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Biomedical subjects

S Vaaler

Publications and source records attributed to S Vaaler.

51 records · Page 3Linked to original sources
PubMed1992

The effect of selective beta 1-blockade on glucose thresholds for release of counterregulatory hormones and symptoms in insulin-dependent diabetes mellitus.

To evaluate the effect of beta 1-blockade (metoprolol) on the plasma glucose thresholds initiating counterregulatory hormone responses and symptoms of hypoglycemia, we used a modified glucose clamp technique to produce a standardized gradual glucose decline from 5.0 to 2.0 mmol/l in nine patients with insulin-dependent diabetes mellitus (IDDM) (HbAlc range 6.7-10.3%, duration of diabetes 5-18 years, autonomous neuropathy present in three of the patients). The responses were studied once with metoprolol and once with placebo, in random order. With the beta 1-selective blockade, epinephrine release was triggered at a significantly higher (p less than 0.02) plasma glucose level (3.5 mmol/l) than it was with placebo (3.0 mmol/l). Metoprolol did not change thresholds for growth hormone (3.7/3.5 mmol/l), cortisol (2.9/2.9 mmol/l), glucagon (2.8/2.8 mmol/l) or for pancreatic polypeptide (2.8/2.7 mmol/l). The peak responses of epinephrine and growth hormone were significantly higher (p less than 0.01) with the beta 1-blockade. Metoprolol did not change the thresholds for neuroglycopenic and autonomic symptoms. Six out of the seven patients who answered yes to having hypoglycemia did so at a higher blood glucose with metoprolol than without. In our study, the beta 1-selective blockade altered the responses of counterregulatory hormones, but it did not change the thresholds for hypoglycemic symptoms.

Adrenergic beta-Antagonists↗
PubMed1992

Carbohydrate metabolism, insulin resistance, and metabolic cardiovascular syndrome.

Insulin resistance is seen in several pathophysiological conditions, such as obesity, diabetes mellitus, and essential hypertension. This means that a greater than normal amount of insulin is needed to give a normal biological response. A major biochemical defect in insulin resistance seems to be a defect in the intracellular nonoxidative metabolism of glucose in muscle cells. However, in many individuals, there is also increased hepatic glucose output. The result of insulin resistance in individuals with normal insulin-secreting capacity is hyperinsulinemia, a potential risk factor for cardiovascular disease.

Blood Glucose↗
PubMed1991

[Diabetic care--a model of cooperation (Prima Dia)].

The article points to some recent improvements in the field of diabetology. Modern methods of treatment facilitate better metabolic control. To meet these challenges there is a need for more flexible diabetic care schemes and closer cooperation between all categories of medical personnel involved. Prima Dia is an example of such an initiative. It is based upon a continuous diabetes re-education programme and the same simple diabetic record card for general practitioner, hospital diabetologist and patient.

Diabetes Mellitus↗
PubMed1990

Continuous subcutaneous insulin infusion (CSII), multiple injections (MI) and conventional insulin therapy (CT) in self-selecting insulin-dependent diabetic patients. A comparison of metabolic control, acute complications and patient preferences.

Continuous subcutaneous insulin infusion (CSII) and multiple injections (MI) have been shown to have metabolic advantages in highly-selected insulin-dependent diabetics (IDDs), but there have been few comparative studies in self-selected IDDs. With MI, the optimal insulin preparation for overnight insulin delivery has not been defined. We compared conventional 2-3 injection therapy (CT), CSII and MI with human isophane insulin (MI/human isophane) and human ultralente insulin (MI/human ultralente), respectively, at bedtime in self-selected IDDs. Of 275 IDDs who were invited to participate, 52 individuals (18.9%) entered the study. Most indices of glycaemic control showed better values on CSII and also on MI compared to CT, but the differences were small. Fasting blood glucose was higher on MI/human ultralente than on MI/human isophane. Only one subcutaneous abscess and one case of ketoacidosis requiring hospitalization occurred on CSII. Serious hypoglycaemic episodes were non-significantly increased on intensified therapy. Most patients clearly preferred intensified insulin therapy; approximately one half CSII.

Adult↗
PubMed1989

[Reflectometric measurement of blood glucose in general practice].

Blood glucosestix and reflectometers are widely used in measurement of blood glucose in general practice. This study has investigated the accuracy and precision of this method at nine general practitioners' offices. The results show a strong trend towards less accurate and exact values with declining values of blood glucose. The authors ask for routines for quality control of these methods in general practice. Today this method, when used in general practice, is neither accurate nor precise enough to make the diagnose diabetes mellitus, unless the diagnose is obvious, with very high values of blood glucose and classical symptoms.

Blood Glucose↗
PubMed1989

Early morning glycaemia and the metabolic consequences of delaying breakfast/morning insulin. A comparison of continuous subcutaneous insulin infusion and multiple injection therapy with human isophane or human ultralente insulin at bedtime in insulin-dependent diabetics.

We studied morning glycaemia and metabolic consequences of delaying morning insulin/breakfast in insulin-dependent diabetics on (i) continuous subcutaneous insulin infusion (CSII) (n = 27), (ii) multiple-injection therapy (MI) with human isophane insulin at bedtime (MI/human isophane) (n = 23) and (iii) MI with human ultralente insulin at bedtime (MI/human ultralente) (n = 14). After an overnight fast, food and insulin (except for the basal infusion on CSII) were withheld, and blood glucose, serum free insulin and serum betahydroxybutyrate were followed from 0800 hours to 1300 hours. At all times blood glucose was lowest on CSII, intermediate on MI/human isophane and highest on MI/human ultralente; serum free insulin was highest on CSII, intermediate on MI/human ultralente and lowest on MI/human isophane; serum betahydroxybutyrate was lowest on CSII, intermediate on MI/human ultralente and highest on MI/human isophane. Blood glucose rose significantly on MI/human isophane (p less than 0.001) and CSII (p less than 0.02); serum free insulin declined significantly on MI/human isophane (p less than 0.001), and betahydroxybutyrate rose significantly on all regimens. Morning metabolic control is better with CSII than MI. Human isophane insulin is preferable to human ultralente insulin overnight in MI. Delaying morning insulin is not advisable on intensified insulin regimens, being most unfavourable with MI/human isophane.

3-Hydroxybutyric Acid↗
PubMed1987

Sorbitol as a sweetener in the diet of insulin-dependent diabetes.

UNLABELLED: We compared sorbitol given alone and as part of a mixed meal to nine insulin-dependent diabetics (IDD's) during continuous subcutaneous insulin infusion (CSII). Blood glucose, sorbitol and breath hydrogen + methane were measured following six test meals: Pure glucose, sorbitol and lactulose, a mixed meal alone, and sweetened with sorbitol and sucrose. Blood glucose increase was very small after lactulose and sorbitol, significantly larger after glucose. A considerable increase in breath hydrogen + methane appeared after sorbitol and lactulose, but not after glucose. No differences in blood glucose responses were found after the mixed meal alone or sweetened with sorbitol and sucrose. A sustained low level increase in breath hydrogen + methane occurred after all solid meals. Sorbitol was not detected in serum after any meal. CONCLUSION: Sorbitol ingested by IDD's during CSII in watery solution is not absorbed in the small intestine and causes osmotic diarrhoea. Ingested in a composite meal it does not affect blood glucose and does not cause osmotic diarrhoea.

Adolescent↗
PubMed1986

Diabetic control is improved by guar gum and wheat bran supplementation.

Twenty-eight insulin-dependent diabetics were treated with different dietary regimes for three periods of three months. Initially they used a white flour bread (run-in period), then their daily bread ration was enriched with guar gum (mean dose: 29 g), and then with wheat bran (mean dose: 33 g) in a randomized crossover pattern. Fasting and postprandial blood glucose levels were measured on filter paper spots collected once weekly at home, and other biochemical values were measured monthly. No improvement in diabetic control was seen during the run-in period. Mean postprandial blood glucose decreased from 12.0 +/- 3.8 mmol/l (mean +/- SD) in the run-in period to 9.7 +/- 2.8 mmol/l (p less than 0.01) in the guar period and to 9.7 +/- mmol/l (p less than 0.01) in the bran period. HbA1 decreased from 10.5 +/- 2.1% in the run-in period to 9.7 +/- 1.6% (less than 0.05) at the end of the guar period and 9.9 +/- 1.2% (not significant) at the end of the bran period. Only modest changes were seen in serum-lipids--total cholesterol decreased significantly in the guar period, but not in the bran period. In this study both guar gum and wheat bran were well tolerated and produced a substantial decrease in postprandial blood glucose.

Adolescent↗
PubMed1982

Increase in blood glucose in insulin-dependent diabetics after intake of various fruits.

The increase in blood glucose in insulin-dependent diabetics after different fruit meals was investigated. Apple, banana and orange loads were compared with an equal amount of glucose dissolved in water. The postprandial blood glucose responses to pure glucose, apple and banana were almost identical, while the response after orange was somewhat weaker. We therefore conclude that though these fruits contain considerable amounts of fructose, they represent an important source of rapidly absorbable carbohydrate and should mainly be used in mixed meals.

Adolescent↗
PubMed1980

Effect of different kinds of fibre on postprandial blood glucose in insulin-dependent diabetics.

Dietary fibre may retard glucose absorption in normal and diabetic subjects. It is, however, unclear which type of fibre would be most suitable for this purpose. We therefore studied whether pectin differs from fibre from barley (85%) and citrus (15%) (Dumovital) in its effect on postprandial blood glucose responses. Eight insulin-dependent diabetics fasted overnight and were then given a meal without their morning insulin. The basic meal, composed of 90 g white bread and 120 g jam (total carbohydrate 105 g), was given three times: alone, with 15 g pectin and with 15 g Dumovital fibre. Blood glucose was measured for three hours. The tests showed that pectin administration considerably inhibited the postprandial rise in blood glucose, while Dumovital showed no such effect. Barley/citrus fibre (a mixture of cellulose, hemicellulose, lignin and pectin) has not the same inhibiting effect on postprandial rise in blood glucose as pure pectin in insulin-dependent diabetics. Thus, the specific type of fibre must be considered when prescribing dietary fibre to diabetics.

Adolescent↗
PubMed1980

Sucrose and sorbitol as sweeteners in the diet of insulin-dependent diabetics.

Blood glucose levels following breakfast meals containing sorbitol or sucrose as sweeteners were investigated. Nine insulin-treated diabetics received two test meals after an overnight fast. The meals were composed of 90 g white bread, 9 g butter and 100 g strawberry jam which on one occasion contained 18 g sorbitol as sweetener and on another 18 g sucrose. Blood glucose was measured for three hours following the meal. The test meal sweetened with sucrose showed a slightly faster postprandial rise in blood glucose than the sorbitol-sweetened meal, but this difference is not statistically significant at any point of the curves. Taking into consideration that sorbitol has a sweetening effect of only 60% of that of sucrose, we conclude that neither sucrose nor sorbitol are acceptable sweeteners for insulin-dependent diabetics.

Adolescent↗
PubMed1980

Plasma glucose and insulin responses to orally administered carbohydrate-rich foodstuffs.

Healthy individuals were given different carbohydrate-rich test meals (each with an energy content of 300 kcal) after a standardization period. Plasma glucose and insulin were measured during the tests. When compared with an ordinary oral glucose load, potato had a post-prandial plasma glucose and insulin response not statistically different from the glucose load, the bread group had a weaker and slower response than the potato group, and rice had a response between the two other groups. Gastric emptying, the availability of the starch for digestion and differences in the carbohydrate content are discussed as possible explanations for these differences.

Adult↗
PubMedDate not supplied

The effect of cooking upon the blood glucose response to ingested carrots and potatoes.

Ten insulin-dependent diabetic subjects were given the following tests in randomized order: 50 g glucose dissolved in water, 250 g raw and cooked potato (equal to 50 g carbohydrate), 270 g raw and cooked carrot (equal to 25 g carbohydrate), and 4 h of fasting. Blood glucose was measured for 4 h following the tests. The postprandial blood glucose responses after pure glucose and cooked potato were almost similar (90-min values: glucose 8.8 mmol/L, cooked potato 8.0 mmol/L), while the response after raw potato was considerably slower and weaker (90-min value: 3.3 mmol/L). There were no differences between the postprandial blood glucose responses after raw and cooked carrot (90-min values: raw carrot 3.2 mmol/L, cooked carrot 2.8 mmol/L), but the responses were statistically different from blood glucose values during fasting alone (90-min value: 0.8 mmol/L). The study shows that cooking is responsible for the rapid increase in blood glucose after ingestion of cooked potato, while no such phenomenon is seen after cooking of carrots.

Adolescent↗