Insulin-treated Diabetes Mellitus Research Articles

Hyperzincuria in insulin treated diabetes mellitus—its relation to glucose homeostasis and insulin administration

In order to elucidate some pathogenic factors of diabetic hyperzincuria we studied 60 adult insulin treated diabetic out-patients (40 males and 20 females), all with normal serum creatinine concentrations and absence of proteinuria during a 24-h period. Diabetic males and females both had significantly ( p < 0.01) increased zinc excretion rates (1.14 ± 0.06 (S.E.M.) μmol/mmol creatinine and 1.37 ± 0.10 μmol/mmol creatinine) compared with normal males and females (0.55 ± 0.06 and 0.48 ± 0.08, respectively). The urinary zinc excretion rate correlated positively with the degree of glycosuria ( r = 0.36, p < 0.01), but was not associated with the duration of the disease. However, serum zinc levels gave no evidence of a state of zinc depletion in these patients. It was calculated that zinc originating from a diabetic bone loss and the exogenous insulin administration accounted for only a small part of the hyperzincuria. Compensatory hyperabsorption and/or increased zinc content in the diabetic diet may therefore serve to explain the lack of zinc depletion in the presence of hyperzincuria.

Epidemiological studies of diabetes mellitus in Denmark. II. A prevalence study based on insulin prescriptions.

The study aimed at tracing the population of insulin-treated diabetics living in the Funen County, Denmark (approximately 450000 inhabitants) on 1 July 1973. It was based on a recording of insulin prescriptions among all prescriptions handled by the pharmacies in Funen County during a five-month period. Through information from medical records and public registries the verification of the diagnosis and the identity of the insulin prescription holders were checked, and it is estimated that the completeness of the study material was above 98%. Age- and sex-specific prevalence rates of insulin-treated diabetes mellitus were calculated. The overall prevalence rate for males was 3.6 per 1,000 and that for females 3.3 per 1,000.

Influence of smoking on insulin requirement and metbolic status in diabetes mellitus.

This study was performed in order to examine the influence of tobacco smoking on carbohydrate and lipid metabolism and microangiopathy in diabetic patients with normal serum creatinine. Among 163 adult insulin-treated patients 114 smoked daily (smokers). Compared with nonsmokers, smokers had on the average a 15--20% higher insulin requirement (P < 0.001) and serum triglyceride concentration (P < 0.05), increasing to a 30% rise in heavy smokers (P < 0.01). The degree of retinopathy was equal in the two groups, as was the average creatinine clearance [99 +/- 2 (mean +/- 1 SEM) versus 101 +/- 4 ml/min in smokers compared with nonsmokers]. Smokers and nonsmokers were comparable regarding sex ratio, age at diabetic onset, duration of diabetes, residual beta-cell function, fasting hyperglycemia, and glycosuria. Evidently, tobacco smoking represents a strain on both carbohydrate and lipid metabolism in insulin-treated diabetes mellitus.

Osteopenia in insulin treated diabetes mellitus. Its relation to age at onset, sex and duration of disease.

Bone mineral content was measured by photon absorptiometry in 215 insulin treated diabetic out-patients aged 7--70 years. As bone mass increases until the age of 20--25 years, patients were so selected that all remained within the same phase of bone mineral storage throughout the entire course of their diabetes. Other criteria for exclusion were diseases or drugs interfering with mineral metabolism and previous use of oral antidiabetic agents. As a group the patients demonstrated a bone mineral deficit of 9.8% compared with sex- and age-matched controls (P less than 0.001). Comparison between patients who had developed diabetes before the age of 20 years and after that of 25 years revealed deficits of 14% and 7%, respectively (P less than 0.001). Sex differences were not observed. The initiation of osteopenia seemed to coincide with the onset of clinical diabetes mellitus, and significantly reduced bone mineral content was observed after 2 years of diabetes (P less than 0.001). After 3--5 years the osteopenia appeared to attain a stable level.

DIURNAL VARIATIONS IN PLASMA PROLACTIN, GROWTH HORMONE, CORTISOL AND BLOOD GLUCOSE IN LABILE DIABETES MELLITUS

In labile diabetes mellitus wihout ketoacidosis we have studied plasma prolactin levels and a possible causal connection between fluctuation in blood glucose concentration and plasma prolactin, growth hormone and cortisol levels. The hormone concentrations in plasma and blood glucose concentration were determined at 20 min intervals for a 24 h period in six male patients with insulin treated diabetes mellitus. Prolactin varied within the normal range but without any significant rise in relation to sleep in five out of the six patients. Growth hormone levels were low with superimposed secretory peaks. Plasma cortisol showed a normal diurnal rhythm. Blood glucose fluctuated as expected, but the variations and especially the falls in blood glucose to non-hypoglycaemic levels were not followed by increases in plasma hormone concentrations. No relationship could be demonstrated between the changes in the plasma concentration of prolactin, growth hormone and cortisol.

Beta-adrenergic blocking agents and anaesthesia: a review.

Beta-adrenergic receptor blockade may have extensive use in clinical medicine. Interactions between beta-adrenergic blocking drugs and anaesthetic agents may have life-threatening ramifications and sequelae. Physiological responses to anaesthetic agents which stimulate sympatho-adrenal activity may be altered markedly. Beta-adrenergic blocking agents are contraindicated in patients with atrio-ventricular block and idioventricular rhythm, because all cardiac electrical activity may be abolished. Relative contraindications include asthma and other broncho-spastic states and conditions predisposing towards hypoglycaemia, e.g. insulin-treated diabetes mellitus. Anaesthetized patients subjected to beta-adrenergic blockade will have decreased tolerance to any factor that increases cardiac work. Patients with hearts dependent upon sympathetic support for survival will not tolerate removal of that support, regardless of anaesthetic agent superimposed. Without beta-adrenergic support, evidence of falling cardiac output will be manifested as hypotension and bradycardia. Central venous pressure will rise if the myocardium fails.

Increased Activity of “Anti-Willebrand Factor” in Diabetic Plasma

SummaryIn a group of 25 patients with insulin-treated diabetes mellitus a marked increase in the ADP-induced platelet adhesiveness was demonstrated. This phenomenon was due to a plasmatic factor. In vitro-plasma from these patients restored the decreased ADP-induced platelet adhesiveness in von Willebrand’s disease.The factor was also effective in vivo, since transfusion of 450 ml diabetic plasma to a patient with von Willebrand’s disease normalized the decreased platelet adhesiveness and shortened the prolonged bleeding time. The role of this factor in the ADP platelet reaction as a cofactor together with calcium is stressed.