Biomedical subjects

H Dorchy

Publications and source records attributed to H Dorchy.

At least 145 records · Page 8Linked to original sources

PubMedDate not supplied

[Lipoprotein and apolipoprotein levels in young insulin-dependent diabetic patients. Relations with glycosylated hemoglobin and fructosamine].

The pathogenesis of premature atherosclerosis in diabetic patients has not yet been fully elucidated, but it seems to be related to changes in circulating lipoproteins and to a poor metabolic balance. In this study plasma levels of triglycerides (TG), total cholesterol (TC), HDL- and LDL-cholesterols, apolipoproteins (Apo) A1 and B were measured in 120 young patients aged from 4 to 32 years (mean +/- 1 SD: 17 +/- 6 years) whose diabetes had been present for a mean period of 10 +/- 6 years (range: less than one year to 25 years). The results obtained were analysed in relation to glycosylated haemoglobin (N: 6.8 +/- 0.6 per cent) and plasma fructosamine (N: 1.9 +/- 0.2 mmol/l) levels. The patients were divided into 3 groups according to their HbA 1 level: (group 1: less than 9 per cent, group 2: 9 per cent less than or equal to HbA1 less than 11 per cent; group 3: greater than or equal to 11 per cent. The most significant increases of TG, TC, LDL-C and ApoB levels were observed in group 3, i.e. in patients whose diabetes was the most poorly controlled (HbA 1: 12.9 +/- 1.3 per cent; fructosamine: 4.6 +/- 0.9 mmol/l). These parameters were significantly correlated with HbA1 (p less than 0.01) and even more significantly with fructosamine (p less than 0.001). No significant difference in HDL-C and ApoA1 levels was found in the 3 groups of patients. Thus, TG, TC, LDL-C and ApoB are increased in young diabetics whose HbA1 and fructosamine levels exceed reference values by more than 5 standard deviations.

Adolescent↗

PubMedDate not supplied

[Nutrition of diabetic children in 1989].

Diabetic children should consume the number of calories normal for their age, with an ideal % nutrient distribution: +/- 55% carbohydrate (especially delayed-resorption carbohydrates), +/- 30% lipid and +/- 15% protein. In some countries e.g. Belgium, the excessive proportion of fat in the diet must be reduced. Calorie requirements may vary a lot from one day to the next, but nutrient fluctuations do not entail proportional changes in metabolic control, as long as insulin adaptation is adequate. It is essential that diabetic children adapt their food intake to their appetite; they do not have set needs, since they are growing and their physical activity varies. Imposing a weighed and measured diet is neither desirable for diabetic control nor for the psychological factor. A diet which reduces only carbohydrates automatically favours an excessive supply of lipids which is bad for the blood vessels. A general calorie restriction prevents normal growth and this, in extreme cases, can lead to Mauriac's syndrome. At the other extreme, a disordered diet causes large glycaemic fluctuations with hypoglycaemic accidents and hyperglycaemic spurts responsible for degenerative complications. Dietary democracy, rather than anarchy or authoritarianism, leads to better control of diabetics. The diet must be well-balanced and individually adapted, bearing in mind insulin, physical activity, etc. Where two daily insulin injections are given, what is most important is the distribution of glucides over the various meals. The use of pen-injector provides for greater freedom in the diet. It must be borne in mind that the hyperglycaemic effect of sucrose is restrained if the sucrose is mixed with proteins and lipids during a meal; some sweets may be allowed even in the absence of intense physical activity or hypoglycaemia. The use of synthetic sweeteners and "diabetic" diet products, often useless and expensive, is not recommended.

Blood Glucose↗

PubMedDate not supplied

Transfer from purified porcine insulins to semisynthetic human insulins decreases insulin antibodies and circulating immune complexes in diabetic children and adolescents. A two-year follow-up.

In this long-term prospective study, including 45 diabetic children and adolescents under the age of 20 years, insulin antibodies and other immunological factors (circulating immune complexes, autoantibodies, etc.) were compared before and during a two-year follow-up after a switch-over from monocomponent porcine insulins to monocomponent semisynthetic human insulins. IgG insulin antibodies were detected in 21 children out of 45 (47%) at a mean level of 0.96 mU/ml (0.77-1.15). A significant and important decrease of both the number of patients having insulin antibodies and the level of insulin antibodies was observed 18 months after the switch-over. After 24 months, IgG insulin antibodies were only present in 5 patients (11%) at a mean level reduced by half (0.53 mU/ml; p less than 0.05). Four patients out of the five (80%) had HLA-DR3 DR4 antigens while this phenotype was only prevalent in 26% of the initial patient cohort. On the other hand, 3 months after the transfer, there was a significant and persistent decrease (by half) of non-specific immune complexes (39% of the patients with porcine insulins) which did not appear to correlate with the level of insulin antibodies. The prevalence of autoantibodies and of antinuclear factors showed no significant variations. The practical implication of these findings is that the use of semisynthetic human insulins could be of interest in patients previously treated by porcine insulins.

Adolescent↗

PubMedDate not supplied

Normalization of complement activation and consumption in diabetic children and adolescents after switch-over from porcine to semisynthetic human insulin.

As the use of human insulin could possibly modify the immunogenicity of insulin, the present prospective study compares complement evaluation (CH50, C3, C3d/C3, C4) as well as other immunological factors (insulin antibodies, autoantibodies, ...), metabolic control (HbA1, lipids, ...) and clinical data (insulin dose/kg, number of hypoglycaemic episodes, ...), before and after a switch-over from monocomponent porcine insulins (Actrapid MC, Monotard MC) to human semisynthetic insulins (Actrapid HM, Protaphane HM). Forty-six type I diabetic children and adolescents (mean age +/- SD: 14.3 +/- 3.8 years) participated in the trial. The duration of diabetes ranged from 1.0 to 16.9 years (mean +/- SD: 7.3 +/- 3.7). The study protocol consisted of a 9 month period during which, at monthly intervals, the subjects were assessed clinically and blood samples taken for measurement of biological data. After 3 months, porcine insulins were switched to human insulins. The main results were as follows: 1) The insulin dose/kg was increased after the switch-over (porcine insulin: 0.90 +/- 0.03 U/kg; human insulin: 0.98 +/- 0.03 U/kg; p less than 0.001). This can perhaps be explained by the different bioavailabilities of Monotard MC and Protaphane HM. 2) The objective degree of metabolic control (HbA1), as well as the HDL-cholesterol level and the apo A1/B ratio, were not statistically different before and after the switch-over. 3) IgG insulin antibody binding was not statistically different on transfer from porcine insulin to semisynthetic insulin. 4) Mean level of total IgE and IgE specific insulin antibodies, determined before and after the switch-over, were not different. 5) Autoantibodies and antinuclear factor were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied