Disturbed Glucose Tolerance Research Articles

Intravenous glucose tolerance in myocardial infarction.

Summary Intravenous glucose tolerance tests were carried ont on forty patients with recent myocardial infarction and thirty-nine matched controls with recent bone injury. Abnormal results were detected in 77·5% of cardiac patients and 68% controls. When tests were repeated after acute stress factors had settled, normal results were obtained in 85% of thirty-three cardiac subjects and 84% of thirty-eight controls. It is concluded that the disturbance of glucose tolerance in myocardial infarction is a non-specific stress effect and should not be regarded as necessarily indicating a latent diabetic tendency.

Alterations in carbohydrate metabolism induced by progesterone in cases of endometrial carcinoma and hyperplasia

1.1. The influence of progesterone on carbohydrate metabolism in man has not been previously reported, although some studies have been made on laboratory animals.2.2. Such a study on a group of patients was prompted by the findings of a high incidence of disturbed glucose tolerance in two endometrial diseases (carcinoma and hyperplasia) where progestational activity is absent.3.3. 17α-hydroxyprogesterone caproate was administered to such patients and its effect on glucose metabolism was studied.4.4. In 10 out of the 18 cases studied, glucose tolerance was improved. In most of the cases, the depression of plasma inorganic phosphate levels following a glucose load was markedly enhanced, the mean value being doubled. Urinary corticoid excretion was unchanged.5.5. This study suggests that, (in the dosage administered) this progesterone compound increases the peripheral use of glucose, thereby improving glucose tolerance, and that this effect is probably not mediated through the adrenal cortex. It is likely that the dosage and the type of progestational compound may influence such findings, as has been the case in laboratory animals.

Laboratory Diagnosis of Diabetes

IT IS QUITE possible that means will soon be developed for identifying a specific defect in persons with genetically determined diabetes. But for the present the diagnosis still requires evidence of disturbed glucose tolerance. It has now been more than half a century since Jacobsen1(1913) reported on the use of a glucose-loading test as a means of measuring carbohydrate tolerance. Other pioneers in this field included Hopkins,2and Hamman and Hirschman.3These early workers observed that in contrast to normal persons those with diabetes exhibited blood sugar levels, after an oral glucose load, which were usually over 200 mg/100 ml at some time during the first hour and which failed to return to fasting levels by the third hour. Hamman and Hirschman3concluded in 1917 that: "In normal persons after ingestion of 100 gm of glucose, the blood sugar rises promptly to a level not

THE AETIOLOGY, COURSE AND SURGICAL ASPECTS OF PANCREATITIS: A REVIEW OF 108 CASES

Summary1. A consecutive series of 10s cases of pancreatitis comprised 29 patients who had a single acute attack, 73 who developed chronic relapsing pancreatitis, and 6 who presentedwith chronic “silent pancreatitis.2. Gall‐stones in 46 patients and alcoholism in 24 patients were common associated conditions. Trauma, vascular disease and viral infection were true aetiological factors in some cases.3. Laboratory studies disclosed jaundice in 29 cases, hyperlipaemia in 24 cases, disturbed glucose tolerance in 27 cases and an abnormal secretin test in 14 cases.4. Surgical biopsies in relapsing pancreatitis showed a wide variety of histological appearances.5. Ten deaths resulted from pancreatitis. Frank diabetes occurred in 16 patients and was directly related to the frequency of attacks of pancreatitis. Pancreatic insufficiency with steatorrhoea was rare except in chronic insidious pancreatitis.6. In relapsing pancreatitis, remissions of two or more years eventually occurred in 44 per cent. of all cases, and in 36 per cent. of those who were not treated surgically. It is suggested that results of surgical treatment in pancreatitis be evaluated in terms of the expected cure rate in patients not receiving surgery.

Disturbances of Glucose Tolerance and of the Acid-Base Equilibrium in Manic-Depressive Insanity

It has been recognized for many years that in certain cases of mental disorder there is a demonstrable disturbance of carbohydrate metabolism. Among early observations may be mentioned those of Raimann (1902), Schultz and Knauer (1909) and Laudenheimer (1898). These workers reported the presence of sugar in the urine of patients suffering from depressive and anxiety states, and noted that the glycosuria often varied with the severity of the mental disturbances and disappeared with them. They remarked, however, that the phenomenon was of little diagnostic importance, inasmuch as it could be found in depressive states associated with many different types of mental illness. Such observations were of value as an indication for further research, but until it was established that the glycosuria was not due to a derangement of the renal mechanism of sugar excretion, it could not be claimed that the findings indicated such a fundamental metabolic disturbance as is now known to exist. Although Santenoise and Tinel (1923) stated that the renal threshold varies according to the mental state of the patient, many more recent workers have shown that the increased sugar excretion is always associated with a greater or less degree of hyperglycæmia, and, although agreement on this point is not complete, the balance of evidence favours the belief that such hyperglycæmia is alimentary in origin, and not spontaneous. As the earliest workers appeared to recognize, the metabolic disturbance is found mainly in states of depression, which may be retarded or agitated, and in certain cases of schizophrenia, which, too, may be stuporose or restless. Some investigators are of the opinion that the same disturbance may be found in states of mania as well as or even to the exclusion of depressive states, but this is a view which is held only by a minority.