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PubMedDate not supplied

Ganglioside treatment in diabetic peripheral neuropathy: a multicenter trial.

Ganglioside treatment was evaluated with a multicenter, randomized, double-blind, controlled, cross-over vs placebo trial in 140 insulin-treated diabetic subjects with peripheral neuropathy. The patients entered the study when they showed an impairment in at least two of the electroneurographic parameters, and were assigned to two protocols according to the presence and severity of their neurological symptoms. Ninety-seven diabetic subjects with no or mild symptoms were assigned to protocol I, whereas 43 symptomatic patients were assigned to protocol II. the treatment periods lasted 6 weeks with an intermediate washout period of 4 weeks. The treatment consisted in the daily i.m. administration of 20 mg gangliosides or of placebo. Electroneurographic parameters were recorded at the beginning and at the end of each treatment period, whereas clinical and metabolic data (mean daily plasma glucose, glycosuria and glycosylated hemoglobin) were evaluated every three weeks in protocol I and every two weeks in protocol II. No change in the metabolic parameters was observed throughout the trial period. However, the treatment induced a statistically significant improvement of paresthesias (protocol II) and of some electrophysiological parameters; in particular, ganglioside treatment improved MCV of peroneal nerve (p less than 0.03) in patients of protocol I, MCV o ulnar nerve (p less than 0.002) and SCV of median nerve (p less than 0.06) in patients of protocol II. Furthermore, 22 subjects of protocol II showed a 'drug preference' while 10 preferred placebo and 9 had no preference. In conclusion, ganglioside treatment seems to have a positive effect on diabetic peripheral neuropathy, improving both some symptoms and some electrophysiological parameters.

Adolescent↗

PubMedDate not supplied

Semen analyses in adolescent diabetic patients.

We studied the semen quality and plasma testosterone levels (T) in 32 adolescent patients with insulin-dependent diabetes mellitus and in an aged-matched control group. Semen volume, motility and morphology were significantly lower in diabetics whereas seminal fructose and glucose were significantly higher. Even though the sperm count was lower in these adolescent diabetics, the difference was not significant when compared to the control group. No difference was observed in plasma testosterone levels. Patients were divided into two groups according to the presence of retinopathy and neuropathy, and degree of metabolic control. Spermiogram parameters, seminal fructose and glucose were lower in diabetics with neuropathy. No difference was observed in spermiogram parameters between diabetic patients with or without retinopathy, but seminal fructose, and glucose were lower in the former. All spermiogram parameters, as well as seminal fructose were lower in diabetics with poor metabolic control but seminal glucose was higher. No correlation was detected between clinical parameters (age at onset and duration of diabetes mellitus and time since first ejaculation), semen parameters, plasma T, glycemia and glycosuria. In conclusion, a deterioration of the quality of human semen occurs in adolescent diabetic patients. Neuropathy and poor metabolic control seem to be important factors of this deterioration. The presence of retinopathy does not correlate with T and semen quality.

Adolescent↗

PubMedDate not supplied

Critical evaluation of several years' activity aimed at the diagnosis of asymptomatic diabetes in the Province of Florence. Revision of method.

The authors have based this critical evaluation on the methods at present adopted for mass screening for symptomatic diabetes in a group of 39,405 subjects, in full working activity. The results obtained from these tests confirm the social importance of this illness in the active population. However, the authors suggest that the glycosuria test be abandoned as the primary discriminating criterium and suggest that blood glucose assay in specimens drawn two hours after a standard glucose and load (50 g as proposed by WHO) and the singling out of potential diabetic individuals by reason of their family and physiological background be adopted for this purpose. The relationship between diabetes, obesity, dysmetabolism and cardiovascular alterations lead us to stress once more the importance of primary prevention, aimed at correcting the eating habits and life style of patients with a potential predisposition to the illness.

Adult↗

PubMedDate not supplied

Effects of a high protein diet on the evolution of diabetes in streptozotocin-induced and spontaneously diabetic "BB" Wistar rats.

Recently, we demonstrated a reduction in the diabetogenic action of streptozotocin (STZ) in rats previously adapted to a high protein (HP) diet. These data suggested that amelioration of diabetes resulted from the combination of two effects of the HP diet: initial protection against the diabetogenic action of the drug at the time of exposure and subsequent improvement of the induced diabetic condition. The present study evaluated the effects of a HP diet on the evolution of the metabolic condition in rats with STZ-induced or spontaneous diabetes (BB Wistar rats). Two days after STZ injection, the animals were given isocaloric HP (70% protein, 8% fat) or control (66% carbohydrate, 16% protein, 8% fat) diets for 15 days. After 13 days, the STZ-treated rats fed HP diet showed an impressive decrease in severity of diabetes, as judged by rate of body weight change, plasma glucose, urine volume and glycosuria, serum and pancreatic insulin. The BB Wistar rats, already diabetic for 5 weeks before being transferred to the HP or control diet, were treated with daily injections of insulin. After 31 days on the HP diet, the BB rats showed reduced insulin requirement, reduced blood and urinary glucose levels, but no difference in body weight gain or pancreatic insulin content. The data show that short-term use of HP diets can greatly improve the diabetic condition in STZ-treated animals, but that the beneficial effects of the diet are much less marked in rats with chronic spontaneous diabetes. These data suggest that the ameliorating effect of HP diet is fully manifested only when the diabetic rats have a sufficient number of residual functioning B-cells.

Animals↗

PubMedDate not supplied

Clinical application of the 24-H urinary C-peptide excretion rate and its relationship to metabolic control in diabetics.

In this study, we evaluated in normal subjects, insulin-dependent (IDD) and non-insulin-dependent (NIDD) diabetics, the diurnal urinary C-peptide excretion rate (CPR-U) and its relationship to serum C-peptide concentration and glucose:C-peptide molar ratio, and to the common parameters of metabolic control. The CPR-U (and CPR-U/g creatinine) were significantly lower in IDD and higher in NIDD compared to control subjects. Moreover, a good and significant correlation with serum C-peptide concentrations and the glucose:C-peptide ratio in diabetic subjects as well as in controls and diabetics considered together was found. A slight but significant correlation was present in diabetic subjects between CPR-U and body mass index (r = 0.45), 24-h glycosuria (r = 0.36), HbA1 levels (r = 0.31), post-prandial glucose concentrations (r = 0.26) and per cent glucose variation after each meal (r = 0.34). No differences were found in CPR-U and the degree of metabolic control between obese and non-obese NIDD. In conclusion, CPR-U may be a useful and simple method of defining the secretory activity of the B-cell. Metabolic control in diabetics is slightly correlated to the degree of B-cell function as evaluated by the diurnal excretion rate of C-peptide in urine.

Adult↗

PubMedDate not supplied

Short-term subcutaneous insulin infusion in diabetic children. Comparison with three daily insulin injections.

Sixteen insulin-dependent diabetic children and adolescents were studied on intensified insulin treatment (3II) and during continuous subcutaneous insulin infusion (CSII). Mean blood glucose, M-value and 24-h glycosuria were similar in both types of treatment. Symptomatic hypoglycemia occurred more often in patients on 3II than CSII. With 3II we observed blood glucose peaks early in the morning confirming that better overnight control can be achieved by CSII.

Adolescent↗

PubMedDate not supplied

The effect of two new glucosidase inhibitors on blood glucose in healthy volunteers and in type II diabetics.

Two new glucosidase inhibitors (BAY m 1099 and BAY o 1248) were studied in volunteers and type II diabetics under various conditions. In 6 non-diabetic controls BAY m 1099 when given 3 X 50 mg/day caused a marked depression of the post-meal glucose rise. The effect was found to be more marked after breakfast than after lunch or after dinner. In type II diabetics BAY m 1099, when given in a dose of 2 X 25 mg/day over one week, had no significant effect on post-meal glucose or serum insulin levels. BAY o 1248, when given as a single dose of 15 mg in the morning to type II diabetics, induced a significant decrease of post-meal glucose rise (35 mg/dl after breakfast, 25 mg/dl after lunch) when compared to placebo. Although in parallel serum insulin levels were slightly lower, this change was statistically not significant. The drug reduced glycosuria by 50%. Both compounds induced side effects, such as flatulence or diarrhea when given in therapeutically effective amounts, but were tolerable in most cases. On a weight basis BAY o 1248 was found to have greater therapeutic effects than BAY m 1099. Both drugs can be recommended for use in unsatisfactorily controlled type II diabetics. Further studies should concentrate on the critical dosage which may strike a satisfactory balance between effects and side effects.

1-Deoxynojirimycin↗

PubMedDate not supplied

Renal lesions in a strain of spontaneously diabetic WBN/Kob rats.

In WBN/Kob strain rats, only males spontaneously develop hyperglycemia, glycosuria, hypoinsulinemia and glucose intolerance from about nine months of age. The kidneys of male rats of this strain were histopathologically studied to evaluate the changes which appeared as complications of diabetes mellitus. Thickening of the basement membrane, increase of the mesangial matrix and fibrin-cap lesions were noted in the glomeruli. Armanni-Ebstein degeneration was occasionally found in the tubules. Linear deposition of plasma components such as IgG and albumin in the basement membrane of the glomeruli, tubules and Bowman's capsule characterized the immunohistological pattern. These findings are similar to the findings in diabetic nephropathy in humans. Since the onset of diabetes mellitus in the strain is slow and symptoms are generally mild, insulin administration is usually not necessary for survival. This strain, therefore, appears to be an important animal model for the study of complications of diabetes in humans.

Animals↗

PubMedDate not supplied

Effect of polyaspartic acid on CdCl2-induced nephrotoxicity in the rat.

We produced an animal model of CdCl2 nephrotoxicity in rats, and treated them with polyaspartic acid (PAA) to prevent renal damage. Male Sprague-Dawley (SD) rats (190-200 g) were used to induce proximal renal tubular damage by daily injection of CdCl2 3.0 mg/1,000 g body wt for 2 wk. CdCl2-exposed SD rats exhibited significant increases in urine volume, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and fractional excretion of sodium (FENa) and a decrease in the percentage of tubular reabsorption of phosphate (%TRP). Of these indicators of proximal tubular function, AAP and %TRP are more sensitive than NAG or FENa. No glycosuria or aminoaciduria, however, were observed. PAA markedly improved these indicators of proximal tubular function. Daily urinary protein excretion and creatinine clearance, on the other hand, did not change after administration of PAA. Cd concentrations in the cortex were 3 times higher than in the medulla, however, there were no differences between Cd-treated rats and PAA-treated rats. Our animal model is an excellent one for determining the effect of cadmium on renal proximal tubule damage. PAA appears to be useful in the treatment of CdCl2 nephrotoxicity.

Acetylglucosaminidase↗

PubMed2003

Regulation of blood glucose level in diabetes mellitus using palatable diet composition.

Diabetes mellitus results from the failure of the endocrine system to control the blood glucose levels within the normal limits. Normal people have fasting sugar level that generally run between 70-110 mg/dl, while a person is said to suffer from diabetes if the blood glucose level in the interval of 2 hours equals to or exceeds 180 mg/dl. It can be understood as a disorder of carbohydrate metabolism and characterized primarily by hyperglycemia and glycosuria with second anomalies of the metabolism of protein and fat. It is not only the leading cause of blindness, renal failure and non-traumatic amputations in adults but also a major cardiovascular risk factor in developing countries. So, it is of great interest to propose a palatable composition of quantitative diet for the human beings suffering from Diabetes Mellitus to regulate the blood glucose and insulin level. In the present study, the palatable composition is calculated by two mathematical models and given in the form of calories for protein (P), fat (F) and carbohydrate (C). For the calculations, the mixed population has been distinguished into three categories namely men, women and juvenile having various body frames i.e. small, medium and large. With the substitution of this composition in the solutions, the near-normal level of blood glucose and insulin is achieved. Hence, a plausible palatable composition of protein, fat and carbohydrate has been proposed which can be incorporated in diet for the significant regulation of blood glucose and insulin level in diabetic patients.

Adolescent↗

PubMed1999

Diabetes-induced vascular dysfunction in the retina: role of endothelins.

AIMS/HYPOTHESIS: Vasoactive factors like endothelins, by virtue of the microvascular regulation as well as by other effects, possibly play important parts in the pathogenesis of diabetic retinal microangiopathy. We investigated retinal vascular dysfunction in streptozotocin-induced diabetes and its relation with endothelins in short- and long-term diabetes. METHODS: Diabetic rats with or without an endothelin receptor antagonist (bosentan) treatment were investigated after 1 month and 6 months of follow-up. Retinal blood flow was measured and compared with age- and sex-matched non-diabetic control animals. Retinal tissues were analysed for endothelin-1, endothelin-3, endothelin A and endothelin B mRNA. Distribution of endothelin-1 and endothelin-3 was investigated by immunocytochemistry and that for endothelin receptors by ligand binding and autoradiography. RESULTS: Diabetic animals showed hyperglycaemia, glycosuria, elevated glycated haemoglobin values and reduced body weight gain. Retinal blood flow showed an increased resistivity index, an indicator of vasoconstriction, after 1 month of diabetes which was prevented by treatment with bosentan. This functional change in diabetes was eliminated after 6 months of follow-up. The retina from the diabetic animals showed increased mRNA expression for endothelin-1, endothelin-3 and endothelin A after one month. In addition, endothelin B mRNA expression was increased after 6 months. Furthermore, endothelin-1 and endothelin-3 immunoreactivity and endothelin receptor concentrations were increased in the retina of diabetic rats. CONCLUSION/INTERPRETATION: The results from this study indicate that the endothelin system is of importance in mediating retinal changes in diabetes although mechanisms of the endothelin system alteration as well as their effects might vary depending on the duration of diabetes. [Diabetologia (1999) 42: 1228-1234]

Animals↗

PubMed2000

Nephrotoxicity of D-proparglyglycine in mice.

When D-propargylglycine was injected intraperitoneally into mice, polyuria, glycosuria, and aminoaciduria were observed as has been previously reported in rats. The urine of the mice treated with D-propargylglycine contained twice as much protein as that of the control mice. Polyacrylamide gel electrophoresis showed a new protein of approximately 62 kDa in the urine of the D-propargylglycine-treated mice. Protein sequencing revealed that this protein was serum albumin. Since the above-mentioned symptoms suggested dysfunction of the renal proximal tubules, the activity of urinary N-acetyl-beta-D-glucosaminidase, a marker enzyme of injury to the proximal tubules, was measured. The urinary enzyme activity was 2.6 times higher in the D-propargylglycine-treated mice than in the control mice. Light- and electron-microscopy showed degenerative and necrotic cells in the straight part of the proximal tubules of the treated mice. However, none of these symptoms was observed in D-propargylglycine-treated mutant mice, lacking D-amino-acid oxidase. These results indicate that D-propargylglycine itself is not nephrotoxic but its metabolite produced by the D-amino-acid oxidase reaction is nephrotoxic and injures proximal tubular cells, resulting in an impairment of the reabsorption of water, glucose, amino acids, and proteins.

Alkynes↗

PubMed2003

Diabetes Mellitus: Does it Affect Bone?

Both diabetes and fractures affect a large proportion of older adults. Recent cohort studies indicate that diabetes itself is associated with increased risk of fracture of the hip, proximal humerus, and foot. Observational studies and animal models suggest that decreased bone strength in diabetes may contribute to fracture risk but this remains a controversial issue. Type 1 diabetes is associated with modest reductions in bone mineral density (BMD) but type 2 diabetes is often characterized by elevated BMD. This paradox of higher BMD but increased fracture risk in type 2 diabetes may be explained by a combination of more frequent falls and poorer bone quality. Diabetes can impact bone through multiple pathways, some with contradictory effects, including obesity, changes in insulin levels, higher concentrations of advanced glycation end products in collagen, hypercalciuria associated with glycosuria, reduced renal function, lower insulin-like growth factor-I, microangiopathy, and inflammation. A better understanding of how diabetes metabolism and treatments affect bone would improve fracture prevention efforts in older diabetic adults.

Animals↗

PubMed2003

Isovaleric acidaemia: cranial CT and MRI findings.

Isovaleric acidaemia is an inborn error of leucine metabolism due to deficiency of isovaleryl-CoA dehydrogenase, which results in accumulation of isovaleric acid in body fluids. There are acute and chronic-intermittent forms of the disease. We present the cranial CT and MRI findings of a 19-month-old girl with the chronic-intermittent form of isovaleric acidaemia. She presented with severe metabolic acidosis, hyperglycaemia, glycosuria, ketonuria and acute encephalopathy. Cranial CT revealed bilateral hypodensity of the globi pallidi. MRI showed signal changes in the globi pallidi and corticospinal tracts of the mesencephalon, which were hypointense on T1-weighted and hyperintense on T2-weighted images.

Amino Acid Metabolism, Inborn Errors↗

PubMed1998

High-pressure liquid chromatographic determination of toluene in urine as a marker of occupational exposure to toluene.

OBJECTIVE: To establish a convenient method by high-pressure liquid chromatography (HPLC) to measure toluene in urine as a marker of occupational exposure to toluene. METHODS: As soon after sampling as possible, 1 ml of urine was mixed with an equal volume of acetonitrile in a 2.2-ml HPLC glass bottle, and the bottle was tightly sealed and stored at 4 degrees C. Immediately before HPLC determination, 100 microl methanol was added to the mixture to prevent confounding effects of glycosuria, and the bottle was spun to remove any suspended matter. An aliquot of the supernate was introduced into the HPLC system and analyzed on a PRODIGY column, with an acetonitrile - perchloric acid phosphoric acid - water mixture serving as the mobile phase. The effluent was monitored at 191 nm. RESULTS: The method can measure toluene in urine every 20 min, the detection limit was 2 microg/l, the coefficient of variation was less than 5%, and the recovery rate was 100%. No significant reduction in toluene concentration was observed for 1 week after storage at 4 degrees C. When the method was applied to end-of-shift urine samples from 13 male workers exposed to toluene at 18-140 ppm and also to urine samples from 10 nonexposed male controls, toluene in urine was linearly related to toluene exposure concentration, with a regression line passing close to the origin. The correlation coefficient was as high as 0.97 (n=23). No toluene was detected in control urine samples. Calculations suggest that urinary toluene accounts for as little as less than 0.01% of the toluene absorbed via inhalation and that the absorbed toluene is converted almost quantitatively to hippuric acid and, by less than 0.1%, to o-cresol.

Adult↗

PubMed2003

The sodium/glucose cotransport family SLC5.

The sodium/glucose cotransporter family (SLCA5) has 220 or more members in animal and bacterial cells. There are 11 human genes expressed in tissues ranging from epithelia to the central nervous system. The functions of nine have been revealed by studies using heterologous expression systems: six are tightly coupled plasma membrane Na(+)/substrate cotransporters for solutes such as glucose, myo-inositol and iodide; one is a Na(+)/Cl(-)/choline cotransporter; one is an anion transporter; and another is a glucose-activated ion channel. The exon organization of eight genes is similar in that each comprises 14-15 exons. The choline transporter (CHT) is encoded in eight exons and the Na(+)-dependent myo-inositol transporter (SMIT) in one exon. Mutations in three genes produce genetic diseases (glucose-galactose malabsorption, renal glycosuria and hypothyroidism). Members of this family are multifunctional membrane proteins in that they also behave as uniporters, urea and water channels, and urea and water cotransporters. Consequently it is a challenge to determine the role(s) of these genes in human physiology and pathology.

Amino Acid Sequence↗

PubMed2002

Identification of a novel mutation in the GLUT2 gene in a patient with Fanconi-Bickel syndrome presenting with neonatal diabetes mellitus and galactosaemia.

We describe a patient with Fanconi-Bickel syndrome diagnosed by clinical manifestations and the identification of a novel mutation in the GLUT 2 gene. She was initially diagnosed with neonatal diabetes mellitus due to hyperglycaemia and glycosuria at 3 days of life. In addition, newborn screening for galactosaemia revealed hypergalactosaemia. Thereafter, she was managed with lactose-free milk and insulin therapy. However, she failed to grow and her liver became progressively enlarged. Her liver function deteriorated with increased prothrombin time. A liver biopsy done at age 9 months showed micronodular cirrhosis with marked fatty changes and she succumbed to hepatic failure with pneumonia at 10 months of age. DNA sequencing analysis of the GLUT 2 gene using her genomic DNA revealed a novel mutation in codon 5, lysine5 stop(K5X).

Diabetes Mellitus↗

PubMed2002

Drug-induced acute tubulointerstitial nephritis: a case with elevated urinary cadmium.

Acute tubulointerstitial nephritis (ATIN) has many different causes, but is most frequently caused by drugs. We report a 13-year-old vegetarian girl with drug-induced ATIN, confirmed by renal biopsy, and simultaneous occurrence of elevated urinary cadmium. Four weeks prior to admission she had been treated with antibiotics and acetaminophen for respiratory infection, and remaining febrile, was treated with different "home-made" herbal mixtures. She presented with acute non-oliguric renal failure, tubular dysfunction, and sterile pyuria, but without skin rash or edema. Laboratory data showed a raised erythrocyte sedimentation rate, normal white blood count with eosinophilia, and a serum creatinine of 245 micromol/l. Urinalysis was remarkable for glycosuria, tubular proteinuria, and elevated beta(2)-microglobulin and N-acetyl-beta-D-glucosaminidase excretion. Immunoserological tests characteristic of acute glomerulonephritis and systemic diseases were negative. She was treated with steroids and her renal function improved. Follow-up analyses disclosed normal urinary cadmium and enzyme excretion within 6 months. Heavy metal analysis of herbal preparations that she had taken confirmed the presence of cadmium, but within approved concentrations. In conclusion, elevated urinary cadmium in the case of drug-induced ATIN may be assumed to be an accidental finding. However, consumption of different herbs containing cadmium and cadmium-induced nephro-toxicity could be the reason for such serious renal damage.

Adolescent↗