Normal Blood Sugar Levels Research Articles

METABOLIC STUDIES IN DIABETIC ACIDOSIS

IT IS now well recognized that the phosphate cycle constitutes the mechanism whereby energy resulting from oxidation is rendered available to living cells.1A notable rise in the plasma level and urinary excretion of phosphorus has been found in diabetic acidosis.2This apparently causes a significant depletion of phosphorus stores in the body, as shown by the response to insulin. The plasma and urinary phosphorus levels fall precipitously and remain subnormal for as long as a week after institution of insulin therapy.2bThe fact that death may occur in circulatory collapse after abolition of ketosis, restoration of a normal blood sugar level and replacement of apparently adequate amounts of water and sodium chloride raises the question of the clinical importance of deficiency of other elements, notably phosphorus and potassium. One of the objectives of the present study was to determine the clinical efficacy of intravenously administered sodium

Diabetes: A Concise Presentation.

This is a readable book which discusses the modern treatment of diabetes in an interesting way. The author expresses the belief that the essential criterion for success lies in the maintenance of a nearly normal blood sugar level. He defends this thesis loyally. The portions dealing with the composition of diets, the use of insulin and the management of complications are more orthodox but no less clearly expressed. As is stated in the preface, a good deal of the contents can be found in articles which the author has written and published in various medical journals. It is useful, however, to have so much of his experience documented in a single volume. Dr. William S. Middleton has added a foreword which is characteristically charming and well written. On the whole, the book is worth owning.

Diet and insulin in the care of the diabetic patient

Procedure for instruction of the diabetic patient about urinalysis, diet, and adjustment of the dose of insulin is presented. The use of soluble, protamine zinc, globin, and combined soluble and protamine zinc insulin is described. Satisfactory methods of measurement and injection of insulin, and of adjustment of the dose according to fractional urinalysis are given. The combined dose of regular and protamine zinc insulin given once daily before breakfast-seems to be the simplest method for obtaining nearly normal levels of blood sugar.

LIVER FUNCTION STUDIES IN DIABETES MELLITUS

Excerpt The liver is intimately associated with the storage of glycogen, the maintenance of the normal blood sugar level and the formation of ketone bodies. The important role of the liver in carbo...

SIGNIFICANCE OF GLYCOSURIA

Nearly three centuries ago Thomas Willis observed the urine from a diabetic patient to be wonderfully sweet, as if imbued with honey or sugar. Ever since then glycosuria has been of paramount interest to the clinician, for it has become synonymous with diabetes mellitus. However, glycosuria may be due to factors that have no relation to diabetes (e. g., glycosuria), while, conversely, diabetes may exist in the aglycosuric patient (e. g., in the presence of severe nephrosclerosis). Furthermore, there is a possibility that glycosuria alone is not an index of the severity of diabetes. Hence, controversies exist in the literature concerning the significance of transient glycosuria, the significance of glycosuria associated with a normal blood sugar level and the relative importance of the blood sugar level as compared with the amount of sugar excreted in the urine. Recent studies in renal physiology have provided information that should clarify some

Disposal of Glucose at High and Normal1 Blood Sugar Levels under Action of Insulin

It is of practical importance in the treatment of diabetic patients to know if there is a difference in the rate of disappearance of glucose under the action of insulin at different blood-sugar levels. Our interest in this problem was aroused during routine observations on diabetic patients. We observed a patient on insulin with the blood sugar in the normal range who did not excrete the extra glucose ingested when placed on a high carbohydrate diet with the same insulin dose. The latter regime was associated with a high blood-sugar level and the result was similar to that which has been reported by others (1, 2, 3). This paper summarises the results of a study of the disposal of glucose at normal and high blood-sugar levels under the action of the same amount of insulin. The study was made on depancreatized animals as well as diabetic patients.

On the Mechanism of Insulin Resistance in Toxemic States1

It is well known that the early stages of toxemia, from whatever cause, may be accompanied by hyperglycemia, glycosuria, and a diminished carbohydrate tolerance as indicated by the dextrose tolerance test (1, 2). The response to a given dose of insulin is less than that in the normal individual (3). Diabetic patients who were formerly well controlled by a small dose of insulin may, with the advent of toxemia, be poorly controlled even with very large insulin dosages (4). This condition has been commonly referred to as ‘insulin resistance.’ Previous work has clearly shown that the liver is a major factor in determining carbohydrate tolerance (5). It has also been demonstrated that liver damage by toxins diminishes carbohydrate tolerance by interfering with the homeostatic mechanism for the maintenance of the constant normal blood sugar level (6, 7). Since insulin is an important regulator of this heptatic mechanism, it was logical to seek the cause of insulin resistance in the liver.

Intensive Carbohydrate Therapy in Diabetic Patients with Manifest or Suspected Liver Disease

THE IMPORTANT ROLE OF THE LIVER in carbohydrate metabolism, first demonstrated by Claude Bernard, has been reviewed recently by one of us (1). It is generally recognized that the glycogen stores of this organ have an important bearing upon its functional integrity and upon its resistance to damaging agents, and wide use has been made of high carbohydrate therapy in liver disease (2). Recent work has clearly shown that the liver is a major factor in the maintenance of the normal blood sugar level. Diabetes mellitus may be regarded as a disturbance in this homeostatic regulation because of a relative lack of insulin or a relative excess of the opposing endocrine factors. The endocrine balance controls the level at which the liver regulates the blood sugar. Under these circumstances it is readily understandable that liver disease which interferes with the responsiveness of this organ to endocrine influences alters carbohydrate tolerance in the non-diabetic organism and decreases the effectiveness of administ...

Clinical and Laboratory Observations on So-Called “Kidney Threshold for Glucose”

Renal threshold is usually denned as that concentration of sugar in the blood above which sugar appears in the urine. If this definition could be literally applied in the diagnosis, prognosis, and treatment of diabetics, the whole matter of control would be a simple procedure. Urine analysis alone would be sufficient to judge the status of blood sugar. For many years physicians specializing in metabolic diseases have depended too much on urinary findings alone; at times, are confronted with cases where they are baffled by the inadequacy of the management and hence are led to question the laboratory results when there is a great discrepancy between blood and urinary sugars. With this paper we will attempt to present extensive observations on diabetic, and non-diabetic patients and also some experimental work on animals. Opinion differs concerning the importance of glycemia. Do urines negative for sugar necessarily indicate low or normal blood sugar levels? Do urines positive for sugar indicate hyperglycemia in normal or diabetic individuals? Does the testing of urines for sugar in diabetics offer a satisfactory means of control of the patients? Do diabetics build up a tolerance for glucose with the passage of years? Does infection always upset the glycemia levels, and give rise to glycosuria because of lack of control? In answering these questions the results assembled by clinical and

TIME-ACTIVITY CURVES OF PROTAMINE ZINC INSULIN

Among the roles played by insulin in carbohydrate metabolism, two have been stressed in previous publications from this laboratory.1These roles may be summarized briefly as follows: (1) the control of new sugar formation in the fasting state, taken care of by the basal and (2) the dextrose-disposing mechanism of insulin, operating by oxidation or storage. It has been shown by many observers that the depancreatized dog in the fasting state has a high blood sugar level. The maintenance of a constant normal blood sugar level in the fasting diabetic dog requires the intravenous injection of insulin at the rate of 0.0051 to 0.035 unit per kilogram per hour, as shown by Greeleylaand Houssay.2Evidence that certain patients with severe diabetes may also have a rising blood sugar level in the fasting state has been reported by Martin, Drury and Strouse.1cThey showed that

Renal glycosuria: A hereditary and clinical study of one family

Summary 1. An American family has been observed in which renal glycosuria has been transmitted directly through three generations as a dominant character. 2. The eldest member, who has had glycosuria with normal fasting blood sugar levels for twenty years, has developed diabetes mellitus with a normal renal threshold. 3. A rise in the renal thresholds for sugar to within normal limits has been observed in two cases of renal glycosuria. 4. Clinical studies have been reported on a 4-year-old member of this family who exhibited ketonuria, mild acidosis, and a renal threshold for sugar below 50 mg. per cent.

CONTROL OF DIABETES MELLITUS

There continues to be a great deal of anxiety concerning the healing of wounds in cases of diabetes mellitus. Before the discovery of insulin a rising blood sugar level with increasing glycosuria was an ominous sign after a surgical operation or if the patient had an infected wound. The wounds of those who did not succumb to acidosis were likely to heal very slowly or become infected, and existing infection tended to spread. Since the advent of insulin, acidosis has been preventable and has ceased to be formidable. The other complications, however, continue to be menacing. The idea is prevalent that such complications occur more frequently among patients with a high blood sugar level and glycosuria than among those who have a normal blood sugar level and no glycosuria. Study of the literature reveals that the methods advocated for the control of diabetes after surgical operations, or when the patient

THE COMPARATIVE ACTIVITY OF DESOXYCORTICO-STERONE ACETATE AND PROGESTERONE IN ADRENAL-ECTOMIZED RATS

DESOXYCORTICOSTERONE prepared by Steiger and Reichstein (1) is considered by them and by Simpson (2) to be similar to the substance B of Kendall et al. (3); the latter is now known as corticosterone. Desoxycorticosterone acetate has been shown to be effective in correcting the symptoms of adrenalectomy in dogs (1, 4, 5) and in rats (1,6, 7). Relief of symptoms was also obtained in hypoadrenal function in man (2, 4, 5). We were interested in this new compound with reference to the dose for rats in comparison with the dose of progesterone for rats. The first reference to the rat did not state the dose used (1) but, since the present data were started, two papers on the rat have been published (6, 7). Grollman (6) indicated that the rat should be given 1 mg. or more daily to obtain growth, and Harrison (7) showed that 2.5 mg. were needed to maintain normal blood sugar levels in adrenalectomized rats.

THE LIVER AND CARBOHYDRATE METABOLISM

THE SECRETION of sugar into the blood by the liver of the fasting animal 11 was demonstrated by the brilliant pioneer work of Claude Bernard (i). The inadequate chemical and physiological methods available to him and his contemporaries initiated an involved controversy which ultimately partly obscured his original conceptions (2). It remained for F. C. Mann (3), who devised the first practical method for complete hepatectomy in mammals, to finally establish the liver as the prime factor for the maintenance of the normal blood sugar level. The presence of appreciable quantities of glycogen in the muscles of their hepatectomized dogs during profound hypoglycemia, ledMann and his coworkers (4) to conclude that muscle glycogen is incapable of sufficiently rapid conversion to glucose to play a significant r6le in maintaining the blood sugar level.

SURGICAL ASPECTS OF HYPOGLYCEMIA ASSOCIATED WITH DAMAGE TO THE LIVER

One of the many important functions of the liver is concerned with carbohydrate metabolism. It is fairly well established that the liver makes and stores glycogen and liberates it to the blood stream as dextrose, through which mechanism the normal glycemic level is maintained. It has been shown that gross interference with the liver, such as surgical extirpation, massive destruction by poisoning or replacement of large amounts of liver tissue by tumor, greatly disturbs this function. The experiments of Mann1on extirpation of the liver established the fact that this organ is absolutely essential to the maintenance of a normal blood sugar level. Several hours after total hepatectomy his animals had a definite train of symptoms on the basis of demonstrated hypoglycemia. Invariably the animals were temporarily restored to normal by intravenous injection of dextrose. Recognition of the clinical state of hypoglycemia followed the introduction of insulin into diabetic

SOCIETY FOR PEDIATRIC RESEARCH

Equilibrium of the Diabetic Child. Dr. J. D. Boyd and Dr. R. L. Jackson, Iowa City. Since diabetes mellitus is not curable, the ideal of management should be the approximation of normal conditions as far as possible. This implies, among other measures, the maintenance of normal blood sugar levels and the avoidance of glycosuria, even of mild degree. Though less stringent treatment may seem to meet the patient's needs, the physician should not be content with poor control if

Water Intake and the Blood Sugar Level

In our studies which have involved blood sugar determinations on rats, considerable effort has been expended to secure uniformity both in the animal material and in the routine care of the colony. But in spite of all this care to secure uniformity we have found at times that the normal blood sugar level showed considerable variation.1 Recently, upon our return from the summer vacation, the routine normal control series of sugar determinations was made. At the same time, determinations were made upon a group of rats used in the study of prolonged high carbohydrate feeding.2 These animals represented the 4th, 5th and 6th generations which had been kept continuously on the high carbohydrate diet. It was noticed that the sugar levels in both groups were not only high but far above any mean value thus far obtained. Two and a half months previously the water supply had been changed from the open jar to the tubulated-bottle system. It had been observed that some of the water bottles did not deliver properly. The...

Measurement of Insulin Action.

The insulin required to maintain a normal blood sugar level in depancreatized dogs has been studied by Holm1 and in the laboratories of Houssay2 and Soskin.3, 4 Holm and Houssay found that 0.01 unit insulin per kilogram of body weight per hour was necessary. Soskin found values as low as 1-175th unit insulin per kg. per hour in dogs under pento-barbital sodium (Abbott).We have determined the insulin requirement in dogs of different sizes which have completely recovered from the pancreatectomy. These dogs were maintained at a constant weight on a measured balanced diet and sufficient insulin to keep the urine nearly sugar-free. They received no food or insulin for 24 hours prior to a determination. No anesthetic was used. The initial high blood sugar was lowered to about 100 mg.% by an intravenous injection of 2-6 units of insulin, depending upon the size of the animal. A continuous or hourly intravenous injection of a weak solution of insulin in physiological saline was started about 4-6 hours following t...

Chronic hypoglycemia in childhood

Summary Two cases of persistent chronic postabsorptive hypoglycemia in children are described. The first child, I. S., presented a condition which is probably familial. The enlarged liver showed no glycogen but extensive fatty infiltration of the liver. There was sufficient hepatic tissue to perform its metabolic functions except that of glycogenesis. This primary failure to form glycogen from glucose, and the consequent absence of deposits of glycogen in the liver resulted in its secondary inability to mobilize the glucose and maintain a normal blood sugar level. A hypothesis is advanced for the presence of the fatty infiltration, e.g., the conversion of the glucose into fat since the dextrose could not be transformed into glycogen. The nature of the hypoglycemia of the second child is still not definitely known. The associated organic central nervous system condition has raised the question as to whether this lesion is not responsible for the hyperinsulinism rather than that we are dealing with a purely pancreatic hyperinsulinism due to neoplasm or hypertrophy and hyperplasia of the islands of Langerhans. It is felt that, since to date there has been described no definite case of hypoglycemia due to a central nervous system lesion and since, on the other hand, there are a sufficient number of unquestionable cases of hyperinsulinism due to a pancreatic lesion, we are probably dealing with pancreatic hyperinsulinism and that the central nervous system changes are either secondary or independent of the primary condition.

GLUCOSE TOLERANCE STUDIES IN CHILDREN AND IN ADOLESCENTS*

At the outset, let us refresh our minds about some of the basic factors to be considered in blood sugar studies. The normal fasting blood sugar level fluctuates between 70 and 110 mg. per cent. This level, if followed for a period of hours, fluctuates but little in the adult, as can be seen from Chart 1. This is also true of a child, and in Chart 2, I have reproduced from the splendid publication by Svensgaard, a series of blood sugar determinations on infants, aged two to five months. These show but slight fluctuation in the blood sugar levels. The second curve in the series, in which the blood sugar level rose more than in the others is the only exception, but when the blood sugars were studied the second day on this same infant, a fairly even curve resulted.