A Therapeutic Answer for The Controversy of Insulin Cardio-Protection Among Dysglycemic Patients

Abstract

Ghrelin and leptin are peptide hormones which, working antagonistically, regulate the energy balance of the body. Abnormal concentrations of these hormones are observed in the course of gastrointestinal diseases, where the clinical picture is characterized by nutritional disorders. Approximately 70% of patients with cystic fibrosis have body weight deficiency due to exocrine pancreatic insufficiency, respiratory failure, and secondary circulatory disorders as well as eating disorders. The aim of the study was to evaluate the levels of ghrelin and leptin in the blood serum of patients diagnosed with cystic fibrosis, in relation to their nutritional status and function of liver cells. Patients and methods: The study group consisted of 34 patients, 17 girls (50%) and 17 boys (50%), aged from 3 months to 18 years (mean age 4.5 years) who were diagnosed with cystic fibrosis on the basis of screening and/ or diagnostic tests. The analysis included the nutritional status (body weight and height, BMI), CFTR gene mutation, assessment of the exocrine pancreas function (albumin and glucose concentration in the blood serum, acid steatocrit in stool), abnormal lipid metabolism (cholesterol and triglyceride levels in blood serum), as well as liver cell function parameters and cholestasis (serum activity amino-transpherase, gamma-glutamyl transpeptidase, concentration of bile acids, coagulation parameters). In all children, serum ghrelin and leptin levels were measured by means of an immunoenzymatic test, using reagents from DRG Instruments. The results were statistically analyzed. Results: Serum ghrelin levels were significantly lower in the youngest patients (<1 year of age) compared with older age groups. Ghrelin concentration was significantly lower in patients with salt wasting syndrome (p<0.05). The statistically lower serum leptin levels were observed in patients with growth deficiency and increased parameters of cholestasis, particularly in the youngest age group. Conclusion: Ghrelin and leptin levels in children with cystic fibrosis correlate with the nutritional status and can be an early marker of exocrine pancreatic insufficiency. The study aimed to illustrate the cardio-protective effect of blood-let out cupping therapy in dysglycemia. The controversy of insulin cardio-protection among dysglycemic patients is a confusing challenge. Glucose-insulin disproportion is a major reason for accumulation of acidic metabolites in the body leading to the current controversy about insulin role in cardio-protection. The micro-capillary dysfunction, the improper tissue perfusion with blood and the accumulation of acidic metabolites in the myocardium are leading to each other and could contribute to progression into major cardiac events. Withdrawal of these metabolites could disturb this ischemic vicious circle and offer the answer for the controversy of insulin cardio-protection among dysglycemic patients. Suction in cupping therapy works specifically on the blood trapped within the tissues together with the acidic metabolites which are believed to be functionally obliged to it. Skin scratching with the action of repeated suction delivers nitric oxide to the area which is a potent cardio protectant in health and disease. Seven diabetic patients on insulin with recurrent moderate chest tightness due to variable grades of myocardial ischemia refused coronary catheterization. Therefore; a session of basic cupping therapy on the upper back and front of the chest was advised and employed for them. Dramatic symptomatic relief and clinical recovery was documented in six patients. They were followed up for 18 months without any further cardiac issues. On conclusion; cupping therapy in this way becomes a maneuver that could lead to correction of ischemic myocardial situations, and the tissues interstitial space therefore constitutes the intelligent yard where cupping exerts its biological talents.