[Teaching and education of diabetic patients]. / Die Instruktion und Erziehung des Diabetikers.

The instruction of the patient with diabetes mellitus, aimed at the mastery of technical elements in self-management, as well as his/her education to a coherent behavior respecting both the quality of metabolic control and the quality of life, are basic elements of diabetes treatment. To neglect them would be a professional error. The physician in charge of a diabetic patient must take into account the knowledge and the capabilities that have been acquired by the patient before, as well as his/her actual demand for information and instruction. Concepts and methods of learning and teaching for diabetic patients that have been developed and applied over the last decade may serve as reference for all levels of health education.

[Insulin injection/insulin pharmacokinetics]. / Insulininjektion/Insulinpharmakokinetik.

Whereas the importance of changing dietary composition and physical activity for metabolic control in diabetic patients is well respected, pharmacokinetic variables of insulin are often neglected in therapeutic decisions. The ambitious goal of euglycemia can rearly be achieved, however, without a profound knowledge of factors influencing the pharmacokinetics of insulin, such as site of injection, injection technique, miscibility of insulins, dose of insulin, injection volume, local blood flow, etc. Available data indicate that it is of major importance to implement pharmacokinetic aspects in the daily care of the insulin-treated patient.

Comparison of glucose, fructose, sorbitol, and xylitol utilization in humans during insulin suppression.

During fructose, sorbitol, and xylitol perfusions, carbohydrate utilization was studied by continuous indirect calorimetry and compared with glucose utilization during pharmacologic inhibition of endogenous insulin secretion. The experiment was performed in 28 normal volunteers divided into 5 groups (glucose, fructose, sorbitol, xylitol, and saline), each subject being its own control. Insulin suppression was obtained by means of a constant infusion of epinephrine (6 microgram/min) and propranolol (0.08 mg/min). After 90 min, during plasma insulin steady state, each sugar or polyol was infused at a rate of 6 mg/kg/min for 120 min. In contrast with a rise in plasma glucose from 161 +/- 6 mg/dl) to 291 +/- 14 mg/dl during glucose infusion, glucose levels remained unchanged during infusion of the glucose substitutes. Carbohydrate oxidation showed a rise of 24, 65, 76, and 44 mg/min during infusions of glucose, fructose, sorbitol, and xylitol, respectively. Lipid oxidation rates decreased by 7, 20, 33, and 23 mg/min during the same infusions. These results indicate that fructose, sorbitol, and xylitol are oxidized at a higher rate than glucose during suppression of endogenous insulin secretion, without any significant rise in glycemia.