bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin Production Rate in Normal Man as an Estimate for Calibration of Continuous Intravenous Insulin Infusion in Insulin-dependent Diabetic Patients
Authors: Waldhäusl W K , Bratusch-Marrain P R , Francesconi M , Nowotny P , Kiss A
Published: March 2007

This study examines the feasibility of deriving the 24-h insulin requirement of insulin-dependent diabetic patients who were devoid of any endogenous insulin release (IDD) from the insulin-production rate (IPR) of healthy man (basal, 17 mU/min; stimulated 1.35 U/12.5 g glucose). To this end, continuous intravenous insulin infusion (CIVII) was initiated at a precalculated rate of 41.2 ± 4.6 (SD) U/24 h in IDD (N = 12). Blood glucose profiles were compared with those obtained during intermittent subcutaneous (s.c.) insulin therapy (IIT) and those of healthy controls (N = 7). Regular insulin (Hoechst CS) was infused with an adapted Mill Hill Infuser at a basal infusion rate of 1.6 U/h (6:00 a.m. to 8:00 p.m.), and of 0.8 U/h from 8:00 p.m. to 6:00 a.m. Preprandial insulin (3.2–6.4 U) was added for breakfast, lunch, and dinner. Daily individual food intake totaled 7688 ± 784 kJ (1836 ± 187 kcal)/24 h including 184 ± 37 g of glucose. Proper control of blood glucose (BG) (mean BG 105 ± 10 mg/dl; mean amplitude of glycemic excursions 54 ± 18 mg/dl; and 1 h postprandial BG levels not exceeding 160 mg/dl) and of plasma concentrations of β-hydroxybutyrate and lactate was maintained by 41.4 ± 4.4 U insulin/24 h. Although BG values only approximated the upper normal range as seen in healthy controls, they were well within the range reported by others during CIVII. Therefore, we conclude that in adult IDD completely devoid of endogenous insulin (1) the IPR of normal man can be used during CIVII as an estimate for the patient's minimal insulin requirement per 24 h, and (2) this approach allows for a blood glucose profile close to the upper range of a normal control group. Thus, deriving a patient's daily insulin dose from the insulin production rate of healthy man may add an additional experimental protocol which aids in making general calculations of a necessary insulin dose instead of using trial and error or a closed-loop insulin infusion system.
“Bovine ketosis” in a nondiabetic postpartum woman
Authors: Chernow Bart , Finton Chris , Rainey Thomas G , O'Brian John T
Published: March 2007

A 19-yr-old woman developed ketoacidosis 7 wk after the delivery of her first child. Despite breast feeding, she had been on a weight reduction diet resulting in a loss of 12 kg/body wt. With the development of a urinary tract infection, the patient became dehydrated and was found to be in ketoacidosis (arterial pH was 7.25 and PaCO2 was 17 mm Hg). The patient did not use alcohol and was nondiabetic. Therapy with adequate calories, intravenous fluids, and an appropriate antimicrobial agent resulted in prompt normalization of the laboratory abnormalities and resolution of the patient's symptoms. The hypothesis is advanced that the postpartum status of the patient put her at particular risk for development of ketoacidosis and that this may represent the first reported episode of “bovine ketosis” in a human.
Constant Intravenous Insulin Infusion During Labor and Delivery in Diabetes Mellitus
Authors: Caplan Robert H , Pagliara Anthony S , Beguin Everett A , Smiley Carolyn A , Bina-Frymark Mary , Goettl Kathryn A , Hartigan J Michael , Tankersley James C , Peck Theodore M
Published: March 2007

We treated 30 diabetic women (31 pregnancies) during the peripartum period with a continuous insulin infusion. A mean infusion rate of 1.0 μm/h maintained the mean plasma glucose concentration below 100 mg/dl in 84% of the patients; the plasma glucose concentration was below 100 mg/dl within an hour of delivery in 71% of the women. Mild hypoglycemia developed during the infusion in three women and after delivery in another patient. Only two infants of the diabetic mothers developed transient and asymptomatic hypoglycemia. We conclude that continuous insulin infusion is a practical, safe, and effective method for treating diabetic mothers during the peripartum period and suggest that this technique may decrease the frequency and severity of neonatal hypoglycemia.
Optimizing Pumped Insulin Delivery
Authors: Skyler Jay S , Seigler Deborah E , Reeves Michael L
Published: March 2007

The use of portable devices for the subcutaneous infusion of insulin may facilitate the attainment of improved glycemic control in selected patients with insulin-dependent diabetes mellitus. Successful use of a program of continuous subcutaneous insulin infusion requires patient cooperation and motivation, routine monitoring of glycemia, and attention to food intake and activity. This article describes an approach by which patients may optimize glycemic control utilizing a set of algorithms based on patientdetermined blood glucose measurements. The algorithms permit programing the insulin infusion device to achieve the desired control.
Implanted Electroenzymatic Glucose Sensors
Authors: Clark Leland C , Duggan Carol A
Published: March 2007

The advent of electrochemical sensors for intermittent sampling of blood gases and hydrogen ions in the clinic, intensive care, and surgical units has revolutionized diagnostic and critical care medical technics. The use of electrochemical sensors for continuous transcutaneous monitoring of blood gases is further enhancing the medical surveillance of patients. The more recent introduction of glucose and other electroenzymatic sensors has stimulated broad research in the development of metabolic monitoring.

For the present research, the glucose sensor widely used for the rapid specific micro-analysis of whole blood and plasma is explored for possible use as an in vivo intravascular or tissue-implanted sensor. This sensor is based on the polarographic measurement of hydrogen peroxide generated by glucose oxidase (EC 1.1.3.4) held between two membranes. The first membrane allows the diffusion of glucose, ions, and many other small molecules, while the second membrane allows the diffusion of the glucose-generated hydrogen peroxide to the platinum surface, but excludes ascorbic acid, bilirubin, and uric acid. Such sensors respond rapidly and specifically when acutely implanted subcutaneously in cats and dogs. They function well as glucose-sensor-tipped venous catheters. One sensor was repeatedly used for in vitro polarograms, subcutaneous and blood glucose monitoring, over a period of ten months, with storage in the cold between uses, with the complete retention of its response characteristics.
A Miniature Fiberoptic pH Sensor Potentially Suitable for Glucose Measurements
Authors: Peterson John I , Goldstein Seth R
Published: March 2007

A fiberoptic sensor that we have developed for measuring physiologic pH is a potentially useful model for similar probes for other important applications such as monitoring glucose in the body. A fiberoptic probe has important advantages over an electrode in safety, reliability, applicability, and cost. The pH probe is described, with suggested approaches for making a device for glucose measurement.
Urinary Estriols: Are They of Value in Normoglycemic Diabetic Pregnancy?
Authors: Fern Peter E , Grunert George M , Lewis Stephen B
Published: March 2007

The purpose of the study was to assess the value of 24-h urinary estriols in the management of diabetic pregnancies. Twenty-seven pregnant diabetic patients (White's class B through R) received insulin dosages twice daily as a combination of NPH and regular insulin. Laboratory and home monitored blood glucose was maintained within the range of 70–150 mg/dl. From 32 wk onward daily 24-h urinary estriols, weekly fetal heart rate monitoring, and, when indicated, amniotic fluid lecithin/sphingomyelin ratio were used to evaluate fetal well-being. Fetal heart rate and amniotic fluid testing were of value while urinary estriols failed to be useful in management or timing of delivery. We conclude that when third-trimester normoglycemia is maintained in pregnant diabetic patients, one obviates the need for the costly and odious task of daily urine estriol measurements.
Adult Respiratory Distress Syndrome Complicating Severely Uncontrolled Diabetes Mellitus: Report of Nine Cases and a Review of the Literature
Authors: Carroll Patrica , Matz Robert
Published: March 2007

We report the occurrence of the adult respiratory distress syndrome (ARDS) in association with uncontrolled diabetes in nine patients. In reviewing the literature we found nine similar cases reported in little over a decade. In most cases no condition known to precipitate ARDS was discovered. The evidence suggests that the severely uncontrolled diabetic state in some way may initiate pathologic events leading to the capillary leak of ARDS. This description of the association of these two entities not commonly recognized as occurring simultaneously has important clinical implications: the entity should be anticipated in uncontrolled diabetic patients who present with acidosis, hypotension, hypothermia, and/or coma. The clinical or radiologic diagnosis of pneumonia or fluid overload should not be made in the uncontrolled diabetic patient in the absence of unequivocal evidence of infection or congestive heart failure. The development of dyspnea, hypoxemia, rales, or infiltrates in the otherwise routine resuscitation of these patients should lead the clinician to suspect the development of ARDS. Prompt invasive monitoring in these cases is indicated to aid in their management and may help to improve survival. We found calculation of the A-a gradient to be useful in patients with uncontrolled diabetes. Although not necessarily predictive, widened gradients were the earliest detectable abnormality found in all patients who developed ARDS
Comparison of Plasma Glucose and Plasma Free Insulin During CSII and Intensified Conventional Insulin Therapy
Authors: Buysschaert M , Marchand E , Ketelslegers J M , Lambert A E
Published: March 2007

The plasma glucose and plasma free insulin profiles of six totally insulin-dependent diabetic patients were compared during periods of 4 days in hospital under a conventional insulin therapy (ICIT) comprising 4 daily injections of regular insulin and under continuous subcutaneous insulin infusion (CSII). Two profiles of prandial insulin administration with CSII were compared: a rectangular (R) and an exponential wave (E) in which 50% of the dose was given rapidly followed by an exponential decrease. In both cases, the basal infusion rate was increased by 30–50% between 5 a.m. and 8 a.m. Mean circadian blood glucose was equally good with ICIT: R and E: 7.0 ± 0.9, 7.3 ± 1.0, and 7.1 ± 1.0 mmol/L, respectively. In five patients, fasting plasma glucose was higher with ICIT than with R and E (12.7 ± 1.8 versus 6.9 ± 1.0 and 6.8 ± 0.8 mmol/L, respectively; t test: P < 0.05; Wilcoxon: P = 0.06). Mean plasma free insulin level was significantly higher (t test: P < 0.005; Wilcoxon: P < 0.05) with ICIT (0.46 ± 0.04 nmol/L) than with R (0.37 ± 0.04 nmol/L) or E (0.36 ± 0.05 nmol/L), although the daily doses were similar. In conclusion, CSII leads to a better glycemic control than ICIT, since it appears to prevent the morning rise of blood glucose.
Small Muscle Wasting of the Hands in Diabetes Mellitus
Authors: Borsey David Q , Cull Roger E , Fraser David M , Ewing David J , Campbell Ian W , Clarke Basil F
Published: March 2007

The clinical features and peripheral somatic and autonomic nerve function were studied in 10 diabetic subjects (nine men, one woman; mean age 59 yr, range 41–68 yr; mean duration of diabetes 20 yr, range 8 mo to 33 yr) with generalized small muscle wasting of the hands. Five patients were insulindependent and five non-insulin-dependent. Nine had retinopathy (two proiiferative, seven background), five nephropathy, two ischemic heart disease, and seven peripheral vascular disease. Nine patients Jiad clinical evidence of sensory peripheral neuropathy and absent reflexes in the lower limbs. Eight patients had distal sensory impairment and/or absent reflexes in the upper limbs. Seven had two or more symptoms of autonomic neuropathy. Nerve conduction measurements in the median, ulnar, and lateral popliteal nerves showed that all patients had moderate to severe polyneuropathy affecting both motor and sensory fibers. Nine had one or more abnormal cardiovascular autonomic function tests. Electromyography of affected muscles in the hands showed changes of chronic partial denervation and collateral reinnervation in all cases.
High Prevalence of Echocardiographic Abnormalities in Diabetic Youths
Authors: Lababidi Zuhdi A , Goldstein David E
Published: March 2007

M-mode echocardiography was performed on 107 young insulin-dependent diabetic subjects aged 2 – 24 yr (± SE: 13.8 ± 0.4 yr) and 636 age-group-matched controls. All patients were normotensive and free of cardiorespiratory symptoms. Diabetic patients showed a high prevalence of echocardiographic abnormalities that increased with age. Mean dimensions of the left atrium, right ventricle, and left ventricle (systolic and diastolic) were increased significantly in diabetic individuals (P < 0.01). Hypertrophy of the interventricular septum was present in some patients older than 12 yr of age. Mean interventricular septum excursion was markedly decreased in diabetic individuals compared with controls (3.9 ± 0.1 mm versus 5.6 ± 0.2 mm, respectively; P < 0.01). Fifteen percent of the diabetic patients but none of the controls had septal excursions less than 3 mm (2 SD below mean). Patients with decreased septal excursions showed a higher prevalence of other echocardiographic abnormalities than patients with normal septal excursions. Echocardiographic abnormalities did not correlate with either duration of diabetes or glucose control as assessed by hemoglobin Alc and plasma glucose concentrations at the time of echocardiographic testing. The results show a high prevalence of echocardiographic abnormalities in young diabetic subjects that may represent preclinical cardiomyopathy.
Severe Hypoglycemia During Maximized Insulin Treatment of Diabetes in a Randomized Clinical Trial
Authors: Barbosa Jose , Johnson Sandra
Published: March 2007

Our experience with hypoglycemia during a randomized clinical trial testing the hypothesis of a causal relationship between hyperglycemia and diabetic complications is described. Patients under maximized control experienced hypoglycemia much more often than patients under standard control. There were five episodes of serious hypoglycemia, none of them on pumps, in the former group, but none in the latter. Lack of compliance (or overcompliance) with certain aspects of intensive treatment increases the danger of grave hypoglycemia and should be part of exclusion criteria when considering maximized Control.
Long-Term Use of a High-Complex-Carbohydrate, High-Fiber, Low-Fat Diet and Exercise in the Treatment of NIDDM Patients
Authors: Barnard R James , Massey Manzoor R , Cherny Samuel , O'Brien Lynne Trexler , Pritikin Nathan
Published: March 2007

The purpose of this study was to assess the long-term effects of a high-complex-carbohydrate, high-fiber, low-fat diet and exercise on 69 NIDDM patients. During the initial 26-day program, fasting glucose was reduced from 179.5 ± 10.6 to 133.5 ± 4.0 mg/dl. This decrease in fasting glucose was achieved along with the discontinuation of oral hypoglycemic agents in 24 of 31 patients and of insulin in 13 of 18 patients; one patient was placed on insulin. Serum cholesterol and triglycerides were reduced by 25% and 27%, respectively. At 2–3 yr of follow-up, fasting glucose was not significantly different from the value observed at the end of the 26-day program. Compared with the end of the 26-day program, seven more patients were taking oral agents and four more were on insulin. Exercise and diet inventories obtained at follow-up indicated good compliance to the program and also indicated that the main difference between those patients who went back on medication at follow-up compared with those remaining off medication was the percent of calories derived from fat.
Successful Pregnancy in a Diabetic Patient Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Kioko Ernest M , Shaw Kenneth M , Clarke Anthony D , Warren David J
Published: March 2007

In this article we describe the successful management of pregnancy and delivery in a 26-yr-old patient with advanced diabetic nephropathy and chronic renal failure. Targets for control of blood urea and hemoglobin were achieved with the aid of continuous ambulatory peritoneal dialysis (CAPD). Peritoneal dialysis did not interfere with normal recovery from cesarean section. With CAPD, successful pregnancy is now possible in this group of patients, among whom fetal loss would otherwise be high.
Age-dependent Insulin Secretion of the Endocrine Pancreas In Vitro from Fetuses of Diabetic and Nondiabetic Patients
Authors: Reiher Horst , Fuhrmann Kurt , Noack Silke , Woltanski Klaus-P , Jutzi Erich , Dorsche Herwig Hahn v , Hahn Hans-J
Published: March 2007

Fetal hyperinsulinemia is assumed to play a key role in the pathogenesis of diabetic fetopathy. To investigate the role of enhanced fetal B-cell mass as one cause of fetal hyperinsulinemia during diabetic pregnancy, we studied human fetal pancreatic slices from diabetic women (FDW) with poor metabolic control and nondiabetic women (FNDW) between 11 and 26 wk of pregnancy, morphometrically and by in vitro incubation experiments. Abortions had been performed due to different medical indications. We found a good correlation between the calculated B-cell mass and the gestational age in both FDW and FNDW, but the increase in FDW was much more pronounced. Such a correlation was also found in vitro regarding the insulin response to glucose and IBMX. The FDW had significantly higher values than FNDW of the same age range. In contrast to this, we found in two diabetic patients with tight metabolic control during the whole pregnancy results similar to those in FNDW. Therefore, we assume that it could be possible to prevent fetal hyperinsulinemia and perhaps even diabetic fetopathy in diabetic women by tight metabolic control during the whole pregnancy, but further investigations are necessary.
Urinary C-Peptide as a Measure of Beta-Cell Function After a Mixed Meal in Healthy Subjects: Comparison of Four-hour Urine C-Peptide with Serum Insulin and Plasma C-Peptide
Authors: Hoogwerf Byron J , Barbosa Jose J , Bantle John P , Laine Dawn , Goetz Frederick C
Published: March 2007

Urinary C-peptide (UCP) is a noninvasive measure of integrated insulin production, and the usefulness of 24-h collections has been previously reported. Only small numbers of subjects have been studied using shorter urine collections. To see how well 4-h urine collections for C-peptide (UCP) correlate with serum immunoreactive insulin (SI) and plasma C-peptide (PCP), we studied 41 healthy subjects (19 men, 22 women) using as a stimulus a 600-kcal mixed meal and the same mixed meal after oral prednisone. UCP values correlated best with the area under the curves for SI (γ = 0.457, P < 0.001) and PCP (γ = 0.557, P < 0.001). UCP was also significantly correlated with peak SI (γ = 0.382, P < 0.001), peak PCP (γ = 0.496, P < 0.001), fasting SI (γ = 0.297, P = 0.007), and fasting PCP (γ = 0.341, P = 0.007) values. Urinary C-peptide was significantly correlated with SI and PCP concentrations in a broad range of physiologic values for SI and PCP supporting the usefulness of UCP as a simple, noninvasive measure of beta-cell function. Four-hour collections for UCP may be useful in further studies of beta-cell function.
Glycosylated Serum Albumin: An Intermediate Index of Diabetic Control
Authors: Jones Ian R , Owens David R , Williams Sheila , Ryder Robert E J , Birtwell Anthony J , Jones Martin K , Gicheru Kimani , Hayes Tom M
Published: March 2007

Glycosylated hemoglobin (HbA1) is widely used as an index of glycemic control in diabetic patients. However, due to the long survival time of erythrocytes (120 days), it remains elevated for several weeks after improved control. Other plasma proteins are similarly glycosylated, and as glycosylated serum albumin (GSA) has a shorter half-life (20 days), it should detect glycemic changes earlier. Fasting blood glucose (FBG), GSA, and HbA1 were measured weekly in newly diagnosed diabetic patients (N = 12) for 8 wk after beginning treatment. After 4 wk, a similar fall in FBG and GSA levels, i.e., 72% and 58% respectively, was observed. In contrast, HbA1 fell significantly less (P < 0.01), by only 39% of its initial value. By 8 wk there was no significant difference between the percentage reduction in the three indices of control. Therefore, GSA provides the clinician with earlier objective evidence of the metabolic response to therapeutic intervention and can be regarded as an intermediate index of diabetic control.
Uncontrolled Diabetes Mellitus in Adults: Experience in Treating Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma with Low-Dose Insulin and a Uniform Treatment Regimen
Authors: Carroll Patricia , Matz Robert
Published: March 2007

A number of changes in therapy of uncontrolled diabetes have occurred in recent years. These include low-dose insulin regimens, often routine phosphate repletion, more cautious bicarbonate replacement, infusion of larger fluid volumes, the use of hypotonic solutions in hyperosmolar states, and recently magnesium repletion. These modalities (with the exception of routine magnesium repletion) have been employed at North Central Bronx Hospital since its opening in 1976. Through this retrospective analysis of 275 cases of uncontrolled diabetes we have tried to answer the following questions: What is the outcome of all episodes of uncontrolled diabetes in a municipal hospital population with a uniform treatment protocol? What are the results of treatment with new modalities in various age groups? Are the causes of death different from those tabulated in previous reports? Our results indicate a good outcome in those under the age of 50 yr regardless of the diagnosis of hyperosmolar nonketotic coma (HNC) or diabetic ketoacidosis (DKA). Mortality from DKA was 2% in those under age 50 yr and 26% in the older age group. Surprising was the low mortality in the hyperosmolar group with 0% mortality under age 50 yr and 14% in patients over this age. The major categories of causes of death in the series included sepsis, adult respiratory distress syndrome (ARDS), metabolic, cardiovascular, and shock. With the exception of ARDS, these categories were not different from other reported series. There were few thromboembolic events in this series. We conclude that the newer therapeutic approaches are effective in the treatment of uncontrolled diabetes mellitus, both ketoacidotic and hyperosmolar, and that they can be used safely and effectively in managing these metabolic derangements in diabetic patients of all ages.
Diabetic Ketoacidosis During Long-Term Treatment with Continuous Subcutaneous Insulin Infusion
Authors: Peden Norman R , Braaten Jan T , Mckendry J B Ralph
Published: March 2007

During 1880 patient-months of treatment with continuous subcutaneous insulin infusion in 101 patients with IDDM, 36 episodes of acute, severe loss of glycemic control, including 29 with significant ketoacidosis, occurred in 20 patients. Fifteen episodes were attributable to failure of insulin delivery to the patient while 13 were precipitated by infection. Insufficiently frequent blood glucose monitoring, failure by patients to detect mechanical and technical problems with infusion systems, failure to adhere to “sick day” regimens, and delay in seeking medical help all contributed to the progression of a number of episodes. Thirst, nausea, and vomiting were the common clinical manifestations of decompensation; and the degree of acidemia was often mild in relation to the degree of hyperglycemia. Response to conventional management was usually prompt.
Fasting Early Morning Rise in Peripheral Insulin: Evidence of the Dawn Phenomenon in Nondiabetes
Authors: Schmidt Maria Ines , Lin Qi Xiong , Gwynne John T , Jacobs Steven
Published: March 2007

The dawn phenomenon, a tendency for glucose to rise between 0500 and 0800 h in subjects with diabetes, is also reflected as an increase in insulin required to maintain normoglycemia during closed-loop insulin infusion. Individuals without diabetes have minimal or absent rises in early morning glucose. To test the hypothesis that the absence of early morning glucose increases in subjects without diabetes is due to an increase in insulin levels, we measured insulin levels from 2400 to 0800 h in four male and two female volunteers. Subjects were on an unrestricted diet with three main meals and one bedtime snack at 2100 h. Blood samples were collected continuously in hourly pools by a constant-rate withdrawal pump. We observed the following: (1) hourly integrated concentration of glucose was stable from 2400 to 0800 h (range of mean plasma values, 94.5–97.3 mg/dl), and (2) hourly integrated concentration of insulin increased from the 0300–0400 (4.6 μU/ml) to the 0700–0800-h pool (6.2 μUμml) (P < 0.05). The observed increase in insulin in the early morning hours despite stable levels of glucose indicates a temporally increased insulin need in nondiabetic individuals similar to that found in individuals with diabetes. The mechanism underlying this increased insulin need may be similar in diabetes and nondiabetes, with the ensuing rise in glucose being dependent on the availability of compensatory insulin.
Delayed Vascular Reactivity to Ischemia in Diabetic Microangiopathy
Authors: Haitas B , Barnes A , Shogry M E C , Weindling M , Rolfe P , Turner R C
Published: March 2007

To investigate vascular responses in insulin-dependent diabetic patients both with and without retinopathy, we have assessed vasodilation by forearm transcutaneous pO2 measurement after 10 min of ischemia produced by a sphygmomanometer cuff. Diabetic patients with proliferative retinopathy had a delayed vasodilatory response at 60 s (mean ± SD pO2 = 9 ± 3 mm Hg) compared with those having diabetes without retinopathy (15 ± 4 mm Hg, P < 0.01) and matched normal subjects (14 ± 4 mm Hg, P < 0.01). Recently diagnosed insulin-dependent diabetic patients had a very similar response (15 ± 5 mm Hg) to matched normal subjects (15 ± 3 mm Hg). The diminished vascular reactivity may be a consequence of microangiopathy and neuropathy, although patients with an impaired vascular response might be particularly at risk from the development of capillary closure.
Senile Cataract and Glucose Intolerance: The Israel Study of Glucose Intolerance Obesity and Hypertension (The Israel GOH Study)
Authors: Karasik Avraham , Modan Michaela , Halkin Hillel , Treister Giora , Fuchs Zahava , Lusky Ayala
Published: March 2007

Association of “senile” cataract (SC) with glucose intolerance (impaired tolerance and diabetes) was assessed by sex and age in a random population sample comprising 930 individuals aged 40–70 yr, who underwent concurrent oral glucose tolerance test and ophthalmoscopy. The eye examination was performed without knowledge of the glucose tolerance status. SC was defined as lens opacification preventing visualization of the eyeground or as surgical aphakia due to SC. To assess the independent effect of hyperglycemia, glycosylated hemoglobin (HbA1) was determined in 769 participants. In men, no association was found between SC, glucose intolerance, and HbA1. In women of all ages, glucose intolerance was associated with an SC risk ratio of 6.1 (95% confidence limits 3.3–11.1; P < 0.001). Furthermore, SC was associated in women with increased HbA1 independently of the effect of glucose intolerance (P < 0.01). These findings confirm the reported association of SC with diabetes (although unlike the Framingham and HANES population studies, the association was confined in women), indicate its presence at all degrees of glucose intolerance, and suggest a possible independent role of nonenzymatic glycosylation in its pathogenesis.
Can β-Hydroxybutyrate Be Detected at the Bedside by In Vitro Oxidation with Hydrogen Peroxide?
Authors: Oster James R , Rietberg Barbara , Taylor Andrew L , Perez Guido O , Chandra Rajiv , Gardner Laurence B
Published: March 2007

The diagnosis of ketoacidosis with an inordinately high plasma and urinary concentration ratio of β-hydroxybutyrate (β-OHB) to acetoacetate (AcAc) is difficult, because only AcAc and acetone react with the diagnostic reagents used clinically to detect ketones. The purpose of this study was to assess the validity of the claim that β-OHB can be identified with a simple modification of the usual bedside test for ketones, using hydrogen peroxide (H2O2) and Ketostix (Ames Division, Miles Laboratories, Inc., Elkhart, Indiana). Unfortunately, the lowest detectable concentration of urinary β-OHB was 50 mmol/L, and serum β-OHB could not be detected at levels less than 100 mmol/L, a clinically irrelevant level. The relative insensitivity, the inapplicability to serum, and the potential hazard of the routine use of 30% H2O2 by practicing physicians or houseofficers render the method of limited value.
Morphine, Opioid Peptides, and Pancreatic Islet Function
Authors: Giugliano Dario
Published: March 2007

Since the isolation of enkephalins 7 yr ago, there has been an explosive increase in knowledge and an enormous interest in the action of both exogenous and endogenous opiates. This review deals with the interaction of opiates with the endocrine pancreas. The results of animal studies performed in vitro do not allow any conclusion to be drawn, because the effects of opioid peptides on pancreatic hormone release seem dependent on many variables, including the agent investigated, dose administered, concentration of glucose in the medium, and experimental procedure used. The results of in vivo animal studies suggest that central administration of opiates and opioid peptides acts indirectly via the sympathetic nervous system to cause hyperglycemia and impaired insulin secretion, while peripheral administration tends to stimulate insulin and glucagon secretion. This last statement seems also to be true for studies performed in human beings. The narcotic addict offers a model to evaluate the hormonal and metabolic effects of a chronically administered agent that binds and activates endogenous receptors. In these subjects, it is possible to find increased concentrations of glycosylated hemoglobin A1 and a marked reduction of the acute insulin response to intravenous glucose, but not to arginine, which suggests a state of defective glucose recognition by pancreatic β-cells during narcotic addiction. Thus, the heroin addict, like patients with non-insulin-dependent diabetes, does not respond appropriately to glucose signals. Moreover, naloxone, an opiate-receptor blocking agent, can cause a partial restoration of the acute insulin response to i.v. glucose in some subjects with non-insulin-dependent diabetes. An increased sensitivity to endogenous opiates—enkephalins—might be important in the pathogenesis of non-insulin-dependent diabetes in human beings.
Traditional Insulin-Use Practices and the Incidence of Bacterial Contamination and Infection
Authors: Borders Laura M , Bingham Pauline R , Riddle Matthew C
Published: March 2007

While complex procedures are usually recommended to prevent infection atinsulin injection sites, adherence to these procedures is imperfect and their value incompletely established. Among 254 adult insulin users in two clinic populations, the reported prevalence of complete performance of four traditional insulin-use practices (handwashing, vial prep, skin prep, discarding of plastic syringes after one use) was 29%, and none of the individual practices considered was performed regularly by more than two-thirdsof the subjects. Even so, there was no infection at 2828 injection sites, and there was no significant bacterial contamination of insulin or syringes. These findings fail to support the view that traditional practices provide protection to insulin users against infection or bacterial growth in insulin or syringes. The authors suggest that modification of traditional teaching methods would do no harm, and that benefits could include financial savings, improved client success with self-care, and enhanced health care provider credibility.
The Effect of Cooking upon the Blood Glucose Response to Ingested Carrots and Potatoes
Authors: Vaaler Stein , Hanssen Kristian F , Aagenæs Øystein
Published: March 2007

Ten insulin-dependent diabetic subjects were given the following tests in randomized order: 50 g glucose dissolved in water, 250 g raw and cooked potato (equal to 50 g carbohydrate), 270 g raw and cooked carrot (equal to 25 g carbohydrate), and 4 h of fasting. Blood glucose was measured for 4 h following the tests. The postprandial blood glucose responses after pure glucose and cooked potato were almost similar (90-min values: glucose 8.8mmol/L, cooked potato 8.0 mmol/L), while the response after raw potato was considerably slower and weaker (90-min value: 3.3 mmol/L). There were no differences between the postprandial blood glucose responses after raw and cooked carrot (90-min values: raw carrot 3.2 mmol/L, cooked carrot 2.8 mmol/L), but the responses were statistically different from blood glucose values during fasting alone (90-min value: 0.8 mmol/L). The study shows that cooking is responsible for the rapid increase in blood glucose after ingestion of cooked potato, while no such phenomenon is seen aftercooking of carrots.
Accuracy in Estimating Fasting Blood Glucose Levels by Patients with Diabetes
Authors: Wing Rena R , Epstein Leonard H , Lamparski Danuta , Hagg Sigrid A , Nowalk Mary Patricia , Scott Nancy
Published: March 2007

This study was designed to assess the accuracy with which diabetic patients can estimate their fasting blood sugars (FBS) and to determine whether experience with self-monitoring of blood glucose improves this ability. Twenty patients with type II diabetes who had no experience with self-monitoring of blood glucose were compared with 17 patients who had been monitoring blood sugar regularly for the previous 8 mo. All patients were asked to estimate FBS immediately before it was measured in the laboratory. Patients were very accurate in estimating their FBS; the average error in estimation was 2 mg/dl, and 65% of patients estimated FBS within 20% of actual FBS. However, there was no evidence that experience in self-monitoring of blood glucose improved the accuracy of estimation. Additional studies are needed to determine the types of cues that patients use in estimating blood sugar.
Diabetic Lipohypertrophy Delays Insulin Absorption
Authors: Young Robert J , Hannan W James , Frier Brian M , Steel Judith M , Duncan Leslie J P
Published: March 2007

The effect of lipohypertrophy at injection sites on insulin absorption has been studied in 12 insulin-dependent diabetic patients. The clearance of 125 I-insulin from sites with lipohypertrophy was significantly slower than from complementary nonhypertrophied sites (% clearance in 3 h, 43.8 ± 3.5 ± SEM) control; 35.3 ± 3.9 lipohypertrophy, P < 0.05). The degree of the effect was variable but sufficient in several patients to be of clinical importance. Injection-site lipohypertrophy is another factor that modifies the absorption of subcutaneously injected insulin.
Comparison of the Acute and Long-Term Effects of Exercise on Glucose Control in Type I Diabetes
Authors: Zinman B , Zuniga-Guajardo S , Kelly D
Published: March 2007

To determine the long-term effect of exercise training on glucose control, 13 subjects with type I diabetes and 7 control subjects performed 45 min of cycle exercise three times per wk for 12 wk. The acute blood glucose response, the long-term effect on glucose control (glycosylated hemoglobin and fasting plasma glucose), and changes in nutrient intake were assessed. Fitness as measured by VO2 MAX increased in both control (33.8 ± 1.7 to 43.2 ± 3.5 ml/min/kg) and diabetic (38.7 ± 3.3 to 46.5 ± 3.6 ml/min/kg) (P < 0.05) subjects although body weight remained unchanged. In the diabetic subjects, an acute glucose-lowering effect occurred with each exercise session throughout the 12-wk training period (225.8 ± 16.1 to 148.5 ± 16.8 mg/dl, P < 0.001). However, fasting plasma glucose and glycosylated hemoglobin remained essentially unchanged (pretraining, 193.7 ± 27.5 mg/dl and 10.7 ± 0.3%; 6-wk training, 192.5 ± 27.1 mg/dl and 10.7 ± 0.03%; 12-wk training, 202 ± 30.1 mg/dl and 10.3 ± 0.8%). Total caloric intake as assessed by diet history increased significantly on exercising days (2569–2849 kcal, P < 0.05). Although plasma glucose decreases acutely with exercise, increased caloric intake on exercising days obviates a long-term effect of training on glucose control. More precise guidelines and recommendations as to exercise timing and nutrient intake, likely based on self-monitoring of blood glucose, are required to achieve a beneficial effect of exercise training on metabolic control in type I diabetes.
The Etiology of Incapacitating, Brittle Diabetes
Authors: Schade David S , Drumm Denise A , Duckworth William C , Philip Eaton R
Published: March 2007

Incapacitated brittle diabetic subjects are a small subset of insulin-dependent diabetic individuals who are unable to maintain a normal lifestyle because of frequent disruptions secondary to severe hypergly-cernie and/or hypoglycemic episodes. Thirty incapacitated patients were referred for evaluation because the cause of their diabetic instability could not be determined by their personal physicians despite extensive patient training in correct diabetes management, frequent hospitalizations for observation, and multiple diagnostic testing. From the 30 patients, a diagnostic algorithm was developed (described in the companion article) from which the etiology of brittle diabetes could be established in 29. This article provides the clinical characteristics of each of the 30 patients, a description of the etiologie categories of brittle diabetes, and the clinical follow-up from the time that the etiologie diagnosis was established and treatment recommended. Although extensive medical records were sent with each patient, without prospective objective testing under rigidly controlled conditions, the correct etiologie diagnosis would not have been evident from the clinical presentation of the patient. Of equal importance in identifying the etiology of brittle diabetes was the acceptance and cooperation of the referring physician in providing close follow-up and repeat insulin challenge testing when necessary. In this referred patient population, eight subjects had factitious disease, eight were malingering, seven had communication deficits, two had gastroparesis, two had systemic insulin resistance, two had miscellaneous causes of brittle diabetes, and one patient remained undiagnosed. Using a prospective algorithmic approach to determine the etiology of brittle diabetes, not only is the cause of diabetic instability almost always identifiable, but a significant improvement in lifestyle is achieved in greater than 50% of the incapacitated individuals.
Age of Onset and Type of Diabetes
Authors: Laakso Markku , Pyörälä Kalevi
Published: March 2007

The age of onset and the clinical type of diabetes mellitus were evaluated on the basis of a cross-sectional study of medical records of 14 municipal health centers in East Finland. Altogether 281 patients were classified as having insulin-dependent (IDDM) and 2713 as having non-insulin-dependent (NIDDM) diabetes. Nearly all patients diagnosed before the age of 19 had IDDM, but a large proportion (37%) of all diagnoses of IDDM were made after that age. Six percent of all diabetic subjects in the age group 15–19 yr were classified as NIDDM and the proportion increased rapidly in older age groups. Half of the patients with NIDDM were diagnosed over the age of 64.
Alterations in Plasma Lipids in the Presence of Mild Glucose Intolerance in the Offspring of Two Type II Diabetic Parents
Authors: Ganda Om P , Soeldner J Stuart , Gleason Ray E
Published: March 2007

Plasma lipids and oral glucose tolerance were determined in 67 normal control subjects (age range 19–67 yr) and 150 individuals (17–69 yr) who were offspring of two type II diabetic parents. Age- and weight-adjusted analyses of covariance were performed for lipids and for glucose and insulin responses. For both men and women, the mean concentrations of total, low-density-, and high-density-lipoprotein-cholesterol and of triglycerides in the offspring with normal glucose tolerance (N = 109) were similar to respective controls. For offspring with abnormal glucose tolerance (N = 41), the mean levels of total cholesterol, LDL-cholesterol, and triglycerides were significantly elevated (P = 0.02 or less) in women but not in men. The mean HDL-cholesterol levels were 20% lower and LDL/HDL-cholesterol ratios 60% greater in women with abnormal glucose tolerance, whereas no significant differences existed for any of the lipid fractions in men, compared with respective controls. Both men and women with abnormal glucose tolerance had a comparable magnitude of hyperglycemia as well as hyperinsulinemia. These observations indicate that significant alterations in plasma lipids exist in individuals with mild, asymptomatic glucose intolerance and there are important sex differences in lipid metabolism in the early stage of diabetes, despite comparable degrees of glucose intolerance and insulin responses.
Closing the Gap: The Problem of Diabetes Mellitus in the United States
Authors:   The Carter Center of Emory University
Published: March 2007

Diabetes mellitus is a major public health problem and a leading cause of death, disability, and cost in the United States. We review the epidemiology of diabetes and its complications, the costs of diabetes, and discuss intervention strategies to reduce the burden of diabetes in the United States.
Initial Psychologic Responses of Parents to the Diagnosis of Insulin-dependent Diabetes Mellitus in Their Children
Authors: Kovacs Maria , Finkelstein Richard , Feinberg Terry L , Crouse-Novak Mary , Paulauskas Stana , Pollock Myrna
Published: March 2007

As part of a prospective, longitudinal study of school-aged children with newly diagnosed insulin-dependent diabetes mellitus (IDDM), we examined how the parents adjusted to the illness. The present article documents this process for the first year of IDDM. We found no support for earlier claims that most parents resort to blatantly neurotic or psychopathologic behavior to cope. Instead, the initial strain of living with IDDM generally elicited mild and subclinical depression, anxiety, and overall distress. Mothers were more affected than fathers: they were more symptomatic (about one of four developed a mild grief reaction) and the bulk of them worried considerably about their children. However, the parents' initial emotional upheaval resolved in ≈6 mo; most mothers came to terms with IDDM by the end of the first year; and other areas of parental functioning (e.g., quality of their marriage) were not affected. Therefore, along with our previous report on how the children coped initially, the findings document the emotional resiliency of families during the first year of IDDM.
Correlations Among Autonomic, Sensory, and Motor Neural Function Tests in Untreated Non-insulin-dependent Diabetic Individuals
Authors: Pfeifer Michael A , Weinberg Clarice R , Cook Daniel L , Reenan Andrew , Halar Eugene , Halter Jeffrey B , LaCava Edward C , Porte Daniel
Published: March 2007

A well-defined group of untreated non-insulin-dependent (NIDD) subjects were evaluated to determine whether involvement of neural function measurements is generalized and symmetrical and to compare the autonomic, sensory, and motor neural measurements. After age adjustment, the sensory and motor neural function measurements were significantly slower in the diabetic group than in normal subjects (P < 0.01). Similarly, the autonomic nervous system function measurements were also abnormal in the NIDD group (P < 0.01). Further analysis revealed that each of the specific measurements–median motor nerve conduction velocity (NCV, P < 0.005), peroneal motor NCV (P < 0.005), median sensory NCV (P < 0.005), dark-adapted pupil size after muscarinic blockade (P < 0.02), pupillary latency time (P < 0.02), and RR-variation after beta adrenergic blockade (P < 0.001)—was significantly less by analysis of covariance after age adjustment in the NIDD group than in normal subjects. Thus, there was evidence of motor and sensory neural impairment in the upper and lower extremities as well as evidence of impairment of the reflex arcs involving the parasympathetic nerves to the heart and eye and the sympathetic nerves to the iris. Further analysis revealed that right and left NCV were correlated (P < 0.01), as were the median motor and median sensory NCV (P < 0.01), the median motor and peroneal motor NCV (P < 0.001), and the peroneal motor and median sensory NCV (P < 0.001). Thus, there was evidence of symmetrical upper and lower limb, as well as motor and sensory proportional involvement of large nerve fiber NCV in this group of NIDD subjects. Within the autonomic nerve reflex arcs that were tested, the studies showed that there was correlation between measures assessing the reflex arcs involving the parasympathetic nervous system (PNS) to the heart and iris (P < 0.01). However, the measure assessing the sympathetic nervous system (SNS) reflex arc to the iris did not correlate significantly with either of the measures assessing PNS reflexes. Overall, measurements of sensory and motor NCV were correlated with the results of the autonomic nervous system (ANS) tests (P < 0.05). Thus, in a group of untreated NIDD men, age-adjusted measures of SNS, motor (MNS), and ANS function were reduced and there was a correlation between the measures of sensory and motor nerve tests and those of ANS function.
The Diabetes Education Study: A Controlled Trial of the Effects of Diabetes Patient Education
Authors: Mazzuca Steven A , Moorman Nicky H , Wheeler Madelyn L , Norton James A , Fineberg Naomi S , Vinicor Frank , Cohen Stuart J , Clark Charles M
Published: March 2007

The Diabetes Education Study (DIABEDS) was a randomized, controlled trial of the effects of patient and physician education. This article describes a systematic education program for diabetes patients and its effects on patient knowledge, skills, self-care behaviors, and relevant physiologic outcomes. The original sample consisted of 532 diabetes patients from the general medicine clinic at an urban medical center. Patients were predominantly elderly, black women with non-insulin-dependent diabetes mellitus of long duration. Patients randomly assigned to experimental groups (N = 263) were offered up to seven modules of patient education. Each content area module contained didactic instruction (lecture, discussion, audio-visual presentation), skill exercises (demonstration, practice, feedback), and behavioral modification techniques (goal setting, contracting, regular follow-up). Two hundred seventy-five patients remained in the study throughout baseline, intervention, and postintervention periods (August 1978 to July 1982). Despite the requirement that patients demonstrate mastery of educational objectives for each module, postintervention assessment 11–14 mo after instruction showed only rare differences between experimental and control patients in diabetes knowledge. However, statistically significant group differences in self-care skills and compliance behaviors were relatively more numerous. Experimental group patients experienced significantly greater reductions in fasting blood glucose (−27.5 mg/dl versus −2.8 mg/dl, P < 0.05) and glycosylated hemoglobin (−0.43% versus + 0.35%, P < 0.05) as compared with control subjects. Patient education also had similar effects on body weight, blood pressure, and serum creatinine. Continued follow-up is planned for DIABEDS patients to determine the longevity of effects and subsequent impact on emergency room visits and hospitalization.