immobilized Flavin Fuel Cell Electrode for Glucose Measurements
Authors: Wingard Lemuel B
Published: March 2007

Preliminary work is described on the attachment of riboflavin to solid carbon via a coupling group that should provide a pathway for easy electron transfer. Such an approach, when extended to the flavin cofactor portion of glucose oxidase, has the possibility of forming a fuel cell electrode of high specificity for glucose and in which the current would be related to the concentration of glucose.
Measurement of Glucose Concentration in the Presence of Coreactants with a Platinum Electrode
Authors: Lerner Harry , Soeldner J Stuart , Colton Clark K , Giner Jose
Published: March 2007

An implantable glucose sensor is being developed that is based on the use of a high-area platinum electrode. The sensor is operated in a controlled potential mode, in which the potential of the platinum working electrode versus an unpolarized reference electrode is periodically varied according to a preselected voltage-time regimen. The change in potential is accompanied by a flow of current between the platinum working electrode and a counter-electrode. This current serves to periodically rejuvenate the electrode surface and to provide a signal that is proportional to the glucose concentration. A method for analyzing this signal has been developed, the compensated net charge (CNC) method, that involves integration of the current over one complete potential cycle. This method significantly improves both the sensitivity and selectivity for determining glucose in the presence of the normal physiologic coreactants. For a solution containing glucose, amino acids, and urea, a change in glucose concentration from 50 to 150 mg/dl gives about a 50% change in the net charge. A change in the urea concentration from 20 to 40 mg/dl has no effect on the net charge. A change in the amino acids concentration from 35 to 65 mg/dl has little effect on the net charge above a glucose concentration of about 100 mg/dl. Negligible effects on the net charge have also been found for creatinine (0–1.5 mg/dl) and uric acid (0–4 mg/dl).
Amperometric Glucose Sensor: Short-Term, In Vivo Test
Authors: Lewandowski Jan J , Szczepańska-Sadowska Ewa , Krzymień Janusz , Nalxecz Maciej
Published: March 2007

The influence of selected physiologic coreactants on current-voltage scans of a (Pt-pvc) Pt electrode (the working electrode of the amperometric glucose sensor) was tested. It was shown that the electrode is sufficiently sensitive to glucose even in a case when a strong interference of tested substances was observed. On the basis of the preliminary in vivo measurements it was concluded that after the proper pretreatment, the amperometric glucose sensor can be used for short-term blood glucose monitoring.
Affinity Sensor: A New Technique for Developing Implantable Sensors for Glucose and Other Metabolites
Authors: Schultz Jerome S , Mansouri Sohrab , Goldstein Irwin J
Published: March 2007

We describe affinity sensors for monitoring various metabolites in blood plasma by optical means. The principle of detection is similar to that used in radioimmunoassays and is based on the competitive binding of a particular metabolite and a fluorescein-labeled analogue with receptor sites specific for the metabolite and the labeled ligand. This concept has been directed toward the development of an affinity sensor for glucose. Concanavalin A, a protein with specific binding character for glucose, was immobilized on the inside surface of a hollow dialysis fiber. Fluorescein-labeled dextran was selected as the competitive labeled ligand. The molecular weight cutoff of the dialysis fiber is low enough to completely retain the 70,000 MW dextran within the fiber lumen while glucose can freely pass through the dialysis membrane. The sensor is completed by inserting a single optical fiber in the lumen of the dialysis fiber, thus allowing measurement of the unbound FITC-dextran. Preliminary tests of the sensor indicated the feasibility of the approach. Sensitivity to glucose in the physiologic range was obtained, but further work will be required to optimize the sensitivity and response time of the sensor.
Noninvasive Glucose Monitoring of the Aqueous Humor of the Eye: Part II. Animal Studies and the Scleral Lens
Authors: March Wayne F , Rabinovitch B , Adams Robert L
Published: March 2007

We have discussed the nature of a scleral lens that will allow us to follow changes in aqueous humor glucose levels in animals by a method based on optical rotation and a technique described in an earlier paper. We have shown how this lens can be micro-miniaturized and can be used in humans as a non-in-vasive glucose monitor. We have described preliminary experiments designed to show the correlation between the blood glucose assay (BGA) and the aqueous humor glucose concentration as determined by chemical assay (AGA) and by optical rotation determination (ARD). The last mentioned has been obtained by paracentesis directly into a microcell used in conjunction with instrumentation capable of measuring optical rotations as low as 0.0013° (4.5″) corresponding to 20 mg/dl glucose with a sensitivity of 0.0001° (0.36″). The variability among normal rabbits as a function of individuality and diurnal changes is described, and the correlation beteen AGA and ARD shown to be essentially 1.0. Such rabbits are examined when undergoing very rapid decreases in BGA (insulin treatment) or very rapid increases in BGA (bolus of glucose). The AGA and ARD are shown to lag behind the BGA, and this is discussed in terms of the rate of change of BGA with respect to time and its concomitant change in AGA/ARD as well as a simple procedure that would materially reduce this lag.
A Developmentally Staged Curriculum for Teaching Self-Care to the Child with Insulin-dependent Diabetes Mellitus
Authors: Kohler Elaine , Hurwitz Linda S , Milan Deborah
Published: March 2007

A developmentally staged curriculum has been designed to teach children with insulin-dependent diabetes mellitus about their disorder and its care within an organized program of ongoing ambulatory medical care. A preliminary evaluation of the teaching program based on this curriculum indicates that self-care skills are mastered but that the implementation of self-monitoring aspects decreases during adolescence. A survey of a sampling of participants indicates that interest in the program also declines with adolescence. However, the majority had positive responses at all ages and all children and adolescents had positive responses to the experience of being with diabetic peers. The curriculum is presented to help organize the appropriate teaching of diabetes care to children and adolescents.
The Role of Behavior in Diabetes Care
Authors: Surwit Richard S , Scovern Albert W , Feinglos Mark N
Published: March 2007

The treatment of people with diabetes mellitus almost always involves an effort on the part of the health-care team to impose new patterns of behavior on their patients. Too often this behavior modification is undertaken without any specific attention to factors in the treatment regimen that may enhance or detract from patient compliance. If, however, the treatment of disease is viewed in terms of changes in both physiology and behavior, the importance of intervention aimed at either direct behavioral manipulation of physiology, or alterations of secondary behavior related to the disease and its therapy, becomes apparent. We have reviewed in this paper the current “state of the art” of both direct behavioral treatment of diabetes and techniques to enhance compliance with treatment program.
Profiles of Intermediary Metabolites in Insulki-dependent Pregnant Diabetic Women With or Without Endogenous Insulin Production
Authors: Stangenberg M , Persson B , Fredholm B B , Lunell N O
Published: March 2007

The levels of glucose, free fatty acids (FFA), glycerol, 3-hydroxybutyrate (3-HB), cyclic AMP, and Cpeptide immunoreactivity (CPR) were determined in venous plasma samples taken every half hour during an 8-h period under standardized conditions in 10 insulin-dependent pregnant women. The metabolic profiles were determined in each trimester of pregnancy. The women were divided into two groups, one with (group I: 3B, 1C, and ID according to White's classification) and one without (group II: IB, 3C, and ID) measurable plasma CPR levels. Plasma glucose values were significantly higher (P < 0.01) with greater variability in group II than in group I in the first and second trimesters, while no such difference was found in the third trimester of pregnancy. FFA, glycerol, 3-HB, and cyclic AMP levels were not different between the groups in any trimester of pregnancy. Amniotic fluid CPR was higher and skinfold thickness of the newborn greater in group II than in group I. Neonatal complications occurred only in infants of group II mothers. It is concluded that determination of plasma CPR in diabetic women in early pregnancy could give additional prognostic information to that obtained by the White classification.
Bioavailability of Glipizide and its Effect on Blood Glucose and Insulin Levels in Patients with Non-insulin-dependent Diabetes
Authors: Peterson Charles M , Sims Richard V , Jones Robert L , Rieders Fredric
Published: March 2007

The bioavailability of glipizide, plasma glucose, and insulin levels were measured in seven patients with non-insulin-dependent diabetes mellitus. Glucose and insulin response to three standard meals was measured at 11 identical time points on the day of placebo administration and on the first and 15th day of glipizide administration (mean dose of 8.7 mg glipizide orally per day). The bioavailability profile of glipizide was highly consistent between day 1 and day 15 of administration. On both days, the drug peaked within 1.2–1.8 h and displayed a plasma half-life of between 2.5 and 3.2 h. While insulin levels were significantly (P < 0.05) increased at 4 of 11 time points of day 1, significantly elevated insulin levels were found at one time point on day 15 of glipizide administration. Insulin levels were found to be increased only in the presence of plasma drug concentrations of 200 ng/ml or greater. The hypoglycemic effect of the drug was significantly greater on day 15 than on day 1 of administration, and a significant hypoglycemic effect was noted even when drug levels were undetectable in plasma.
Ultrasonographic Determination of Residual Urine in Diabetic Subjects: Relationship to Neuropathy and Urinary Tract Infection
Authors: Beylot M , Marion D , Noel G
Published: March 2007

The presence of residual urine was determined by postvoid bladder ultrasonography in 37 control subjects and 102 unselected insulin-dependent and non-insulin-dependent diabetic patients. Significant residual volume was detected in 19 diabetic subjects without explanation other than diabetic neurogenic bladder dysfunction in 15. The four others had prostatic hypertrophy. Excluding these four subjects, those with residual urine were slightly older than the others (P < 0.05), but the known duration of diabetes was increased only for the insulin-dependent group (P < 0.05). The presence of residual urine was strongly associated with peripheral neuropathy (P < 0.001). In contrast, of all the manifestations of autonomic failure studied, only impotence (P < 0.01) and decreased pupil motility (P < 0.05) were associated with residual urine. The prevalence of urinary tract infection was higher in women than in men (P < 0.02). This prevalence was increased in the presence of residual urine (P < 0.02) but only for men (P < 0.001).
The Effects of Oral Fructose, Sucrose, and Glucose in Subjects with Reactive Hypoglycemia
Authors: Crapo Phyllis A , Scarlett John A , Kolterman Orville G , Sanders Leonard R , Hofeldt Fred D , Olefsky Jerrold M
Published: March 2007

We have evaluated the acute effects of orally administered 100-g loads of fructose, sucrose, or glucose given as drinks and of 100-g loads of fructose and sucrose given in cakes on the postprandial serum glucose, insulin, and cortisol responses in seven subjects with reactive hypoglycemia. We defined reactive hypoglycemia as a serum glucose nadir of 65 mg/dl or less, symptoms compatible with hypoglycemia occurring at or after the serum glucose nadir, a hypoglycemic index of greater than 1.0, and a rise in serum cortisol to greater than 20 μg/dl after the serum glucose nadir. The data demonstrated that (1) pure fructose given as a drink resulted in relatively flat serum glucose and insulin responses and did not cause a hypoglycemic reaction in any of the subjects, compared with the glucose drink, which caused a hypoglycemic reaction in all subjects; (2) ingestion of pure sucrose as a drink elicited significantly flatter serum glucose and insulin responses than did the glucose drink and was associated with some episodes of chemical hypoglycemia and symptoms, but did not result in a hypoglycemic reaction by our definition in any patient; and (3) ingestion of fructose cake led to serum glucose and insulin responses that were lower than those caused by ingestion of sucrose cake, but ingestion of neither fructose nor sucrose cake led to a hypoglycemic reaction by our definition in any patient. In conclusion, the use of fructose as a sweetening agent given either alone, in a drink, or with other nutrients in a cake resulted in markedly flatter serum glucose and insulin responses in subjects with reactive hypoglycemia. Fructose may thus prove useful as a sweetening agent in the dietary treatment of selected patients with reactive hypoglycemia.
Decreased Insulin Requirement and Improved Control of Diabetes in Pregnant Women Given a High-Carbohydrate, High-Fiber, Low-Fat Diet
Authors: Ney Denise , Hollingsworth Dorothy R , Cousins Larry
Published: March 2007

Five quantitative measures of diabetic control [HbA1c determinations, mean 24-h plasma glucose values, mean amplitude of glycemic excursions (MAGE), mean 24-h urinary loss of glucose, and daily exogenous insulin requirement] were compared in 20 pregnant women who were randomly assigned to either a high-carbohydrate, high-fiber diet (HCF) that was low in fat or to a control diet commonly prescribed for pregnancy. Eleven women followed the HCF diet and nine subjects, the control diet, from baseline entry into the study until delivery. Dietary compliance was excellent, with 78% of the women in each group rated good or acceptable. HbA1c values were similar in both groups at baseline (HCF: 11.0 ± 0.5% versus control: 10.2 ± 0.6%), with no different predelivery values (8.6 ± 0.4%). Mean 24-h plasma glucose levels improved in patients on both diets, with lower values noted in the HCF group at predelivery. MAGE values and standard deviations did not differ significantly in the two groups. Glycosuria decreased markedly in both dietary groups, but differences between groups were not significant. Improved control of diabetes on the HCF diet was achieved with significantly lower increments in insulin dose during gestation (HCF baseline: 32 ± 8 U/24 h to 66 ± 10 U/24 h versus control baseline: 27 ± 9 U/24 h to 108 ± 12 U/24 h, P < 0.03). Outcome of pregnancy did not differ in the two groups of patients, but women on the HCF diet gained less weight than those on the control diet (26 ± 3 lb versus 35 ± 5 lb, P < 0.05). Mean newborn gestational age was similar in the two groups (HCF: 37.2 ± 0.7 wk versus control: 36.5 ± 0.7 wk). Mean birth weight in infants of HCF mothers ± was 3809 ± 248 g versus 3313 ± 278 g in infants of control mothers (P < 0.05). We conclude that although marked improvement of diabetic control occurred on both regimens, patients on the HCF diet achieved better control of diabetes with significantly lower increments in exogenous insulin.
Understanding Diabetes Routines: A Professional Training Exercise
Authors: Warren-Boulton Elizabeth , Auslander Wendy F , Gettinger Jeanine M
Published: March 2007

As part of the continuing education programs conducted at the Washington University Diabetes Research and Training Center, 65 health professionals participated in a 4-day simulation exercise which required them to adhere to a diabetic regimen. Instructions covered injections, urine testing, recording results, and calculating and following a meal plan. Evaluation of the simulation focused on the degree of participant adherence to each component, the problems they encountered, and how the experience influenced their patient/clinician interaction. Mean scores for adherence over the 4-day period for each component of the regimen were injections (82%), diet (67%), urine testing (58%), and recording results (56%). Of the total number of adherence problems encountered by the participants, 52% were diet-related, 17% involved urine testing, 17% time constraints, 10% loss of spontaneity, and 4% involved injections. Analysis of the impact of the experience in the work setting indicated improved participant sensitivity to diabetic patient adherence problems and increased ability to effectively counsel patients and family members.
Use and Abuse of Glucose Reflectance Meters
Authors: Mountier Vivienne M , Scott Russell S , Beaven Donald W
Published: March 2007

All diabetic patients who had been using home glucose monitoring devices during the last 2 yr in the area served by the specialist Diabetes Unit in Christchurch, New Zealand were invited to complete a questionnaire designed to provide information on glycemic control, treatment regimen, and patterns of glucose recording. Questionnaires were completed by 111 of 152 patients, of whom 99% were using insulin. The period of use of reflectance meters was between 1 and 18 mo. Forty-three percent used their meters in a manner considered unsatisfactory and 15% failed to write down results. Those patients recording for the longest periods showed a significant trend to more inefficient use of devices. Forty-four percent still relied on their medical supervisor for treatment changes, but most attended infrequently (mode 12 wk; range 1 – 52 wk). Most frequently, treatment changes were to insulin dose and only onethird had adopted more “physiologic” regimens incorporating rapid-acting insulin. Blood glucose control was not significantly changed from that found in a group of diabetic subjects during the first weeks of monitoring. These results suggest that (1) many patients do not use home glucose monitoring devices in a manner likely to allow rational modification to therapy, (2) neither patients nor family physicians have reacted appropriately to high recorded values, and (3) chronic use of home monitoring has not resulted in good glycemic control for many patients.
Umbilical Cord Glycosylated Hemoglobin in Infants of Diabetic Mothers: Relationships to Neonatal Hypoglycemia, Macrosomia, and Cord Serum C-Peptide
Authors: Sosenko Jay M , Kitzmiller John L , Fluckiger Rudolf , Loo Sherry W H , Younger Donna M , Gabbay Kenneth H
Published: March 2007

Relationships of neonatal glycemia and birthweight to antecedent fetal glycemia and insulinemia have been examined in the offspring of 63 insulin-dependent diabetic and 29 nondiabetic mothers. Glycosylated hemoglobin levels in maternal and cord blood were measured by the thiobarbituric acid (TBA) colorimetric technique to estimate antecedent fetal and maternal glycemia; cord serum C-peptide was assayed to estimate fetal insulinemia. Glycosylated hemoglobin levels were significantly elevated in the diabetic mothers and their offspring as compared with controls (P < 0.001), and maternal and cord blood levels were highly correlated in the diabetic group (r = 0.61, P < 0.001). Cord serum C-peptide and glycosylated hemoglobin levels tended to be associated (r = 0.43, P < 0.10). Hypoglycemic infants of diabetic mothers (IDM) had significantly higher glycosylated hemoglobin levels (A443 nm/10 mg hemoglobin hemolysate) in cord blood (0.173 ± 0.009) than did IDM without hypoglycemia (0.153 ± 0.005, P < 0.01). Macrosomic and nonmacrosomic IDM, on the other hand, did not differ as to their glycosylated hemoglobin levels (0.162 ± 0.005 versus 0.161 ± 0.006, respectively). The occurrence of hypoglycemia was not associated with that of macrosomia (X2 = 0.24, P > 0.10). These data strongly suggest that neonatal hypoglycemia is the result of maternal hyperglycemia in pregnancy and consequent fetal hyperglycemia and hyperinsulinemia. However, maternal hyperglycemia in late pregnancy may not be a sufficient explanation for the development of macrosomia in IDM.
Lente Carbohydrate: A Newer Approach to the Dietary Management of Diabetes
Authors: Jenkins David J A
Published: March 2007

The dietary fiber hypothesis has stimulated interest in the possibility that the glycemic response to carbohydrate foods may be reduced by modifying gastrointestinal events to produce sustained-release or “lente” carbohydrate. Associated with this interest, a new branch of pharmacology has been developed involving the use of purified fiber preparations and enzyme inhibitors. These measures, together with the selection of diets containing foods that naturally release their carbohydrate products of digestion slowly, may contribute a useful facet to diabetic management in the future.
An Evaluation of Patient Performance of and Their Satisfaction with Various Rapid Blood Glucose Measurement Systems
Authors: Fairclough Pamala K , Clements Rex S , Filer David V , Bell David S H
Published: March 2007

We evaluated the performance of 50 insulin-dependent diabetic patients in the measurement of their own capillary blood glucose concentrations using Chemstrip bG, Dextrostix-Dextrometer, and StatTek systems. With all systems, patient performance was suboptimal when compared with the accuracy of paramedical personnel. The percentage of patient determinations that differed from the laboratory value by more than 20% was 37%, 30%, and 14% for the Chemstrip bG, Dextrostix-Dextrometer, and StatTek systems, respectively. Only 39 of the patients (78%) could perform accurately with any system. Youth, lack of a higher education, and lower income status contributed significantly to the patients' inaccuracy with the Chemstrip bG technique, whereas these factors had no effect on patient performance with the reflectance meter techniques. Nearly all of the patients were enthusiastic about the value of home glucose monitoring as a means to assess their glycemic control. However, only 30% of the patients selected for home use a technique at which they were suitably adept. In part, this selection error appeared to be due to the greater cost and inconvenience of the reflectance meter techniques compared with the Chemstrip bG technique. These data indicate that unless proper instruction is provided, home glucose monitoring should only be used by a fraction of insulin-requiring diabetic patients and the choice of a particular system for use by an individual patient should be predicated upon his or her demonstrated proficiency with that system.
Diabetes Mellitus and Optic Atrophy in Two Siblings: A Report on a New Association and a Review of the Literature
Authors: Khardori Romesh , Stephens John W , Page Otto C , Dow Robert S
Published: March 2007

Two siblings with diabetes mellitus and optic atrophy (Wolfram syndrome) are described. As often noted, they also had atonic urinary bladders. Only one of the siblings had some impairment of hearing. Other findings not previously reported that appeared in each subject were esophageal dysphagia and vertigo. An autopsy in one revealed brain stem hypoplasia and thinning and flattening of the optic nerves with atrophy of the lateral geniculate bodies.
Long-Term Ambulatory Peritoneal Insulin Infusion of Brittle Diabetes with Portable Pumps: Comparison with Intravenous and Subcutaneous Routes
Authors: Selam J L , Slingeneyer A , Hedon B , Mares P , Beraud J J , Mirouze J
Published: March 2007

This work compares different routes of insulin infusion via portable pumps with chronically implanted catheters and evaluates the long-term feasibility of the technique. Six severely unstable (i.e., uncontrolled by optimized intensive insulin therapy) diabetic individuals (age range: 35 ± 4 yr; duration: 11 ± 2 yr) were selected. Promedos pumps (Siemens A. G., Erlangen, West Germany) were exclusively used because of their portability and long-life insulin reservoir (1-mo duration with U40 acidic Hoechst insulin). Each patient underwent three randomized 1-mo periods of insulin infusion: subcutaneous (s.c), intravenous (i.v.), and intraperitoneal (i.p.) before the catheter wasleft indefinitely in one of these sites. Diabetic control was improved and insulin doses reduced whatever the route of infusion, although the s.c. route gave slightly higher values. These results did not deteriorate with time: mean blood glucose was 126 ± 3 mg/dl and HbA1 was 8.3 ± 0.6% after 10–18 mo of constant infusion versus 237 ± 35 mg/dl and 10.0 ± 0.8%, respectively, under conventional therapy. From a practical point of view, the i.p. route seems preferable since all s.c. catheters provoked local reactions after < 1 mo and the two chronic i.v. catheters obstructedafter 8 and 9 mo. All other incidents were minor and curable without removal of the catheters. All patients argued improvement of both diabetes and quality of life and no one hasresigned so far. Thus, the i.p. infusion technique seems beneficial to unstable diabetic individuals and adaptable to long-term therapy, although intensive education and careful follow-up are necessary