[Diabetes mellitus: new directions in its diagnosis].
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Biomedical subjects
Publications and source records attributed to R Renner.
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Glycosylated haemoglobin (HbA1a-c) and serum albumin (glycosyl-albumin) have been determined in patients with severe diabetic ketoacidosis and non-acidotic coma. Within one week of therapy the level of glycosyl-albumin decreased from 184 mmol 5-hydroxymethylfurfural (HMF)/mol albumin to 152 mmol HMF/mol albumin (p less than 0.01) and was gradually lowered by some 40% during a period of 17 days. In contrast, the level of HbA1a-c remained unchanged. From these observations and findings in a patient with insulinoma, it appears that glycosyl-albumin provides a more acute measure of variation in relative glycaemia than HbA1a-c, and may prove useful as a measure of medium-term diabetes control.
Insulin binding and the effect of insulin on the transport of 3-O-methylglucose, lipogenesis from glucose, glucose oxidation and lipolysis was studied in fat cells of adrenalectomised rats and of a control group of sham-operated rats. The serum insulin level of the adrenalectomised rats (0.7 ng/ml) was lower than that of the controls (1.6 ng/ml). In adrenalectomised rats as compared to sham-operated rats the insulin concentrations causing half-maximal effect were reduced by 50% in lipogenesis and antilipolysis and by 30% in glucose transport. The increase in sensitivity to submaximal insulin concentrations was not observed in glucose oxidation. The maximal responsiveness was unchanged in all test systems. The increase in sensitivity in three of the four studied insulin effects may be related to the 37% increase in the binding capacity of fat cells from adrenalectomised compared with sham-operated rats. The unchanged sensitivity with respect to glucose oxidation indicates possible post-receptor modulation. When adrenalectomised rats were substituted with either insulin or cortisol serum insulin levels were elevated above normal; however, the changes in the receptor were prevented in the cortisol supplemented rats and only partially in the insulin supplemented rats. The observation suggests, that the insulin receptor is regulated not only by the serum insulin level but also by cortisol.
The applications of herbicides in agriculture are very intensive. A great number of admitted compounds and their use require a consequent control of residues, especially in vegetables and fruits. Because the analysis are very costly in time and material only multi-residue-methods are practicable. The Sweep-Co-Method can improve the present situation.
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The influence of Etozolin (Elkapin) on the carbohydrate metabolism was studied in 10 healthy volunteers, 6 patients with chemical diabetes and 10 with overt diabetes by blood glucose measurements and oral glucose tolerance tests with determinations of serum insulin levels. The healthy volunteers received 800 mg Etozolin per day during the treatment period of 3 days, the two groups of patients 400 mg Etozolin for 8 days. The laboratory parameters of the treatment period were compared with the corresponding values of the pre- and posttreatment periods and evaluated statistically. There was no statistically significant difference in the carbohydrate metabolism between the 3 test periods in all groups studied. As a result of the induced diuresis body weight, serum electrolytes and urine volume changed significantly during the Etozolin treatment as compared with the pre- and posttreatment values. Other changes of laboratory parameters could not be seen. In diabetic hypertensive patients a significant reduction of blood pressure was observed.
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Duplicate experiments were conducted to compare energy utilization, growth, cardiac mitochondrial oxidative phosphoryl,tion, and mitochondrial membrane fatty acid composition of chicks fed diets containing 20 parts of high erucic acid rapeseed oil (HER), low erucic acid rapeseed oil (LER) or sunflower seed oil (SFO) for 24 days. Chicks fed diets containing HER deposited less fat and utilized energy less efficiently (kcal gained/kcal consumed) than chicks fed diets containing either LER or SFO. Energetic efficiency and fat deposition of chicks pair-fed diets containing LER were significantly lower than for chicks fed diets containing SFO. Cardiac mitochondria isolated from chicks fed diets containing either HER or LER for 24 days had significantly reduced ADP/O ratios and reduced rates of ATP synthesis utilizing pyruvate and malate as the respiratory substrates when compared with mitochondria isolated from chicks fed SFO. Diet induced transitions in fatty acid composition of cardiac mitochondrial membranes were also observed. The composition of fat ingested affected the fatty acid composition of mitochondrial diphosphatidyl glycerol more than the fatty acid composition of phosphatidyl choline or phosphatidyl ethanolamine. The linoleic acid content of mitochondrial diphosphatidyl glycerol was lower and the gadoleic acid and erucic acid content higher for chicks fed diets containing rapeseed oils than for chicks fed SFO containing diets. These studies indicate that a complex dynamic mechanism exists associating dietary fat with mitochondrial structural-functional changes and energetic efficiency in the growing chick.
For the continuous intravenous application of insulin, a portable open-loop system was developed consisting of a delivery unit with a miniaturized pump and an insulin reservoir which is connected with an electronic control unit. The infusion rates were either preprogrammed or patient-controlled. Blood glucose control with both systems was tested in eight juvenile-type diabetics, among them two of the brittle type. Diabetic control during a 1-2-day pre-infusion period was compared with 2-3 days of continuous insulin infusion; as judged by the mean blood glucose value (MBG), the mean amplitude of glycemic excursions (MAGE), and glucosuria, all patients were significantly better controlled by the open-loop systems than by conventional therapy with subcutaneous insulin. The use of portable open-loop systems offers a promising approach to an improvement of metabolic control in insulin-requiring diabetics.
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Insulin binding experiments were performed with liver plasma membranes from guinea pig, calf and chicken. Bound insulin was separated from free insulin by a simple and rapid centrifugation of membranes through a layer of silicon oil. 125 I-labeled beef insulin was displaced from receptor sites by unlabelled guinea pig, beef and chicken insulin. The receptors of animals with insulins of different biological activity show similar basic characteristics and affinities to the different insulin molecules and thus are not specialised for the interactions with the homologous insulin molecule. The binding capacity of the membranes for beef insulin seems to be inversely related to the affinity of the homologous insulin to the receptor, guinea pig membranes showing the highest and chicken membranes the lowest receptor concentration.
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In an attempt to modify the structure of insulin, the hormone was coupled by covalent linkage to poly-N-vinylpyrrolidone (PVP). PVP-insulin is soluble in aqueous solution and was purified by column chromatography. Special care was taken to check for a possible leakage of insulin from the synthetic polymer. The amount of bound insulin was determined by quantitative amino acid analysis after acid hydrolysis. After protection of the N-terminal glycine residue of the A-chain by citraconylation, a biologically active PVP-insulin was obtained. The molecular weight determined by analytical ultracentrifugation and column chromatography was 50 000-60 000. The biological activity of the coupled hormone was between 0.5 and 7% when compared with native insulin in the system in vitro. The immunological activity was about 20-50%.
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Experiments were conducted to compare energy utilization, growth and tissue composition of chicks fed diets containing 10 or 20 parts of either high erucic acid rapeseed oir 24 days. Results showed that chicks fed diets containing 10 or 20 parts LER grew at the same rate, utilized energy just as efficiently, had similar heart to body weight ratios and levels of heart lipids equal to or less than chicks fed comparable diets containing SFO. The substitution of 10 or 20 parts HER for an equienergetic amount of SFO depressed gorwth, feed consumption and carcass fat deposition but had no effect on level of cardiac lipid or relative heart size when fed from 4 to 11 days of age. When fed from 4 to 25 days of age, chicks fed 20 parts HER grew slower, consumed less feed, and when pairfed, deposited less carcass fat, utilized energy less efficiently, had increased heart to body weight ratios but a lower level of cardiac lipid than chicks fed comparable diets containing SFO. Irrespective of the type of rapeseed oil or of the age of the chick, heart lipids contained less erucic acid than carcass fat, indicating that chick heart is as capable of disposing of erucic acid as carcass tissue. It was also found that irrespective of the diet fed, a greater percentage of erucic acid appeared to be oxidized than of eicosenoic acid.
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