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Aggravation of hypoglycemia in insulinoma patients by the long-acting somatostatin analogue octreotide (Sandostatin).

Recently somatostatin analogues were successfully used to control insulin-induced hypoglycemia in patients with insulinoma. We observed a transient decrease in glucose levels and symptomatic hypoglycemia after administration of the long-acting somatostatin-analogue octreotide (Sandostatin) in two insulinoma patients. We studied the acute effects of octreotide (administered before breakfast) on blood glucose and gluco-regulatory hormones in these patients. In one patient, we studied the effects of glucagon replacement and changing the time of breakfast (relative to octreotide administration) on octreotide-associated changes in blood glucose and glucoregulatory hormones. Compared with control levels, octreotide therapy reduced insulin levels. During hypoglycemia glucagon and growth hormone levels were suppressed, but cortisol levels appropriately increased. The increase in catecholamine levels was normal in one patient, but markedly attenuated in the other. A transient decrease in serum glucose after octreotide was absent after glucagon replacement, but present when breakfast was taken before administration of octreotide. We conclude that in patients with insulinoma, octreotide therapy may be associated with clinically important hypoglycemia, during which counterregulatory hormone secretion may be attenuated.

Adenoma, Islet Cell↗

Dietary carbohydrate, a Big Mac, and insulin requirements in type I diabetes.

Using the artificial beta-cell (Biostator), we determined the insulin requirements in five nonobese type I (insulin-dependent) diabetic subjects who received isocaloric 40 and 60% mixed-carbohydrate diets in a crossover randomized fashion for 4 days, each day consisting of four equal meals. This was followed on day 5 by a "Big Mac Attack" lunch consisting of a Big Mac, french fries, and milk shake. Insulin requirements to maintain normoglycemia were calculated for each 24-h period and for the 2 h after each meal. The mean 24-h insulin requirements to maintain normoglycemia was greater for the 60% carbohydrate diet than the 40% diet. Although the four meals were of equal size, in all patients the insulin required to cover breakfast greater than lunch greater than dinner greater than or equal to snack. Expressed as milliunits per kilocalorie, the amount of insulin to cover breakfast was greater for the 60% (P less than .05) than the 40% carbohydrate diet and greater for breakfast than the other meals (P less than .01). Insulin requirements for the Big Mac (43% carbohydrate) were 58% greater than for the 40% carbohydrate diet, even after correction for caloric differences. In summary, 1) increasing dietary carbohydrate from 40 to 60% results in an increased insulin requirement for meals only; 2) insulin requirements are greater in the morning than in the evening, even when meal size is constant; and 3) very large meals with high fat and carbohydrate content result in a major increase in insulin requirement. These data indicate that diet has an important impact on insulin requirements in diabetes.

Adult↗

Effect of temporal distribution of calories on diurnal patterns of glucose levels and insulin secretion in NIDDM.

The effect of different temporal patterns of calorie intake on plasma glucose, serum insulin, and insulin secretion rates was examined in six patients with moderately well controlled non-insulin-dependent diabetes mellitus (NIDDM). Patients were studied on three separate occasions over 26 h. Total calories and food composition (50% carbohydrate, 15% protein, and 35% fat) were kept constant, but the pattern of calorie intake was varied. In study A (similar meal size), calories were distributed as 30, 40, and 30% at breakfast, lunch, and dinner, respectively. In study B (3 snacks, 3 meals), each subject ate three meals of 20, 20, and 30% of calories for breakfast, lunch, and dinner, respectively, and three snacks, each comprising 10% of calories, presented 2.5 h after the meal. In study C (large dinner), 10% of calories were consumed at breakfast, 20% at lunch, and 70% at dinner. Glucose, insulin, and C-peptide concentrations were measured at 15- to 30-min intervals. Insulin secretion rates were calculated from C-peptide levels with individually derived C-peptide clearance parameters. The different eating patterns were associated with only modest differences in overall levels of glucose and insulin secretion. Daytime insulin secretion was lowest when most of the daily calorie intake occurred in the form of a large dinner. Overnight levels of glucose and insulin secretion rates did not differ for the three eating patterns, and the morning glucose levels were also unaffected by the pattern of calorie intake on the previous day. A morning rise of glucose of greater than 0.28 mM occurred consistently only when dinner was of moderate size (30% of total calories).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗

Abnormalities of antroduodenal motility in type I diabetes.

OBJECTIVE: In the present study, a recently developed manometric technique was used to study antroduodenal motility in ambulant type I diabetic subjects. RESEARCH DESIGN AND METHODS: In 12 patients with type I diabetes, antroduodenal manometry was performed for 20 h during the fasting period and the postprandial period after a standardized dinner and breakfast. All patients had evidence of cardiac autonomic neuropathy and complained of dyspeptic symptoms. During the manometric study, the blood glucose levels were frequently monitored and kept close to euglycemia in the diabetic patients. The results were compared with 12 healthy control subjects. RESULTS: The migrating motor complex cycles observed in the diabetic subjects were longer than in the control subjects, 118.9 +/- 46.0 vs. 87.0 +/- 21.6 min (P < 0.05). This increase was attributable to a prolonged phase II, 78.0 +/- 35.5 vs. 37.7 +/- 18.5 min (P < 0.05). In the diabetic subjects, antral phase III was seen significantly less than in the control subjects, 16.7 vs. 43.3% (P < 0.005). In 50% of the diabetic patients, total absence of antral phase III was observed-this phenomenon was not seen in the healthy control subjects. After dinner, the antral motility index was less in diabetic subjects compared with the healthy volunteers, indicating antral hypomotility (P < 0.01). Six diabetic patients showed abnormal duodenal activity such as early recurrence of phase III and bursts after dinner. No significant differences in antral motility index or in duodenal motility patterns were observed after breakfast. Six diabetic patients complained of dyspeptic symptoms after dinner, whereas none had dyspeptic symptoms after breakfast. In 67% of the patients, nausea was reported after an early phase III or a burst. CONCLUSIONS: This study shows that prolonged ambulatory antroduodenal manometry is a feasible technique in patients. Recording multiple migrating motor complexes showed that interdigestive motor abnormalities of the stomach and duodenum are common in diabetic patients. Furthermore, it shows the occurrence of antral hypomotility and abnormal duodenal motility patterns after a high-calorie meal, with dyspeptic symptoms in diabetic patients being related to the composition of the meal.

Adult↗

Optimal administration of lispro insulin in hyperglycemic type 1 diabetes.

OBJECTIVE: Lispro is a new rapidly absorbed insulin analog. At present, there are no recommendations for the optimal injection time of lispro insulin in hyperglycemic patients. In contrast to normoglycemic patients with diabetes, we hypothesized that injection of lispro insulin 15-30 min before meal ingestion would improve postprandial glucose excursion in hyperglycemic diabetic subjects. RESEARCH DESIGN AND METHODS: In 48 randomized overnight studies, 12 healthy adult type 1 diabetic patients received lispro insulin 0.15 U/kg admixed with human ultralente 0.2 U/kg (as background insulin) subcutaneously at minutes (-30, -15, 0, and +15) relative to the ingestion of an American Diabetes Association breakfast of 8.6 kcal/kg. Pre-breakfast hyperglycemia of 10.2 +/- 0.2 mmol/l was established before the study by continuous overnight infusion of intravenous insulin, which was stopped 30 min before lispro insulin injection. Glucose and insulin levels were measured every 30 min for 5 h after breakfast. RESULTS: Results demonstrated that postprandial glucose excursion was reduced when lispro insulin was administered 15 or 30 min before the meal compared with lispro insulin injected at the meal (P < 0.002). The postprandial glucose excursion (millimoles per liter per hour) was -6.4 +/- 3 for the -30-min group, -5.1 +/- 2.9 for the -15-min group, 3.4 +/- 4.1 for the 0-min group, and 5.7 +/- 4.4 for the +15-min group. Although injecting lispro insulin at 30 min before the meal resulted in a significant reduction in postprandial glycemia, it was accompanied by loss of glucose control at 4 h postmeal in two subjects. CONCLUSIONS: Optimization of lispro insulin in hyperglycemic patients requires timing of the insulin injection at least 15 min before the meal.

Adult↗

Increased prandial insulin secretion after administration of a single preprandial oral dose of repaglinide in patients with type 2 diabetes.

OBJECTIVE: To examine the dose-related pharmacodynamics and pharmacokinetics of a single preprandial oral dose of repaglinide in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 16 Caucasian men with type 2 diabetes participated in two placebo-controlled double-blind randomized cross-over studies. Patients were randomized to receive a single oral dose of repaglinide (0.5, 1.0, and 2.0 mg in study 1 and 4.0 mg in study 2) or placebo (both studies) administered 15 min before the first of two sequential identical standard meals (breakfast and lunch) that were 4 h apart. During each of the study days, which were 1 week apart, blood samples were taken at frequent intervals over a period of approximately 8 h for measurement of plasma glucose, insulin, C-peptide, and repaglinide concentrations. RESULTS: During the first meal period (0-240 min), administration of repaglinide reduced significantly the area under the curve (AUC) for glucose concentration and significantly increased the AUC for insulin levels, C-peptide levels, and the insulin secretion rate. These results, compared with those of administering placebo, were dose dependent and log linear. The effect of repaglinide administration on insulin secretion was most pronounced in the early prandial period. Within 30 min, it caused a relative increase in insulin secretion of up to 150%. During the second meal period (240-480 min), there was no difference between repaglinide and placebo administration in the AUC for glucose concentration, C-peptide concentration, and the estimated insulin secretion rate. CONCLUSIONS: A single dose of repaglinide (0.5-4.0 mg) before breakfast improves insulin secretion and reduces prandial hyperglycemia dose-dependently Administration of repaglinide had no effect on insulin secretion with the second meal, which was consumed 4 h after breakfast.

Administration, Oral↗

Evaluation of conventional blood glucose monitoring as an indicator of integrated glucose values using a continuous subcutaneous sensor.

OBJECTIVE: To use a portable continuous glucose monitoring system (CGMS) to evaluate how well the customary intermittent self-monitoring of blood glucose (SMBG) correlates with integrated values during the surrounding time periods in ambulatory patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: In the study, 18 young patients with type 1 diabetes were monitored with CGMS for up to 72 h, during which they continued to perform the four standard SMBG tests (preprandial and bedtime). Correlations were examined between each of the four standard SMBG tests and the mean CGMS values from defined periods that preceded and followed. We also tested how well a low bedtime SMBG predicted nocturnal hypoglycemia. RESULTS: Strong correlations were found between 1) SMBG at breakfast and the mean CGMS value for the preceding 8 h (r = 0.7514), 2) SMBG at dinner and the CGMS from lunch to dinner (r = 0.7538), 3) SMBG at bedtime and the CGMS from dinner to bedtime (r = 0.8145), and 4) SMBG at bedtime and the CGMS from bedtime to breakfast (r = 0.6463). The remaining correlations were weak and not statistically significant. These correlations seem independent of insulin-delivery method as virtually identical results were obtained when data from patients on conventional versus intensive regimes were separately analyzed. A bedtime SMBG <7 mmol/l did not predict nocturnal hypoglycemia (defined as at least one CGMS value <3). CONCLUSIONS: -The breakfast and dinnertime SMBG values are good indicators of integrated glucose values in the time period preceding them, while the bedtime test correlates well with the integrated values both preceding and following it. This information should aid in the meaningful use of SMBG to evaluate glycemic control and make insulin dose adjustments.

Adolescent↗

Flattening postprandial blood glucose responses with guar gum: acute effects.

It has been proposed that high-carbohydrate, high-fiber (HCF) diets might serve as useful therapeutic modality in non-insulin-dependent diabetes mellitus (NIDDM). One problem in evaluating clinical trials of this therapy is that, by their very nature, the trials cannot be double blinded. We have developed HCF and placebo granola-type bars using complex absorbable carbohydrate and guar gum fiber to circumvent this methodologic problem. The HCF bars, when consumed with an ad lib. diet, assure an HCF intake without imposing other dietary restrictions. To test the short-term efficacy of the bars, 9 normal adult volunteers, 2 women with impaired glucose tolerance, and 20 patients with NIDDM consumed the bars alone or with meals. Blood glucose responses when HCF bars were consumed alone were blunted when compared with the placebo response (P less than 0.0005 to P less than 0.002), with the most marked suppression occurring in the early postprandial period. In contrast, when the bars were consumed along with breakfast, HCF and placebo responses were virtually identical in the early postprandial period, but showed a progressively greater difference from 90 to 240 min (P less than 0.02 to P less than 0.0005). When consumed with lunch as well as breakfast, the HCF bars caused flattening of blood glucose responses during the late postprandial period after breakfast and maintained flattened responses during the early and late postprandial periods after lunch (P less than 0.05 to P less than 0.005). It is concluded that these HCF bars can be used to blunt postprandial blood glucose responses, in subjects with either normal or abnormal carbohydrate metabolism.

Adult↗

Effects of mailed advice on stress reduction among employees in Japan: a randomized controlled trial.

We conducted a randomized controlled trial (RCT) to examine the effects of mailed advice on reducing psychological distress, blood pressure, serum lipids, and sick leave of workers employed in a manufacturing plant in Japan. Those who indicated higher psychological distress (defined as having GHQ scores of three or greater) in the baseline questionnaire survey (n = 226) were randomly assigned to an intervention group or a control group. Individualized letters were sent to the subjects of the intervention group, informing them of their stress levels and recommending an improvement in daily habits and other behaviors to reduce stress. Eighty-one and 77 subjects in the intervention and control groups, respectively, responded to the one-year follow-up survey. No significant intervention effect was observed for the GHQ scores, blood pressure, serum lipids, or sick leave (p > 0.05). The intervention effect was marginally significant for changes in regular breakfasts and daily alcohol consumption (p = 0.09). The intervention effect was marginally significant for the GHQ scores among those who initially did not eat breakfast regularly (p = 0.06). The study suggests that only sending mailed advice is not an effective measure for worksite stress reduction. Mailed advice which focuses on a particular subgroup (e.g., those who do not eat breakfast regularly) may be more effective.

Absenteeism↗

Practical aspects in performing the glucagon test in the measurement of C-peptide secretion in diabetic patients.

The secretion of plasma C-peptide after intravenous glucagon stimulation was studied in 15 insulin-treated diabetic patients with onset of diabetes after the age of 30. The mean stimulation of C-peptide secretion caused by glucagon given in the fasting state and by a standardized breakfast were similar. Low blood glucose values (less than 3.5 mmol/l) were found to suppress the stimulating action of glucagon on the pancreas almost completely. When the glucagon test was performed 1.5 hours after a standardized breakfast, the mean concentration of plasma C-peptide was 62% higher than in the test in the fasting state, showing that the stimulating actions of glucagon and breakfast on the secretion of insulin are additive. The results indicate that when determining the level of plasma C-peptide after stimulation with glucagon, in order to distinguish between insulin-dependent and non-insulin-dependent diabetic patients, it is critical to take into account the consequence of low blood glucose values and to standardize the test conditions in regard to pre-test meals.

Adult↗

VIP and prolactin release in response to meals.

To determine the role of vasoactive intestinal polypeptide (VIP) and prolactin (PRL) in digestion, plasma VIP and PRL levels were measured in healthy, non-obese and obese premenopausal women fed isocaloric breakfasts containing a high carbohydrate or a high fat-protein content. A significant increase in plasma VIP concentration occurred after a high fat-protein breakfast, the increase being independent of body mass index. Plasma PRL level was unaltered by breakfast. Results suggest that the release of VIP after a meal depends on a high fat concentration in the duodenum, which may then stimulate bicarbonate release and fat-stimulated release of cholecystokinin.

Adult↗

Gastrointestinal transit of amoxicillin modified-release tablets and a placebo tablet including pharmacokinetic assessments of amoxicillin.

BACKGROUND: We have investigated the gastrointestinal transit time of, the influence of food intake on, the disintegration of, and the pharmacokinetics of amoxicillin in a modified-release form. METHODS: Radiolabelled modified-release tablets of amoxicillin and placebo tablets were administered, in an open three-way, randomized, crossover design, as single doses during omeprazole treatment, to six male healthy subjects during fasting and non-fasting conditions. Radioscintigraphic images and plasma samples were obtained. RESULTS: The estimated mean (and range) gastric emptying time of the modified-release tablet after drug administration was 0.3 h (0.1-1.0 h) during fasting conditions, 4.3 h (1.7-5.0 h) after a light breakfast, and 4.9 h (1.9-18.0 h) after a heavy breakfast. The small-intestinal transit time during fasting conditions was 4.7 h (2.9-6.9 h) and was not significantly changed after light or heavy breakfast intake. The relative bioavailability of the modified-release tablet was 55%, compared with a commercially available amoxicillin immediate-release tablet. CONCLUSION: The modified-release tablet of amoxicillin administered postprandially apparently increases the amoxicillin release time in the stomach. The relevance of its use for anti-H. pylori treatment can be questioned.

Adult↗

The effects of histamine administered in fish samples to healthy volunteers.

The effects of histamine administered in samples of fish to eight healthy volunteers (4 females and 4 males), aged 21-30 years, were studied. The subjects were given 0, 45 and 90 mg of histamine that had been metabolized from histidine by photobacteria in the fish and 90 mg of histamine added to fresh fish, for breakfast. The subjects were observed during 6 h after breakfast. Special attention was paid to clinical symptoms, blood pressure and ECG. The pH of the gastric contents was recorded continuously from 5 min before to 6 h after the meal. Blood samples to measure the histamine concentration were taken at intervals during 24 h after breakfast. Two of the subjects showed effects (facial flushing, headache) that could be attributed to the ingestion of histamine. No significant changes were observed in the blood pressure and ECG. The pH of the gastric fluids did not decrease significantly. The histamine concentration in plasma correlated closely with the histamine dose ingested (p < 0.001, r = 0.996). The Cmax of the dose of 90 mg did not differ statistically significant from the Cmax of the dose of 90 mg histamine added to unspoiled fish.

Adult↗

How do children's eating patterns and food choices change over time? Results from a cohort study.

PURPOSE: The purpose of this study was to investigate the change in eating patterns and food choices in a cohort of students as they moved from the third to the eighth grade. DESIGN: Dietary behaviors and food choices were abstracted from 24-hour recalls and compared across grade levels. SETTING: The setting for the study was elementary and junior high schools. SUBJECTS: The subjects were a cohort of 291 students from Minnesota. MEASURES: Individual 24-hour dietary recalls from a cohort of students were collected in the third, fifth and eighth grades. RESULTS: As students moved from elementary to junior high and middle school, their consumption of breakfast, fruits, vegetables, and milk decreased. Soft drink consumption increased. In the third grade, nearly 99% of the cohort reported eating breakfast; by the eighth grade, 85% reported eating breakfast. Fruit consumption fell by 41% between the third and the eighth grades while vegetable consumption fell by 25%. The proportion of beverage coming from soft drinks more than tripled between the third and the eighth grades with concomitant reductions in milk and fruit juice consumption. CONCLUSIONS: Family, school, and community-wide efforts are needed to promote healthful eating patterns and food choices among adolescents. Our research indicates that nutrition education is needed in the elementary and middle school years. In addition, we need to work on improving teens' social and physical environments to encourage and facilitate their choice of healthy foods.

Adolescent↗

Sodium and potassium levels in Australian processed foods.

We analysed 118 foods available in retail outlets in Sydney for their sodium and potassium content. The concentration of sodium in the types of food examined was (from highest to lowest); salami, ham, luncheon meat, corned beef, liverwurst, breakfast cereals, cracker biscuits, frankfurters, cheese, crispbread, bread, sweet biscuits, canned vegetables, cheesecake and frozen vegetables. There were large variations within some of these groups, especially cheese and breakfast cereals. We have summarized data recently published on 250 other foods. The concentration of potassium was highest in bran-based breakfast cereals and lowest in cheese.

Australia↗

[Influence of food on the bioavailability of isoniazid in health volunteers].

From the theoretical point of view, food intake exerts a complex influence on the bioavailability of drugs. It may interfere with tablet disintegration, drug dissolution and drug transit through the gastrointestinal tract, may also affect the metabolic transformation of drugs in the gastrointestinal wall and the liver. The knowledge about the influence of food is very important in treatment of tuberculosis, where the drugs are taken once daily or even less frequently. We studied the isoniazid concentrations in blood serum of 20 volunteers (12 slow and 8 fast acetylators of INH) both sexes, after the drug intake 2 hours before breakfast and immediately after breakfast. Concentrations of INH were tested by biological method with Mycobacterium aurum REB as a standard strain. The results have shown, that Cmax (3.55 +/- 0.29 versus 2.56 +/- 0.49 in fast acetylators and 4.34 +/- 0.2 versus 3.67 +/- 0.37 in slow acetylators), tmax (0.75 +/- 0.26 versus 1.31 +/- 0.37 in fast acetylators and 0.87 +/- 0.31 versus 1.79 +/- 0.62 in slow acetylators and AUC0-t (6.6 +/- 1.34 versus 5.47 +/- 1.5 in fast acetylators and 21.82 +/- 2.57 versus 18.61 +/- 2.57 in slow acetylators) are significantly decreased after ingestion of INH with breakfast.

Acetylation↗

Effect of a new starch-free bread on metabolic control in NIDDM patients.

BACKGROUND AND AIM: The aim of the study was to evaluate the effect on blood glucose levels in non-insulin-dependent diabetics (NIDDM) of reduction of the carbohydrate content through the use of a new, almost starch-free type of bread (SF-bread). We only substituted the bread in the breakfast meal. METHODS AND RESULTS: The study consisted of two parts: 1) a two-day randomized study of the effect of SF-bread on the morning blood glucose levels of NIDDM patients and 2) an open, crossover trial of three months duration where each patient was given SF- or ordinary bread. Ten patients participated in the first part and eight in the second part of the study. All patients had well established non insulin-dependent diabetes mellitus. In the first part of the study, the area under the curve describing time-dependent changes in blood glucose level after a standard breakfast was significantly lower in patients on SF-bread (182 +/- 154 Units; mean value +/- SD) than in the controls (630 +/- 258 Units; p < 0.00001). Peak blood glucose concentration was 14.8 +/- 2.3 mM on the control day and 11.6 +/- 1.7 mM on the SF-bread day (p < 0.001). In the second part of the study, the diet including SF-bread reduced fasting blood glucose from 13.3 +/- 3.5 mM to 10.2 +/- 2.0 mM (p < 0.006) and the fraction of HbA1c from 0.090 +/- 0.014 to 0.081 +/- 0.015 (p < 0.02). Similar changes were not seen on the ordinary diet. Serum cholesterol levels were significantly reduced by the SF-bread as compared to the ordinary diet (5.8 +/- 0.6 to 5.5 +/- 0.5 mM versus 5.7 +/- 0.8 to 5.8 +/- 0.7 mM; p < 0.05). CONCLUSIONS: Substitution of ordinary bread with starch-free bread at breakfast causes significant improvements in blood glucose levels in NIDDM patients on both a short and long term basis. Possibly secondary to this, a favorable influence on lipid levels was noted.

Aged↗

The acute effect of D-tagatose on food intake in human subjects.

A double-blind randomized crossover study was performed with nineteen normal-weight men to investigate the effect on subsequent ad libitum food intake of replacing 29 g sucrose with 29 g D-tagatose as sweetener to a breakfast meal. D-Tagatose is a malabsorbed stereoisomer of fructose with potential application as a bulk sweetener. Food intake was measured at lunch offered 4 h after the breakfast meal, during the afternoon with access to abundant snacks, and finally at a supper buffet 9 h after the breakfast. Energy intake at lunch and during the snacking period was similar after ingesting the two sugars, while it was 15% lower after ingesting D-tagatose than with sucrose at supper (P < 0.05). Gastrointestinal factors such as the osmotic effects of unabsorbed D-tagatose causing distension of the gut might have mediated the acute appetite-suppressing effect. The present paper also refers to data from a preceding study in which we observed an increased self-reported energy intake after ingestion of D-tagatose compared with sucrose which, in fact, suggests a relative hyperphagic effect of D-tagatose. However, self-reported food intake may be biased by selective under-reporting and this subsequent study with a more controlled assessment of food intake was therefore conducted. This present study did not support any hyperphagic effect of D-tagatose, but rather suggests that D-tagatose may contribute to a reduced energy intake.

Adult↗