Assessment of insulin resistance in acromegaly associated with diabetes mellitus before and after transsphenoidal adenomectomy

With a euglycemic hyperinsulinemic clamp method, whole-body insulin resistance was assessed in 6 cases with acromegaly associated with diabetes mellitus before and after transsphenoidal adenomectomy. The glucose infusion rate (GIR) correlated well with the plasma IGF-I level but poorly with that of GH. Further improvement in insulin sensitivity occurred 3-4 months after operation without substantial changes in plasma levels of both GH and IGF-I or glycemic control. These results indicate that GH excess can induce insulin resistance in association with plasma IGF-I and also through undefined secondary effect.     

Increased granulocyte aggregation in vitro in diabetes mellitus

Having previously shown an increase in white blood cell (WBC) aggregation in groups known to have a high incidence of cardiovascular events, we compared 28 patients with diabetes mellitus and no history or clinical evidence of macrovascular disease with 28 age- and sex-matched normal controls. Patients and controls had blood taken in the morning and analysed for WBC aggregation in vitro using a whole blood technique. WBC aggregation was significantly higher in the diabetic group compared with the normal controls (mean +/- SD 31.10 +/- 10.26% vs. 25.7 +/- 9.38%; p < 0.04, Student t-test). WBC aggregation predates the appearance of clinical symptoms of macrovascular disease in diabetes.     

Behavioral self-regulation in the treatment of patients with diabetes mellitus.

Conceptualizes the treatment regimen for patients with diabetes in terms of a behavioral self-regulation model for the control of blood sugar. The model, based on a negative feedback control system, includes 4 components: (a) behaviors related to the detection of discrepancies between actual and normal blood sugar, by urine or blood sugar monitoring; (b) corrective responses, such as the use of insulin, to normalize blood sugar; (c) minimization of disturbances to the system by such behaviors as stress reduction or dietary modification; and (d) self-reinforcement of self-regulatory behaviors. The management of Type I and Type II diabetes is discussed in terms of behavioral research related to each aspect of the model. Suggestions for further research that address monitoring and decision-making processes, the effects of various behaviors on blood sugar control, and training in self-regulation itself are derived from the self-regulation model. (70 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serum mineral changes in dithizone-induced diabetes before and after insulin treatment

In this study, diabetes was induced by intravenous injection of dithizone. In dithizonised diabetic animals, the levels of serum zinc, iron, and potassium were found to be higher than normal, while those of serum calcium and sodium were lower. Copper and magnesium levels were unchanged. After treatment with insulin, most of these serum levels approached the normal, except for serum potassium and magnesium.     

Caries in patients with non-insulin-dependent diabetes mellitus

OBJECTIVE: To describe intratrial differences in hind limb symmetry in healthy dogs at the trot, using noninvasive, computer-assisted, three-dimensional kinematic gait analysis. ANIMALS: 8 clinically normal large-breed adult dogs. PROCEDURE: Dynamic flexion and extension angles and angular velocities were calculated for the coxofemoral, femorotibial, and tarsal joints of dogs at the trot. Temporal and distance variables were computed. Essential Fourier coefficients were used to determine mean flexion and extension curves for all joints and to compare differences in movement between right and left hind limbs. Variances attributable to limb, dog, and trial were determined. RESULTS: Each joint had a characteristic pattern of flexion and extension movement that was used to compare intratrial symmetry of hind limb gait. Significant differences were not detected in temporal or distance variables between the right and left hind limbs. Significant differences were not noted in essential Fourier coefficients used to characterize coxofemoral, femorotibial, and tarsal joint angles and angular velocities, with the exception of the cosine-0 coefficient for coxofemoral angular velocity. Variation in joint angle and angular velocity measurements were attributable to individual dog and trial. Variation attributable to limb was negligible. CONCLUSIONS: Intratrial evaluation of right-left hind limb symmetry, using kinematic gait analysis, indicated objectively that hind limb movement is symmetrical at the trot in healthy large-breed dogs. CLINICAL RELEVANCE: Documentation of hind limb symmetry at the trot will help provide a basis for direct comparison of both hind limbs in future studies evaluating gait and treatment of dogs with musculoskeletal disease.     

Foot lesions in patients with diabetes mellitus

Diabetic foot ulcers are common. If treatment is delayed or is inappropriate, the lesions can become infected, resulting in gangrene and amputation. Physicians and clinics that perform aggressive therapy for these ulcers, provide revascularization when indicated, practice a team approach, suggest the use of therapeutic shoes, and repeatedly educate patients in foot care have reduced their amputation rates by 50% or greater. Goals of the United States Department of Health for the year 2000 include a 40% reduction in the amputation rate in patients with diabetes. This should be the goal of everyone providing care for patients with diabetes.     

Hand infections in patients with diabetes mellitus

In a study of diabetic patients with hand infections reviewed at Jackson Memorial Hospital, University of Miami School of Medicine, 20 such diabetic patients with hand infections were found. The most outstanding result was that seven of the 20 had amputation either to control infection or because the function of the extremity was impaired by the remaining ravaged part. Pathologic examination of tissue removed showed the same changes commonly seen in diabetic gangrene of the lower extremity. Electromyographic studies, when done, have been confirmatory of a peripheral neuropathy with delayed nerve conduction studies. The bacterial organisms of the infections were variable, but a predominance of Gram-negative organisms were cultured in twelve of the 20 patients. Early aggressive management, including surgical debridement and intravenous antibiotics, is recommended to prevent unnecessary amputations and improve residual function.     

Thrombocyte lactate dehydrogenase isoenzymes in patients with ischemic stroke

It was established that in the acute period of the ischemic stroke in the maiority of cases a change of isoenzyme structure of LDG thrombocytes was due to a decrease of LDG3 activity. In a number of patients the dominant change in the spectrum was determined by LDG and LDG4 fractions. The changes were of a stable character up to 10 weeks. LDG4 increase was characteristic of the isoenzymes spectrum in the patients with a severe development of the disease and in the patients in the remote period of the stroke. The obtained data can serve as a criterion for evaluating the adaptive changes in acute brain ischemia.     

Long-term administration of theophylline and glucose recovery after hypoglycaemia in patients with type 1 diabetes mellitus

The methylxanthine theophylline increases intrahepatic c-AMP and c-AMP mediates the hepatic glucose response to adrenaline and glucagon. Intravenous theophylline increases glucose recovery during acute insulin-induced hypoglycaemia and caffeine increases hypoglycaemia awareness and glucoregulatory hormone secretion. In this study we tested the hypothesis that long-term administration of theophylline might augment glucose recovery after insulin-induced hypoglycaemia. Eleven healthy subjects and 8 patients with Type 1 diabetes mellitus were made hypoglycaemic by 60 min insulin infusion (40 mU m(-2)) after 2 weeks' oral therapy with Euphyllin Retard (theophylline) or placebo. Plasma glucose nadir was 2.54 (2.31-2.77) mmol l(-1) after Euphyllin Retard and 2.27 (2.05-2.48) mmol l(-1) after placebo (mean difference 0.26 (0.05-0.58) mmol l(-1), p = 0.09) for healthy control subjects and 2.56 (2.07-3.04) mmol l(-1) and 2.19 (1.37-2.65) mmol l(-1) (mean difference 0.38 (0.12-0.63) mmol l(-1), p = 0.01), respectively, for diabetic patients. The area under the glucose curve was greater after theophylline treatment for healthy control subjects (p = 0.0292) and for diabetic patients (p = 0.0241) but there were no concomitant significant increases in plasma c-AMP or in endogenous glucose production rate. Whether the increase in glucose recovery is large enough to suggest that chronic theophylline administration will protect against insulin-induced hypoglycaemia remains unsettled.     

Peripheral osteopenia in adult patients with insulin-dependent diabetes mellitus

Alterations in bone metabolism in diabetes mellitus is a topic of special interest. Bone blood flow is increased in the distal limb of diabetic patients, which is believed to increase osteoclastic activity. We measure bone mineral density using dual-photon absorptiometry in the distal lower limb, the femoral neck, and the lumbar spine in 41 IDDM patients and in 30 control persons. In the diabetic group there was a 10% reduction of bone mineral density in the femoral neck (p < 0.01) and a 12% reduction in the distal limb (p < 0.001) compared with the control group. No significant difference was found in the lumbar spine (p = 0.22). Our data yield incidence for peripheral osteopenia in IDDM-patients, independent of any systemic bone disease such as osteoporosis. A link between decreased bone mineral density and diabetic neuropathy has been observed for the femoral neck (p < 0.001), but not for the distal limb or axial skeleton. Whether there is a common aetiological link or a casual connection between diabetic neuropathy and bone mineral density has still to be determined.     

Ocular arterial flow hemodynamics in patients with diabetes mellitus

The purpose of this study was to investigate ocular blood flow hemodynamics in patients with diabetes mellitus. We used color Doppler sonography, in 22 normal subjects and 52 patients with (n = 25) or without (n = 27) diabetic retinopathy, to determine blood flow velocities and the resistive index of the central retinal artery. The resistive index of the central retinal artery in patients with diabetic retinopathy (0.85 +/- 0.09) was significantly greater (P < 0.01) than that in normal subjects (0.72 +/- 0.08) and in patients without diabetic retinopathy (0.81 +/- 0.09). The resistive index of the central retinal artery in the patients without diabetic retinopathy was also significantly greater than that of normal subjects (P < 0.01). The resistive index of ocular arterial flow was increased in the patients with diabetes mellitus and further increased in the presence of retinopathy. Increased resistance in the peripheral ocular vascular bed contributes to diabetic retinopathy, and this change is present before the appearance of overt diabetic retinopathy.     

Frontal lobe-related cognitive functions in patients with sleep apnea syndrome before and after treatment

Impairments of cognitive executive functions has been previously suspected to occur in Sleep Apnea Syndrome (SAS), as suggested by some neuropsychological studies. However such functions have not been assessed directly. In the present study, ten patients with SAS were evaluated with various focused frontal lobe-related tests in comparison with ten matched normal controls. Such tasks explored attention, short term memory spans, learning abilities, planning and programming capacities, categorizing activities and verbal fluency. Patients were found with a significant decreased ability to initiate new mental processes and to inhibit automatic ones in conjunction with a tendency for perseverative errors. They were also affected with deficits of verbal and visual learning abilities and they had reduced spans. Patients were submitted to continuous positive airway pressure (CPAP) and further reevaluated after 4-6 months of treatment. Patients were found to have normalized most of their cognitive executive and learning disabilities, except for all the short-term memory tests which remained unchanged. These findings are discussed in light of data from the literature concerning cognitive impairments described for patients with isolated daytime sleepiness versus hypoxemia, as illustrated in other pathological or physiological circumstances. The contribution of frontal lobe-related systems in short-term memory functions is also taken into account.     

Improvement of cardiac performance and metabolism in long-term diabetes mellitus after treatment with insulin [see comment

Rat hearts induced diabetic by administration of streptozotocin were investigated after 8 months using the isolated perfused working rat heart model at a physiological workload of approximately 45 min. They are hemodynamically characterized by a significantly reduced cardiac output (p < 0.001) and metabolically by a 49% reduction in glucose utilization (p < 0.001), mainly caused by reduced glucose uptake (p < 0.001) and an increased lactate and pyruvate production (p < 0.001), associated with a reduction of oxygen consumption by 44% (p < 0.001). Both lead to reduced ATP and CP myocardial tissue levels (p < 0.001). Similar results with respect to cardiac performance and metabolism are observed already after 2 months of diabetes. Treating these rats after 2 months of diabetes with insulin for 6 months, cardiac output (ns), cardiac metabolism (ns), oxygen uptake (ns) as well as ATP and CP levels (ns) are restored, indicating that normalization of cardiac function in this model depends mainly on the restored cardiac metabolism. These findings were associated with changes in the angioarchitecture as demonstrated.