Young Diabetics Research Articles

RR interval variations in young male diabetics.

The beat-to-beat (RR interval) variation in resting heart rate was used to detect possible autonomic nerve damage in a group of 42 young asymptomatic male diabetics, employing a sensitive electrocardiographic computer technique. Compared with 25 age-matched controls, the diabetics showed both a significantly smaller mean RR interval (P less than 0.005) and less RR interval variation (P less than 0.001). Whereas only 4 of the diabetic subjects had shorter mean RR intervals, 22 (52%) of the diabetics had RR interval variations that were less than any of the normal subjects. This reduction in heart rate variation has not been previously reported in diabetics without clinical features of autonomic neuropathy and might provide a sensitive method of assessing early autonomic nerve involvement in diabetes.

Continuous electrocardiographic recording during exercise in young male diabetics. A computer study.

Forty selected young patients with diabetes of medium to long duration and 26 control subjects without clinical evidence of ischaemic heart disease were studied using a new and sensitive technique of electrocardiographic recording during exercise with continuous computation of the time course of the ST-T segment changes to detect possible early ST depression indicative of ischaemia. Although no such evidence was found, significant differences in the diabetics were observed in the heart rate and ST-T segment, the latter changes having not been previously reported but which may be attributed to ischaemia or alternatively to autonomic neuropathy in the "presymptomatic" phase.

Increment of Caries in Young Diabetics

Increment of Caries in Young Diabetics

The Relationships between Metabolic Changes and Hormone Balance in Young Obese Diabetics at the Onset of Diabetes Mellitus and during the Remission

The Relationships between Metabolic Changes and Hormone Balance in Young Obese Diabetics at the Onset of Diabetes Mellitus and during the Remission

The response of young diabetics to periodontal treatment.

The response of young diabetics to periodontal treatment.

Diabetes in remission. Insulin secretory dynamics.

Insulin secretory capacity and sensitivity to exogenous insulin were examined in eight nonobese, ketosis-prone young diabetics at the time of a clinical remission during which they could be managed without any insulin therapy. The insulin secretory capacity of these patients was assessed with oral glucose, intravenous glucose and an oral mixed meal test. The insulin responses were variable and relatively subnormal compared to those in normal controls, but definite and substantial responses were found in the majority of the patients to all the stimuli. When small amounts of crystalline insulin were administered intravenously to produce peripheral venous insulin levels in the physiologic range, these patients responded with a normal decrease in blood glucose and plasma free fatty acid levels suggesting maintenance of in vivo insulin sensitivity. Since ketosis-prone, insulin-dependent diabetics are generally characterized by nearly complete failure of beta-cell function, the present finding supports the concept that clinical remission of diabetes is dependent on a functional recovery of the beta cell. Furthermore, it seems likely that no significant “insulin resistance” that often accompanies severe diabetes is present in this remission state.

Gonadotropin levels in sera and pituitary glands of female rats treated with alloxan

Alloxan monohydrate in saline solution was injected intraperitoneally into young (35 day old) and older (95 day old) female rats at dose levels of 7.5 mg or 15.0 mg/100 g of body wt. In both age groups of rats, only the high dose of alloxan was effective to produce permanent diabetes as judged by the presence of hyperglycemia and glucosuria. The rats were bled by cardiac puncture and autopsied 21 days following the alloxan treatment. In young rats, diabetes resulted in a significant reduction in body weight gain and in ovarian and anterior pituitary weights. Serum and pituitary LH levels of these young diabetics were, respectively, significantly lower and essentially the same, whereas their serum and pituitary FSH levels were, respectively, essentially the same and significantly higher than those of the controls. In the older diabetics, although a significant decrease in body weight gain was observed, the ovarian and pituitary weights as well as the serum and pituitary gonadotropin levels were essentially the same as compared to the controls.

A new principle for the comparison of insulin secretory responses. II. The effect of obesity on insulin secretion.

ABSTRACT In an attempt to circumvent the difficulties inherent in the use of insulin/glucose ratios a new principle for the comparison of insulin secretory resonses has been developed. From large groups of obese and non-obese people subjects are selected so that the subgroups ultimately formed are comparable with regard to age and to their degree of glucose tolerance. This means that the blood glucose curves of the two groups are merging and that the beta cells are subjected to identical glycaemic stimuli. The study shows that obese young non-diabetics and obese young and old diabetics exhibit an augmented insulin response to stimulation with oral and intravenous glucose and to intravenous tolbutamide. No increase in plasma insulin secretory response is, however, demonstrable in obese, old non-diabetics.

Euglycaemic diabetic ketoacidosis.

Of a series of 211 episodes of diabetic metabolic decompensation 37 had severe euglycaemic ketoacidosis (a blood sugar level of less than 300 mg/100 ml and a plasma bicarbonate of 10 mEq/1. or less). All were young insulin-dependent diabetics, only one being previously undiagnosed. Vomiting was a common factor, and in all carbohydrate reduction occurred with continued or increased daily insulin dose. Treatment comprised fluid and electrolyte replacement and large doses of insulin covered by adequate carbohydrate, many receiving 10% dextrose. Alkali was either withheld or given sparingly and the therapy was monitored by serial estimations of plasma bicarbonate. All the patients survived.

Profile of young Indian diabetics. Biochemical studies

The clinical and biochemical features of an atypical diabetic group seen in Northern India, the young ketosis-resistant diabetic, are discussed. The studies of intermediary metabolites, such as FFA, plasma glycerol and acetone confirmed their non-ketotic behavior in spite of significant hyperglycemia. Their plasma immunoreactive insulin levels were high and B-cell stimulation with glucose loading or sulphonylurea administration elicited an appropriate response. There was evidence to suggest a high secretion rate of insulin with normal metabolic clearance rate. Heterologous insulin antibody titre was not considered responsible for the metabolic effects seen. The rise in plasma insulin appeared to be compensatory, as the biological effect of this insulin was limitedin vitro andin vivo. Adipocytes in young non-ketotic diabetics did not show structural abnormalities; a shift of neutral fat towards hepatic tissue was seen, lipoprotein lipase was within the normal range. The metabolic effects are related to the biological inefficacy of insulin in the absence of peripheral adiposity. A functional change in the adipose tissue remains an enigma for certain clinical variants of essential diabetes.

Glomerular filtration rate and renal plasma flow in long-term juvenile diabetics without proteinuria.

Glomerular filtration rate and renal plasma flow were examined in 16 young male non-proteinuric diabetics (mean age 28.4 years) with a duration of diabetes of over 15 years (mean duration 21.5 years.) In this selected group of long-term diabetics the glomerular filtration rate was clearly increased, the mean being 136 ml/min (+/-S.D. 11.8) (normal value 114 ml/min (+/-14.1), being comparable to that found earlier in short-term diabetics. There was no change in renal plasma flow. It is concluded that kidney function is generally well preserved in long-term diabetics who have not developed proteinuria.

Evaluation of programmed education among juvenile diabetics and their families.

Patient education and involvement is a vital part of quality medical care in chronic diseases, such as diabetes mellitus. In this study the acceptance and effectiveness of programmed machine instruction was evaluated. Young diabetics and their parents can be taught about the disease and its control using an automated technic. There was no objective evidence to indicate control of the disease was significantly improved over a brief period of three months. Patients and parents participating in this study expressed acceptance of programmed instruction as a valuable adjunct to the total education process but stated that this technic should not be the sole educational method employed.

The ABO and Rhesus blood groups of diabetic mothers and their newborn babies.

In 652 young female diabetics the ABO and Rhesus type distribution did not differ significantly from that of the control series. Subdivision of the patients according to White classes, presence of family predisposition, and ‘good’ or ‘bad’ obstetrical history also failed to demonstrate any significant deviations. In 375 (diabetic) mother/child pairs the segregation of the ABO and Rhesus types in the children were in accordance with the expected values except for a few, probably random, deviations found in the children of Rhesus negative mothers. The present material of young diabetics did not support the assumption of any correlation between the ABO and Rhesus types and diabetes mellitus. There was no evidence of increased fetal wastage associated with these blood types.

Observations on heredity and obesity in the emergence of diabetes.

The 899 offspring of Natal Indian diabetic couples are compared with the general Indian population. Diabetes was present in 25% of offspring aged 40– 49 as against 14.7% of the general population. The ratio of offspring diabetics to population diabetics diminished with age, suggesting that the genetic influence affects mainly age of onset of diabetes. “Old” and “young” diabetic couples had a similar proportion of diabetic children. Another similar comparison could be made between an inbred Tamil Indian family in Cape Town and the general population of Cape Hindus. More young diabetics were obese than old diabetics, in3 different racial groups and in both “clinic” and “survey” diabetics, whereas in the general population obesity is more common over age 40. Overweight may be a more important diabetes risk factor in young than in old people.

Dental caries in young diabetics.

Dental caries in young diabetics.

Studies on neutral fat, lipoproteins and lipoprotein lipase in relation to vascular disease in young Indian diabetics

Eighty diabetics and 20 normals under the age of forty were screened for vascular disease at the All-India Institute of Medical Sciences Hospital, New Delhi, and a relationship was sought with the serum triglycerides, pre-beta-lipoproteins and lipoprotein lipase. The incidence of vascular disease (hypertension, retinopathy, cardiovascular, renal and peripheral vascular disease) was 27.5% in this series. The serum triglyceride and pre-beta-lipoprotein levels and the β/α ratio were significantly higher in the diabetics than in the normals and distinctly higher in diabetics with vascular disease than in those without. Lipoprotein lipase was not altered in either diabetic group. The duration of diabetes and the mode of treatment and control had no significant role in the causation of vascular disease. According to this series, hyper-pre-beta-lipoproteinemia seems to result from a primary lipid disturbance; it is not carbohydrate dependent or associated with PHLA activity.

The Detection of Early Visual Loss in Young Diabetics

The Detection of Early Visual Loss in Young Diabetics

THYROID AND GASTRIC AUTOIMMUNITY IN PATIENTS WITH DIABETES MELLITUS

The organ-specific autoimmune thyroid diseases and pernicious anæmia are alleged to occur more frequently in diabetic subjects. In the present study, the incidence of antibodies to thyroid cytoplasm and to gastric parietal cell cytoplasm was found to be significantly increased (P < 0·001) in the sera of 1054 diabetics without clinical thyroid disease or pernicious anæmia compared to 871 control subjects when analysed by age and sex. The increased incidence of these antibodies in diabetics was particularly pronounced in young insulin-dependent diabetics, especially young females. There was no clear relationship between the incidence of these antibodies with the duration of diabetes, but in patients over the age of 40 years at the time of study the incidence was significantly higher in those who were insulin-dependent than in those who were insulin-independent (P<0·001). Within the insulin-dependent group there was no correlation with the age of onset of the diabetes. The incidence of antibody to thyroglobulin in the diabetics compared to controls was much less pronounced than was the incidence of antibody to thyroid cytoplasm and to gastric parietal-cell cytoplasm. Intrinsic-factor antibody 1 was found more commonly in female diabetics over the age of 40 years than in female controls of comparable age (p<0·005). Of 9 such patients with intrinsic-factor antibody who were available for study there was evidence of achlorhydria in all, latent pernicious anæmia (with malabsorption of vitamin B 12) in 6, and adequate vitamin-B 12 absorption in 3. There seems to be a disorder of the immunological system related to insulin-dependent diabetes with respect to the formation of autoantibodies and the occurrence of organ-specific autoimmune disease.

The influence of age and dietary conditions on diabetes in the db mouse.

The mutant mouse, C 57 BL/KsJ -db, develops spontaneous diabetes with many symptoms similar to those observed in the diabetic human. Food intake, body weight, and plasma insulin in thedb mouse were increased by 4 weeks of age and blood sugar by 7 weeks. The blood sugar continued to increase with age but by 3 months plasma insulin, pancreatic insulin, and body weight decreased despite continued elevated food intake. Blood sugar and plasma insulin could be stabilized and pancreatic insulin increased of young diabetics were kept on a limited diet. Baseline glucose oxidation by adipose tissuein vitro was elevated in weanlingdb mice but depressed in older diabetics. The response to insulin of adipose tissue from olderdb mice was markedly reduced and gluconeogenic enzymes were increased. These observations suggested that diabetes in thedb mouse results from the eventual inability of the pancreas to control a continual, abnormally increased supply of glucose. In the very young diabetics, elevated plasma insulin and increased glucose oxidation by the tissues (adipose tissue) maintained the glucose concentration at a normal level. In the olderdb's, elevated food intake, depressed glucose utilization, and continuous output of glucose by the liver produced a constant, severe stress on the beta cells, resulting eventually in beta cell exhaustion and in the development of lethal diabetes.

Pathological changes in the central and peripheral nervous system of young long-term diabetics. The terminal neuro-muscular apparatus.

Muscle biopsies were studied from sixteen juvenile, long-term diabetics. Most of the patients had severe retinopathy, but clinical signs of other forms of angiopathy and neuropathy were either absent or mild. The biopsies revealed severe degeneration, as well as ineffective regenerative changes of the terminal nerve fibres and endorgans.