[Diabetes and hypoglycemia].
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Diabetes Mellitus↗
Biomedical subjects
K Scheidegger
Publications and source records attributed to K Scheidegger.
[Basedow's disease].
Graves' disease has been shown to be an autoimmune disorder. Circulating antibodies to the thyrotropin receptor stimulate thyroid hormone synthesis and hence lead to hyperthyroidism. The diagnosis is made mainly on clinical grounds. Measurements of thyroid hormone concentrations and titers of thyroid-stimulating immunoglobulins confirm the diagnosis. Further diagnostic procedures are rarely needed. There still exists some controversy about the appropriate treatment for Graves' disease. Nevertheless some therapeutic guidelines are proposed. Advantages and disadvantages of the various methods are discussed. Basically there are three choices: surgery, radioiodine and antithyroid drugs. Treatment of Graves' disease during pregnancy and lactation will be discussed in detail.
Antithyroid Agents↗
[Acute retinal necrosis and HIV infection].
Acute retinal necrosis (ARN) is increasingly being observed among patients with HIV infection. Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are recognized as being the etiologic agents in this syndrome. Among the 538 patients with HIV infection (261 of these with AIDS), who were followed up in our department between 1985 and 1990, we diagnosed ARN in 4 cases. Three of these patients suffered from AIDS. Thus, ARN was the third-most-frequent form of retinitis in our patients with AIDS (prevalence 1.1%), following Cytomegalovirus (CMV) retinitis (17.2%) and toxoplasmosis-retinochorioiditis (2.7%). The course of ARN in patients with AIDS is demonstrated in four case reports. Special features of the retina are documented by photographs of the fundus. The authors suggest that patients with AIDS who experienced an episode of VZV- or HSV infection which necessitated high-dose systemic aciclovir therapy are at risk of developing ARN. We recommend that they be kept on virustatic maintenance therapy.
Acyclovir↗
[The diabetic foot].
The socio-economic, medical and psycho-social consequences of lower-limb injuries in diabetic patients are enormous. The risk of lower extremity amputation is 15 times greater in diabetic patients than in the age-matched non-diabetic population. About 1000 diabetic patients undergo a disabling amputation annually in Switzerland. Implementation of appropriate educational and foot-care programmes by motivated pluridisciplinary teams may reduce major amputations by as much as 50%. Regular examination of the feet of diabetic patients, therefore, deserves the same priority in diabetes care as control of the optic fundus and of kidney function, but unfortunately this is seldom the case. These guidelines summarize the physiopathology, the diagnosis and the treatment of diabetic foot problems. Emphasis is placed on simple preventive measures which should help protect the majority of high-risk patients.
Diabetes Complications↗
[Insulin injection/insulin pharmacokinetics].
Whereas the importance of changing dietary composition and physical activity for metabolic control in diabetic patients is well respected, pharmacokinetic variables of insulin are often neglected in therapeutic decisions. The ambitious goal of euglycemia can rearly be achieved, however, without a profound knowledge of factors influencing the pharmacokinetics of insulin, such as site of injection, injection technique, miscibility of insulins, dose of insulin, injection volume, local blood flow, etc. Available data indicate that it is of major importance to implement pharmacokinetic aspects in the daily care of the insulin-treated patient.
Diabetes Mellitus, Type 1↗
Monodeiodination of triiodothyronine and reverse triiodothyronine during low and high calorie diets.
The impact of varying caloric intake on peripheral monodeiodination and plasma disposal of T3, rT3, and the three diiodothyronines (T2) was studied in five normal subjects while they were consuming a low calorie diet (1200 Cal/day) and again while receiving a high calorie diet (3600 Cal/day). Toward the end of each diet period 240 nmol 3,3'-T2 (126 micrograms) and 80 nmol 3',5'-T2 (42 micrograms) were infused for 7 h, and a bolus injection of 137 nmol 3,5-T2 (72 micrograms) was followed by a 12-h infusion of 69 nmol 3,5-T2 (36 micrograms) and 111 nmol rT3 (72 micrograms) on another day. [125I]T3 (30 muCi) was injected on the third day. The T2 and rT3 concentrations were measured by RIA during the 2 days of infusion, and the serum disappearance of [125I]T3 was studied by immunoprecipitation and trichloroacetic acid precipitation of the labeled T3. Four to 5% of the plasma disposal of T3 was accounted for by 3'-monodeiodination, and 36-39% by 5-monodeiodination. Increasing caloric intake resulted in a higher overall plasma disposal rate of T3, but no change in the percentage of T3 metabolized by monodeiodination pathways. In contrast, 5'-monodeiodination accounted for 21% of the total plasma disposal of rT3 during the low calorie diet and 45% during the high calorie intake. This increase in 5'-monodeiodination of rT3 was at the expense of alternative pathways of disposal. A marked increase in the plasma clearance rate of 3,5-T2 was also found during the high calorie diet, indicating that the level of caloric intake affects pathways of metabolism other than outer ring monodeiodination. These studies emphasize the important role played by diet in the regulation of peripheral thyroid hormone metabolism through modulating outer ring monodeiodination, and that overnutrition changes other pathways of iodothyronine metabolism as well.
Adult↗
[Surgical risk in endocrine diseases].
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Endocrine System Diseases↗
Effect of diet on energy expenditure and plasma norepinephrine in lean and obese Pima Indians.
To assess whether thermogenesis or sympathetic nervous system (SNS) function might differ between lean and obese human subjects, studies of thermic and sympathetic responses to standard stimuli were undertaken in Pima Indians, an ethnic group with a high prevalence of obesity. Plasma levels of norepinephrine (NE) and energy expenditure at rest and in response to feeding, exercise, and graded infusions of NE were compared in five lean and five obese Indians during a period of weight maintenance (WM), after 3 weeks of overfeeding (OF) and, in the obese, also after 6 weeks of underfeeding (UF). Basal energy expenditure, when adjusted for fat free mass, was equivalent during WM and increased 3% with OF (P less than 0.01) in both groups. Thermic responses to exercise or a test meal did not differ in lean and obese and did not change with OF, while thermic responses to NE infusion fell during OF to a greater degree in obese than lean (P less than 0.05). A similar pattern (decreased effect in obese with OF) was also noted in the glycemic response to infused NE (P less than 0.05). Although not quantitatively different in lean and obese, the plasma NE concentration appeared to vary more in response to feeding or dietary alteration in the obese than lean, a finding that may reflect lower plasma clearance of NE in the obese. These studies, therefore, raise the possibility that overfeeding in obese Pima Indians may limit the contribution of sympathetically mediated thermogenesis to energy expenditure, though the implications of this for body weight regulation are speculative.
Adolescent↗
Effect of elevated FFA on carbohydrate and lipid oxidation during prolonged exercise in humans.
Increased availability of circulating free fatty acids (FFA) inhibits the rate of glycolysis in heart and resting skeletal muscle (Randle effect). Whether elevated FFA may play a role in decreasing carbohydrate oxidation during prolonged exercise in humans is more controversial. Using respiratory exchange measurements, we measured substrate utilization during 2.5 h of exercise at approximately 44 +/- 1% maximal O2 uptake (VO2 max) in the presence or absence of elevated FFA levels. After 30 min of base-line determinations, 1,000 U heparin was given intravenously and a 3-h constant infusion of Intralipid 10% (150 g/h) and heparin (500 U/h) was started. After an additional 30 min of rest, subjects exercised for 2.5 h (study 1, n = 6). In another five subjects (study 2) 100 g glucose was ingested after 30 min of exercise. The same protocols (studies 1 and 2) were also performed during a 0.9%-saline infusion. During exercise, without glucose ingestion, higher FFA concentrations prevailed during the Intralipid infusion (1,122 +/- 40 vs. 782 +/- 65 mumol/l), but the relative contributions of carbohydrate (49 +/- 4 vs. 50 +/- 4%) or lipid (49 +/- 4 vs. 47 +/- 6%) oxidation to the total energy expenditure were different only during the first 30 min of exercise. Similarly, higher FFA levels (1,032 +/- 62 vs. 568 +/- 46 mumol/l) did not alter the relative contributions of carbohydrate (62 +/- 4 vs. 69 +/- 2%) or lipid (36 +/- 4 vs. 29 +/- 2%) oxidation to the total energy expenditure after glucose feeding.(ABSTRACT TRUNCATED AT 250 WORDS)
3-Hydroxybutyric Acid↗
Effects of chronic beta-receptor stimulation on sympathetic nervous system activity, energy expenditure, and thyroid hormones.
The effects of hyper- and hypothyroidism on sympathetic nervous system activity and energy expenditure are well recognized. The impact of altered sympathetic nervous system activity on energy expenditure and thyroid hormone metabolism has not been well studied. We investigated the effects of orally administered terbutaline sulfate, a beta 2-receptor agonist (5 mg, three times per day for 2 weeks), on the activity of the sympathetic nervous system, energy expenditure, and thyroid hormone metabolism in six normal men, aged 21-36 yr. The cardiovascular, metabolic, and thermogenic responses to an infusion of the beta-adrenergic agonist isoproterenol were clearly blunted after 2 weeks of treatment with terbutaline sulfate, indicating down-regulation of beta-receptors and/or development of reduced sensitivity. There were no significant changes in the cardiovascular, metabolic, or thermogenic responses to an infusion of the alpha-adrenergic agonist phenylephrine. Basal metabolic rate was significantly increased by the chronic administration of terbutaline sulfate [5.040 +/- 0.167 (+/- SE) vs. 5.421 +/- 0.234 kJ/min; P less than 0.05]. There was a highly significant change in the serum T3 to T4 ratio (19.4 +/- 1.0 vs. 24.4 +/- 1.0; P less than 0.001). This was a result of increased serum T3 concentrations (136 +/- 9 vs. 160 +/- 14 ng/dl; P less than 0.05) and decreased serum T4 concentrations (7.2 +/- 0.8 vs. 6.7 +/- 0.8 micrograms/dl; P = NS). Chronic beta-receptor stimulation with terbutaline sulfate increases the basal metabolic rate and T3 concentrations. These changes occurred despite down-regulation of beta-receptors and/or decreased sensitivity in response to chronic terbutaline administration.
Adrenergic alpha-Agonists↗
Effects of chronic beta receptor stimulation on glucose metabolism.
The acute administration of a beta receptor-stimulating agent profoundly affects insulin-mediated glucose metabolism; however, little is known about the impact of chronic beta receptor stimulation on glucose metabolism and insulin sensitivity. We therefore investigated the effect of the chronic administration of a beta-2-agonist, terbutaline sulfate (TS), on glucose metabolism in 7 healthy, normal-weight, male volunteers between the ages of 21 and 30 yr. Studies were performed using the euglycemic, hyperinsulinemic (1.0 mU/min X kg) clamp technique before and after the oral administration of 5 mg of TS three times a day for 1 and 2 wk. Basal endogenous glucose production (EGP) (2.54 +/- 0.11 versus 2.64 +/- 0.14 mg/min X kg) and basal glucose oxidation (1.87 +/- 0.16 versus 2.0 +/- 0.2 mg/min X kg) were unchanged by the chronic administration of TS. However, insulin-stimulated total glucose metabolism increased by 29% (7.0 +/- 0.47 versus 9.05 +/- 0.67 mg/min X kg; P less than 0.02). Insulin-stimulated, nonoxidative glucose disposal increased by 45% (3.62 +/- 0.42 versus 5.26 +/- 0.48 mg/min X kg; P less than 0.01), while insulin-stimulated glucose oxidation did not change significantly (3.38 +/- 0.15 versus 3.79 +/- 0.22 mg/min X kg). EGP was completely suppressed under both conditions. Mean basal plasma insulin concentration (41 +/- 9 versus 49 +/- 15 pmol/L) and insulin clearance during the clamp procedure was unchanged (477 +/- 45 versus 474 +/- 37 ml/min X m2). We conclude that chronic beta receptor stimulation with TS improves insulin-stimulated glucose disposal in man, mostly by improving nonoxidative glucose disposal, i.e., "glucose storage."(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Successful indomethacin therapy of severe diarrhea with primary orthostatic hypotension].
In a patient with Shy-Drager syndrome the severe episodic diarrhea and orthostatic hypotension were both successfully treated with indomethacin.
Aged↗