The aim of our study was to measure the gastric emptying rate for a solid meal in diabetic patients who had no gastrointestinal complaints with (group 1, n = 12) or without (group 2, n = 10) cardiac autonomic neuropathy and in normal controls comparable in age and sex (group 3, n = 10). Gastric emptying rate was assessed with a sequential scintiscanning method. The percentages of the initial isotope activity remaining in the stomach at different times (20, 40, 60, 80, 100, and 120 min) after the ingestion of a Tc-99m-labeled test meal and the emptying half-time were calculated. Cardiac autonomic neuropathy was determined by the beat-to-beat variations in heart rate during deep breathing. A significant reduction of the gastric emptying rate was observed in group 1. Indeed, at 80, 100, and 120 min the percentage of residual isotope activity was 73 +/- 4, 60 +/- 6, and 50 +/- 6% (mean +/- SE), respectively, in group 1 versus 61 +/- 3 (P less than .05), 45 +/- 4 (P less than .05), and 32 +/- 4% (P less than .02) in group 2. In group 3, residual isotope activity was 57 +/- 4 (P less than .05 vs. group 1), 41 +/- 4 (P less than .05), and 29 +/- 4% (P less than .02), respectively. Emptying half-time was also longer in group 1 (121 +/- 9 min) than in group 2 (95 +/- 6 min, P less than .05) or group 3 (90 +/- 4 min, P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Use of an artificial pancreas as a tool to determine subcutaneous insulin doses in juvenile diabetes.

The present study was undertaken to examine the feasibility of determining the most appropriate subcutaneous insulin treatment in unstable diabetes on the basis of the circadian hormonal profile delivered by an artificial pancreas. The metabolic control of 11 brittle diabetic subjects, as assessed by the M value and the MAGE index (used as indexes of blood glucose control and of glycemic fluctuations, respectively), was compared during a 5-day period before and after a 24-h connection to the artificial pancreas. The usual insulin treatment was continued to that day. Examination of the insulin pattern revealed by the artificial pancreas suggested that a valid scheme for subsequent treatment should consist of two daily injections of a mixture of short-acting and intermediate-acting insulins, which was administered to the patients beginning with the injection given after the artificial pancreas onwards. The new insulin regimen was characterized by a total daily dose that increased from 0.93 +/- 0.10 to 1.20 +/- 0.10 U/kg body weight (mean +/- SEM; P less than 0.005) as well as by a higher proportion of the dose given as regular insulin (37.1 +/- 6.9% before vs. 56.0 +/- 2.1% after; P less than 0.05). These changes led to a better control of blood glucose in 10 patients, as evidenced by a decrease of both the M value and the mean of all blood glucose levels. The mean MAGE index was not decreased, however, by the new insulin program, thereby suggesting that the lability of the disease remained unabated. These results indicate that subcutaneous treatment consisting of two daily injections of regular and intermediate-acting insulins and comprising 50 to 60% of the former could improve the metabolic control in unstable diabetes. The artifical pancreas provided a rapid and simple means to determine the appropriate doses for each type of insulin.

Adult↗

PubMedDate not supplied

Comparison of plasma glucose and plasma free insulin during CSII and intensified conventional insulin therapy.

The plasma glucose and plasma free insulin profiles of six totally insulin-dependent diabetic patients were compared during periods of 4 days in hospital under a conventional insulin therapy (ICIT) comprising 4 daily injections of regular insulin and under continuous subcutaneous insulin infusion (CSII). Two profiles of prandial insulin administration with CSII were compared: a rectangular (R) and an exponential wave (E) in which 50% of the dose was given rapidly followed by an exponential decrease. In both cases, the basal infusion rate was increased by 30-50% between 5 a.m. and 8 a.m. Mean circadian blood glucose was equally good with ICIT: R and E: 7.0 +/- 0.9, 7.3 +/- 1.0, and 7.1 +/- 1.0 mmol/L, respectively. In five patients, fasting plasma glucose was higher with ICIT than with R and E (12.7 +/- 1.8 versus 6.9 +/- 1.0 and 6.8 +/- 0.8 mmol/L, respectively; t test: P less than 0.05; Wilcoxon: P = 0.06). Mean plasma free insulin level was significantly higher (t test: P less than 0.005; Wilcoxon: P less than 0.05) with ICIT (0.46 +/- 0.04 nmol/L) than with R (0.37 +/- 0.04 nmol/L) or E (0.36 +/- 0.05 nmol/L), although the daily doses were similar. In conclusion, CSII leads to a better glycemic control than ICIT, since it appears to prevent the morning rise of blood glucose.

Adult↗

PubMedDate not supplied

[Pre- and peroperative localization of pancreatic endocrine tumors].

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Diagnostic Imaging↗

PubMedDate not supplied

[Microalbuminuria in a population of 653 patients with type 1 and 2 diabetes].

The aim of this retrospective study was to evaluate the prevalence of microalbuminuria in type 1 and 2 diabetic patients with or without high blood pressure levels. 653 patients were involved in the study [type 1: n = 413 (normotensive: n = 298; hypertensive: n = 115); type 2: n = 240 (normotensive: n = 93; hypertensive: n = 147)]. In type 1 diabetic patients, the prevalence of microalbuminuria was of 21 per cent. Microalbuminuria was also found in 28 per cent of type 2 diabetic subjects (p less than 0.10 vs type 1). The prevalence of microalbuminuria was significantly higher in hypertensive than in normotensive diabetic subjects (28 vs 20 per cent; p less than 0.05). Blood pressure in type 1 and 2 normotensive patients was significantly higher in subjects with than without microalbuminuria. We also observed higher HbA1 levels in microalbuminuric type 1 diabetic patients. Finally, we also assessed that the prevalence of diabetic chronic complications was higher in type 1 patients with than without microalbuminuria (p less than 0.05). This relationship was not evidenced in type 2 diabetic patients. In conclusion, the prevalence of microalbuminuria in a population of type 1 and 2 diabetic patients is high. We confirm in this study the relationship between microalbuminuria, blood pressure, and HbA1.

Adult↗

PubMedDate not supplied

Long term reduction of microalbuminuria after 1 year of angiotensin converting enzyme inhibition by perindopril in hypertensive insulin-treated diabetic patients.

We studied the effects of perindopril, an angiotensin converting enzyme (ACE) inhibitor administered during 12 months, on creatinine clearance, albuminuria and glycaemic control in diabetic subjects with mild to moderate hypertension. After 1 month placebo, 40 insulin-treated patients were divided into 3 groups based upon their urinary albumin excretion rate (AER). Group I had a normoalbuminuria (AER less than 15 mg/24 h), group II had a microalbuminuria (AER : 15-150 mg/24 h) and group III had a macroproteinuria (AER greater than 150 mg/24 h and Albustix (+)). They were given perindopril, 4 to 8 mg orally once daily, and received a stable diet. Diastolic blood pressure was normalized within the first 3 months in 80% of the patients. From these, 28 (14.7 and 7 from groups I, II and III respectively) were followed during a total active treatment period of 12 months. They were matched for age, duration of diabetes and hypertension, systolic and diastolic blood pressures, daily insulin dose, postprandial plasma C-peptide and quality of glycaemic control. Mean supine diastolic blood pressure was decreased by 15 and 18% at 1 and 12 months respectively. Heart rate was not significantly modified. At 3 months, plasma ACE activity was nearly totally inhibited while plasma renin activity was markedly increased. In patients of group II, microalbuminuria was reduced from 66 +/- 13 (mean +/- SEM after placebo) to 39 +/- 6 mg/24 h after 1 month perindopril and this effect was maintained at 12 months. In group I, albuminuria remained within the normal range. In group III, macroproteinuria was not consistently modified by perindopril.(ABSTRACT TRUNCATED AT 250 WORDS)

Albuminuria↗

PubMedDate not supplied

Home blood glucose monitoring, glycosylated hemoglobin and fructosamine: their relationships in diabetic patients with and without residual C-peptide secretion.

HbA1c and fructosamine (F) were determined at monthly intervals in insulin-treated diabetic outpatients with (n = 25; C-peptide [+]) and without (n = 30; C-peptide [-]) residual B-cell function (post-prandial C-peptide: 0.76 +/- 0.33 and less than or equal to 0.09 pmol/ml, respectively; mean +/- SD), performing home blood glucose monitoring (HBGM) (40 determinations/month; memory containing reflectometer) during 4 months. Mean monthly blood glucose did not change with time and was equivalent in both groups (9.3 +/- 3.3 and 9.4 +/- 2.0 mmol/l). The magnitude of glycemic excursions was lower in C-peptide [+] than C-peptide [-] patients (mean intra-individual coefficients of variation: 31% and 47%, respectively; P less than 0.001). Overall mean HbA1c was of 7.12 +/- 1.32 and 7.30 +/- 1.06% and F levels were of 44 +/- 6 and 48 +/- 7 mumol/g protein (P less than 0.001) in the C-peptide [+] and [-] groups, respectively. In C-peptide [+] patients, HbA1c strongly correlated with prior mean monthly blood glucose at all visits (range of r valeurs = 0.71-0.84; P less than 0.001); the relation between F and mean monthly blood glucose was always significant but weaker (r = 0.48-0.62; P less than 0.05-0.001). In C-peptide [-] patients, HbA1c correlated weakly with mean blood glucose, only when averaged over 8 weeks (r = 0.40-0.59; P less than 0.05-0.001) but F did not correlate with blood glucose, whether averaged over 1-8 week periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗

PubMedDate not supplied

Response of pancreatic polypeptide to a protein rich meal in diabetic autonomic neuropathy.

The response of human pancreatic polypeptide (hPP) to a protein-rich meal was investigated in 4 groups of subjects: 1) normal controls (n = 11); 2) patients with recent onset type I diabetes, showing no sign of cardiovascular autonomic neuropathy (CAN) (n = 9); 3 and 4) patients with long standing type I diabetes without and with overt CAN (n = 12 and 10 respectively). Patients belonging the group 3 and 4 had equivalent duration of diabetes (17 and 20 years respectively). The mean integrated early hPP responses (0-30 minutes) were respectively (ng. min. ml-1; mean with range): 1) 9.4 (3.3-24.2); 2) 7.4 (0.7-22); 3) 4.8 (0-14.2); 4) 5.4 (0-14.9). The integrated total responses (0-120 minutes) were respectively: 1) 44.0 (12.7-98.7); 2) 39.0 (11.6-118.1); 3) 29.8 (0-81.2); 4) 25.9 (0-71.6). In the group with long standing diabetes, the early and total integrated hPP responses of the patients with CAN did not differ significantly from those without CAN. Early hPP responses of patients with long standing diabetes (group 3 and 4) were slightly (P less than 0.05) lower than those of controls. 5 patients with long standing diabetes had no detectable post-prandial hPP rise, a feature never observed in normals or recent onset diabetics. Two of these had no sign of CAN. These data suggest that an absence of hPP response to a mixed meal may be one of the expression of digestive autonomic neuropathy in long standing diabetes and that impaired hPP response may sometimes be dissociated from overt CAN.

Adult↗

PubMedDate not supplied

Metabolic and psychological evolution of insulin dependent diabetic patients during a 6 months insulin-pen treatment.

The aim of the study is to assess whether an insulin pen-treatment (NovopenR) could be of interest in 10 type I insulin dependent diabetic patients (C-peptide: 0.04 +/- 0.01 pmol/ml, mean +/- SEM), with metabolic and psychological parameters being together taken into account. The daily insulin doses were comparable during the previous treatment with conventional syringes (2-3 daily injections of ActrapidR and MonotardR) and the pen therapy: 0.65 +/- 0.05 vs 0.68 +/- 0.04 U/kg b.w. The metabolic control assessed by HbA1 levels was unchanged before and after 6 months pen treatment: 10.7 +/- 0.7 vs 10.9 +/- 0.6%, respectively. However, fructosamine increased from 2.89 +/- 0.26 to 3.92 +/- 0.20 mmol/l (p less than 0.01) during pen treatment. The psychological objective variables showed no significant changes after pen treatment. In contrast, the staff ratings about the patients attitude toward illness and the spouse evaluation of subjective well-being increased from 40.2 +/- 8.4 to 49.5 +/- 7.8 (p = 0.03) and 34.8 +/- 23.4 to 51.1 +/- 21.1 (p = 0.04), respectively. In conclusion, in a limited group of patients, a multiple injection regimen by pen treatment did not lead to an improved metabolic control. However, subjective psychological tests showed that some aspects of well-being tended to improve.

Blood Glucose↗

PubMedDate not supplied

Effect of the addition of simple sugars to mixed meals on the glycemic control of insulin treated diabetic patients.

In order to evaluate the long term effects of a daily intake of simple sugars upon the glycemic control, 10 insulin treated diabetic outpatients received, according to a randomized cross over design, a conventional or a sucrose-enriched isocaloric, isoglucidic diet (about 20 g sucrose per day, given as desserts and/or soft drinks during or after mixed meals) for 3 months each. The daily insulin doses remained identical during both diets: 0.58 +/- 0.07 vs 0.58 +/- 0.06 U/kg body weight (mean +/- SEM) after conventional and sugar-enriched diet, respectively. The percentages of short acting insulin were also similar: 50 +/- 4 vs 49 +/- 4%. The mean glycemic profiles after lunch and dinner were comparable with both regimens. Moreover, glycosylated hemoglobin levels were 10.0 +/- 0.3 vs 9.9 +/- 0.4% after conventional and sucrose enriched diet, respectively. Plasma cholesterol and triglycerides remained unchanged. In conclusion, a relatively small daily intake of sucrose for 3 months has no clinical and/or metabolic side effects. Therefore, it seems no longer justified to completely ban sucrose from the diet of diabetic patients.

Blood Glucose↗

PubMedDate not supplied

[Artificial pancreas: clinical and therapeutic value in 11 patients (author's transl)].

Fluctuations in blood glucose levels which occur in the brittle diabetic explain the difficulty of blood glucose control by insulin therapy as used at the present time. The artificial endocrine pancreas is a bedside device capable of maintaining blood sugar value within a normal range by the administration of adequate amounts of insulin or glucose given at the optimal time. The glycemic control of 11 brittle diabetics is improved during the 5 days after a 24 hour connection with the AEP. A better determination of adequate subcutaneous doses of insulin, based on the circadian insulin profile infused by the artificial endocrine pancreas, achieved the improvement of glycemia. Glucagon profile preceeding, during and after AEP is also discussed. Using a method of two injections daily of a mixture acterapid and semi-lente, as a general rule it is found that approximately fifty per cent of the dose must be given in the acterapid form. Glucagon value decreases during the 24 h artificial endocrine pancreas. This is suggestive of a possible role of hyperglucagonemia in brittle diabetes.

Adult↗

PubMedDate not supplied

[Organ culture of rat fetal pancreas. I. Liberation of insulin induced by caffeine, sugar and various sugar derivatives].

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Animals↗

PubMedDate not supplied

[Use of the artificial pancreas in the diagnosis and management of an insulinoma (author's transl)].

The artificial endocrine pancreas is generally used to control blood glucose in brittle diabetic patients. In this study, it was applied to the diagnosis and surgical management of a pancreatic insulinoma. Several tests were performed without the risks inherent to severe hypoglycemia. It was also used during surgery, permitting an optimal blood glucose control.

Adenoma, Islet Cell↗

PubMedDate not supplied

[Treatment of insulin-dependent diabetes by continuous subcutaneous infusion of insulin (author's transl)].

Blood glucose levels were measured in 2 groups of patients with insulin-dependent diabetes during continuous subcutaneous infusion of insulin. Results demonstrated that continuous insulin infusion in totally insulin-dependent patients provides control of the diabetes comparable to that obtained by conventional optimized insulin therapy. Furthermore, the good control of blood glucose levels following infusion may permit remission in patients in whom the diabetes is of recent onset.

Blood Glucose↗