Decreasing concentration of interstitial glucose in REM sleep in subjects with normal glucose tolerance.

AIMS: Sleep is divided into two major stages, non-rapid eye movement (NREM) and rapid eye movement (REM), which are distinct in various neuroendocrine respects. NREM/REM cycles influence insulin and glucagon secretion; however, glucose concentrations in REM compared with NREM have not been directly explored. The aim was to investigate the differences in glucose concentrations in interstitial fluid (IGC) between NREM/REM cycles using a continuous glucose monitoring system (CGMS). METHODS: Thirteen subjects were eligible for analysis out of the 28 enrolled. All underwent standard polysomnography for the assessment of sleep stages and the exclusion of sleep apnoea syndrome with CGMS and subsequent morning oral glucose tolerance test (exclusion of glucose intolerance or diabetes). RESULTS: The IGC in REM fell in 12 out of the 13 subjects, whereas the IGC in NREM increased in eight out of the 13 subjects. Therefore, the mean change of IGC differed in direction between sleep stages: -0.028 (-0.045 to -0.011) for REM vs. 0.005 (-0.012 to 0.017) for NREM [median (QR), P = 0.007, n = 13], with the mean difference of 0.038 mmol/l x 5 min(-1) (95% confidence interval 0.012, 0.064). The mean glucose concentration in REM sleep was lower than in NREM: 4.29 +/- 1.00 vs. 4.53 +/- 0.90 mmol/l (mean +/- sd, P = 0.003, n = 13). CONCLUSIONS: The decrease in IGC in REM compared with NREM sleep, with lower absolute values, may arise from different physiological events observed in these sleep stages. The REM-related decline in glucose concentrations may be a risk factor for nighttime hypoglycaemia.

Distribution of the components of the NCEP ATP III-defined metabolic syndrome in newly diagnosed diabetes and non-diabetes caucasian subjects; implications for metabolic syndrome prevention and treatment.

UNLABELLED: The study aimed at assessing the relationship between five components of the NCEP ATP III-defined metabolic syndrome (MS) in diabetes and non-diabetes MS subjects. METHODS: Prevalence of MS and its components was assessed in 1586 adult Caucasian individuals, without known diabetes. Oral glucose tolerance test (OGTT) with 75 g glucose according to WHO protocol was conducted in all subjects. RESULTS: MS was diagnosed in 419 persons (prevalence 26.4%), including 123 subjects with newly diagnosed diabetes. Diabetes subjects presented with higher plasma triglycerides and slightly more pronounced abdominal obesity as well as higher fasting plasma insulin, which in all reflected insulin resistance-related character of MS pathophysiology. However, the distribution of MS components was largely uneven in diabetes and non-diabetes subjects. Elevated plasma triglycerides and low HDL cholesterol were the most prevalent components. The least often found component was elevated fasting plasma glucose (FPG). Non-diabetes subjects with elevated FPG were more likely to present with three or four other components than with two of them only. In contrast, those with high plasma triglycerides, low plasma HDL cholesterol or increased waist circumference were all more likely to have two rather than three or four other MS components. Subjects with diabetes presented significantly more often with four or five MS components when compared with non-diabetes subjects. CONCLUSIONS: The components of metabolic syndrome are not equally prevalent in Caucasian population. Lipid disorders are most often found and glucose intolerance is the least prevalent MS component. Glucose intolerance and diabetes occurred in a more complex setting, concomitantly with three or four other MS components, suggesting that diabetes is associated with more advanced stages of MS. These findings may have important implications for MS prevention and treatment.

Loss of taste-induced hypertension--caveat for taste modulation as a therapeutic option in obesity.

OBJECTIVE: Effective treatment of obesity is extremely difficult, and taste modulation has been suggested as a feasible option. We aim at presenting dangers associated with stroke-induced taste impairment. METHODS: A case report is presented with clinical and laboratory findings. We review literature on the effect of taste modulation on body weight. RESULTS: Eight months after suffering stroke, a 63-year old obese woman with a nine year-old history of type 2 diabetes reported headache and poor general feeling. Physical examination revealed significantly elevated blood pressure of 190/110 mmHg. The patient had never had elevated blood pressure before nor ever been taking any antihypertensive medication. However, stroke resulted in severe persisting dysgeusia. We found out that she had been using up to 110 g of salt daily to make her meals palatable. Standard gustatory tests confirmed severe taste impairment, reflecting the lesion of the glossopharyngeal nerve. Taste loss was not associated with body weight reduction. Limiting daily salt intake to 5 g within 4 weeks resulted in lowering blood pressure to 120/70 mmHg. CONCLUSION: Stroke-induced dysgeusia may lead to increased salt intake in a type 2 diabetes patient, which caused development of severe hypertension. The taste loss did not yield any weight reduction. We suggest that aiming at reducing body weight by means of taste modulation should be done with caution. Physicians must be aware that patients may try to overcome dysgeusia by additional salt intake, if not adequately informed of the risk thereof.

Pancreatic polypeptide secretion in diabetic patients with delayed gastric emptying and autonomic neuropathy.

Measuring postprandial pancreatic polypeptide (PP) plasma concentration is a sensitive method for autonomic nervous system assessment. Delayed gastric emptying (DGE) often does not correlate clearly with cardiac autonomic neuropathy (CAN). This study was conducted to evaluate whether decreased PP secretion (PPS) accompanies DGE and CAN in diabetes. Fourteen long-standing diabetics with DGE assessed by scintigraphy (group A), 14 well-matched diabetics with normal gastric emptying (NGE) (group B), and 12 healthy controls (group C) were the study subjects. CAN and postprandial PPS at 0, 30, and 60 min after test meal ingestion were examined in all the subjects, and the area under curve of PP secretion was calculated. There was no correlation between DGE and CAN (eight diabetics with CAN in A and six in B). Basal PP values were almost the same in all the patients (mean 77.27 +/- 11.0 pg/mL). The area under curve of PP secretion values (PPAUC) after test meal ingestion were significantly higher in B (211.84 +/- 36.13 pg/mL/h; p < 0.0001) and C (233.68 +/- 23.43 pg/mL/h; p < 0.00001) than in A (147.59 +/- 31.77 pg/mL/h). Diabetics with CAN had lower PPS expressed as PPAUC than those without CAN, which was independent of gastric emptying rate (152.31 +/- 37.18 versus 207.12 +/- 39.21 pg/mL/h; p < 0.001). There were no significant differences between test meal-stimulated PPAUC in diabetics without CAN (207.12 +/- 39.21 pg/mL/h) and controls (233.68 +/- 23.43 pg/mL/h), and this was also independent of gastric emptying rate. In patients with both DGE and CAN, the PPS was completely blunt (PPAUC 124.04 +/- 5.71 versus 233.68 +/- 23.43 pg/mL/h in controls; p < 0.001). The PPS in diabetics with CAN and NGE was significantly lower than in controls (PPAUC 190.0 +/- 37.45 versus 233.68 +/- 23.43 pg/mL/h; p < 0.01). In conclusion, the PPS in diabetics with CAN was decreased significantly and independently of DGE. The PP secretion was very low in diabetics with both CAN and DGE.

[Disability due to diabetes in Lódz 1970-1975]. / Ksztaltowanie sie inwalidztwa z powodu cukrzycy na terenie miasta Lodzi w latach 1970-1975.

The paper presents the structure of invalidity due to diabetes in a large industrial town. The studies were based on the data collected from the Social Insurance Centre. The survey covered those examined for the first time by OKIZ in Lódz during 1970--1975, in whom invalidity due to diabetes has been certified. Altogether approx. 337 certificates have been analysed. In the population analysed women prevailed, coming to over 59%. The average age of the subjects was 52.1 years, and only 8% were younger than 40. The diabetes lasted for 8.2 years, on average and most (59%) were treated with insulin. The greatest group was that of the workers carrying on light physical work (45%), then those performing medium-hard work (34%) and the white-collar workers were the least group (21%). During the first 6 years of the disease approx. 72% of the patients have applied for a pension. They performed a medium-hard physical work and suffered from diabetes. Only 10% of white-collar workers applied for the pension. The diabetes itself, with no complications, seldom results in the need to stop work. Those with such diagnosis constituted merely 10% of the total population under survey. In all other subjects complications with accompanying diseases have been diagnosed. Mostly those were heart diseases and vascular complications (26%).

[Evaluation of carbohydrate metabolism in women with previous gestational diabetes mellitus]. / Ocena gospodarki weglowodanowej u kobiet z przebyta cukrzyca ciezarnych.

70 women with previous (1983-1993) history of gestational diabetes mellitus (GDM) were examined in order to assess their present carbohydrate metabolism. The through examination together with oral glucose tolerance test (OGTT) according to WHO were performed. Also the level of glycosylated hemoglobin HbA1c was measured. The following risk factors were analysed: obesity; arterial hypertension; family history of diabetes; number of past pregnancies; time that passed since the pregnancy with GDM; trimester in which GDM was diagnosed. In result 54% of all subjects were diagnosed as having diabetes mellitus, 19% had impaired glucose tolerance (IGT). The presence of diabetes or IGT significantly correlated with the number of past pregnancies, observation time and indirectly with family history of diabetes. Using both measurements of fasting blood glucose and glycosylated hemoglobin enables to diagnose nearly 80% of diabetes following GDM and as a diagnostic method is worth recommending for screening. Women who had GDM should be subjected to control examinations towards diabetes mellitus at least once a year.

[Gastrinemia and heparin stimulated secretion of diamine oxidase on the course of diabetic autonomic neuropathy]. / Gastrynemia oraz stymulowane heparyna wydzielanie oksydazy diaminowej w przebiegu cukrzycy powiklanej neuropatia ukladu autonomicznego.

Gastrin influences polyamine synthesis in the enterocytes, which can lead to increased DAO activity. In diabetics with autonomic neuropathy (AN), a higher than normal gastrin concentration was found. However, in diabetics with enteropathy, a low level of plasma DAO activity was discovered. The purpose of this study was to investigate gastrin secretion and to evaluate DAO activity after i.v. injection of heparin in a group of diabetics with AN. Group I consisted of 12 diabetics with AN, group II 20 patients with diabetes without any complications and group III (the control group) 20 patients without diabetes. It was discovered that basal gastrin concentrations were significantly greater in group I (147 pg/ml +/- 76.5) that in groups II (78 pg/ml +/- 55.5)(p < 0.01) and III (61.5 pg/ml +/- 42.6)(p < 0.01). DAO activity was at its lowest in group I (247.1 pmol/min/ml +/- 104.8) and it was significantly different from group II (441 pmol/min/ml +/- 225.9)(p < 0.001) and III (540.7 pmol/min/ml +/- 171.1)(p < 0.001). There were no differences in the mean values of gastrin and DAO activity between group II and III. In group I low DAO activity was accompanied by a proportionally high concentration of the basal gastrin value (r = 0.567). In conclusion, in diabetics with AN, low postheparin plasma DAO activity was accompanied by a high basal gastrin value.

Blood pressure disturbances and endothelial dysfunction markers in children and adolescents with type 1 diabetes.

OBJECTIVE: Being the earliest step on the way to atherosclerosis, endothelial dysfunction is particularly escalated in diabetes. This study aimed at assessing endothelial dysfunction and blood pressure disturbances in young patients with type 1 diabetes mellitus (T1DM) and defining their interrelations. METHODS: The study group comprised 52 children and adolescents aged 14.07 ± 3.03 years, with T1DM duration 5.13 ± 2.18 years. 20 healthy controls with similar age and sex distribution were included. Chosen serum biochemical markers of endothelial damage: intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), sE-selectin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) as well as ambulatory blood pressure monitoring (ABPM) were performed in all subjects. RESULTS: Patients with T1DM displayed significantly higher concentrations of chosen markers of endothelial dysfunction compared to controls (sVCAM-1 (ng/ml): 951.56 ± 330.68 vs. 710.35 ± 162.12, TNF-α (pg/ml): 16.63 ± 8.32 vs. 9.41 ± 4.23, IL-6 (pg/ml): 3.38 ± 1.31 vs. 2.45 ± 0.81; p < 0.05). Within the study group subjects with an abnormal ABPM reading had significantly higher concentrations of sE-selectin compared with subjects with normal ABPM (in ng/ml: 45.71 ± 15.63 vs. 32.42 ± 11.95; p < 0.01). The study revealed a significant positive correlation between sE-selectin and systolic as well as diastolic pressure loads during the day period (respectively: r = 0.46, r = 0.60; p < 0.01). CONCLUSIONS: Endothelium dysfunction may be present early in the course of T1DM in children and adolescents. It seems to be related with blood pressure disturbances which highlights the need to intensify treatment in this group of patients.

Plasma glucose after stomach or jejunum glucose infusion in Roux-en-Y gastric bypass patients--a possible implication for early satiety mechanism.

BACKGROUND: Morbidly obese patients undergoing gastric bypass surgery experience early satiety soon after the surgery; the mechanism of this effect is poorly understood. As blood glucose concentration plays a role in appetite regulation in humans, we hypothesized that after gastric bypass surgery glucose absorbed mainly in jejunum leads to a greater rise in plasma glucose that if it is ingested in stomach. MATERIAL AND METHODS: 24 non-diabetes morbidly obese patients (15 women, 9 men, mean age [± SD] 35.6 ± 11.9 years, body weight 140.7 ± 33.1 kg, BMI 46.8 ± 8.3 kg/m²) undergoing Roux-en-Y gastric bypass surgery were given 10 ml of 40% glucose solution to the stomach before its size reduction and to the jejunum after gastro-jejunal anastomosis was formed. RESULTS: After jejunal infusion blood glucose increased more rapidly and was ∼30% higher than after stomach infusion. Moreover, this increase was less pronounced in more obese patients. CONCLUSION: In patients after Roux-en-Y gastric bypass surgery glucose absorbed in jejunum leads to greater rise in plasma glucose concentration than if it is ingested in stomach. This phenomenon may help explain satiety feeling occurring early in gastric bypass surgery patients.

Safety of various methods of intensive insulin therapy in hospital condition assessed by hypoglycaemic episodes detected with the use of continuous glucose monitoring system.

PURPOSE: The aim of the study was to determine the safety of three intensive insulin therapy methods: multiple daily insulin injections (MDI), continuous subcutaneous insulin infusion (CSII) and continuous intravenous insulin infusion (IVII) used in poorly controlled type 2 diabetic patients in hospital condition. The safety of these intensive insulin therapy methods was measured by the assessment of number and duration of symptomatic and symptomfree hypoglycaemic events with use of Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed). MATERIAL AND METHODS: The study comprised 90 type 2 diabetic patients treated with conventional insulin therapy based on a twice daily injections with mean glucose profile values > 14 mmol/l. The patients were randomized into three groups according to the method of insulin treatment. The first group was treated with MDI, the second group with CSII and the third with IVII. The glucose monitoring with the use of CGMS lasted 48 hours and was conducted on the second and on the third day of intensive insulin therapy. Glucose level below 3.5 mmol/l were recognized as hypoglycaemic episode. Intensive insulin treatment was continued until "near normoglycaemia" (glucose levels 4.5-10.0 mmol/l) was achieved and then conventional insulin therapy was readministrated. RESULTS: Mean number of symptomatic hypoglycaemic events detected with CGMS was two times higher for MDI than for IVII (p = 0.04) and for CSII (p = 0.04). Number of symptomfree hypoglycaemic events detected with CGMS was higher for MDI than for IVII and CSII, but the differences were insignificant (NS). Mean duration of one symptomfree hypoglycaemic event detected with CGMS was longer in MDI than in CSII (p = 0.02) and IVII (p = 0.03). It was not observed significant differences in mean duration of one symptomatic hypoglycaemic episode between studied groups (NS). CONCLUSIONS: The results of study suggest that CSII and IVII treatment is associated with essentially lower number of symptomatic hypoglycaemic events and shorter mean duration of one symptomfree hypoglycaemic event than MDI.

[Plasma activity of diamine oxidase after heparin in patients with diabetic enteropathy]. / Osoczowa aktywnosc oksydazy diaminowej po dozylnym podaniu heparyny u chorych na cukrzyce powiklana enteropatia.

Diamine oxidase (DAO) is an enzyme found almost exclusively in the enterocyte of the villous tips. In the basal state plasma DAO activity is low but increases significantly after i.v. injection of heparin. It is well recognised that postheparin plasma activity of DAO reflects clearly the integrity of the small bowel mucosa. The aim of this study was to investigate postheparin plasma DAO activity in diabetics with enteropathy. The study was carried out in a group of 72 individuals subdivided into five groups. Group I consisting of 16 patients with type 1 diabetes, group II--20 patients with type 2 diabetes, group III--8 patients with newly diagnosed type 1 diabetes, group IV--8 diabetics with enteropathy and group V--the control group. Blood samples were taken at the time 0' and at 60' and 120' intervals following i.v. injection of heparin. DAO activity was assessed by RIA methods. Basal values of DAO were nearly the same in all of the subjects (< 50 pmol/min/ml). After injection of heparin a very high DAO activity was observed in all groups (> 400 pmol/min/ml) except group IV (< 270 pmol/min/ml) (p < 0.001). There were no significant differences between the groups according to the type of diabetes, its duration and the methods of treatment. In conclusion, the postheparin plasma DAO activity in diabetics with enteropathy was very low, but of itself, diabetes and its treatments had no effect on the results under investigation.

[Pathogenesis of hyperglycemia in diabetes mellitus type II (insulin-independent)]. / Patogeneza hiperglikemii w cukrzycy typu II (insulinoniezaleznej).

The most important causes of hyperglycaemia in the course of diabetes mellitus type 2 are discussed. Those include: insulin secretion disorders, resistance to the insulin and overproduction of glucose in the liver. Affected secretory function of B cells in the pancreatic islets results, first of all, from the primary genetic error and secondary regulatory disorders, chiefly hyperglycaemia. Resistance to the insulin caused by decreased insulin activity in the muscle tissue and adipose tissue includes so-called receptor and postreceptor defects. Mechanism of these disorders is partially explained. Overproduction of glucose in the liver is probably secondary to the above metabolic disturbances and decides on the basic hyperglycaemia. Pathogenetic aspects of the insulin independent diabetes mellitus therapy with particular reference to the role of sulfonylurea derivatives are also discussed.