[Gestational diabetes--recommendations for general screening and treatment]. / Gestationsdiabetes: Screening und Behandlung. Glukosetoleranztest bei jeder Schwangeren!

Gestational diabetes is defined as glucose intolerance that is first diagnosed during pregnancy. Poorly controlled diabetes, and hence, also gestational diabetes, is associated with an elevated risk of complications for mother and child. Therefore, all pregnant women should be screened for gestational diabetes by glucose tolerance tests. Detailed recommendations for the screening process are presented. Diagnostic blood glucose threshold values, treatment recommendations and target blood sugar levels are also given.

Pharmacokinetics of biosynthetic human insulin and characteristics of its effect.

In the last 2 years we have developed a new method for determining insulin biologic activity with the help of the glucose-controlled insulin infusion system (GCIIS). Primarily this closed-loop system infuses insulin. But to prevent hypoglycemia, it can in addition, infuse glucose below a certain blood glucose minimum. This effect is used to reproduce insulin biologic activity. After subcutaneous injection of the insulin to be tested in healthy persons (not in insulin-dependent diabetic subjects), the blood glucose level falls, and this is checked by the counterregulatory glucose delivery from the apparatus. The time and intensity of glucose delivery from the GCIIS reflect the insulin effect, so that each insulin manifests its own particular biologic activity.

Insulin concentrations and time-action profiles of three different intermediate-acting insulin preparations in nondiabetic volunteers under glucose-controlled glucose infusion technique.

This study describes the pharmacokinetics of three intermediate-acting insulin preparations, NPH porcine insulin, NPH human insulin (recombinant DNA), and "Depot-A" insulin, a mixture of 20% regular and 80% NPH human insulin from Eli Lilly and Company. Metabolic healthy normal weight volunteers were selected for the study. After overnight fasting, each test person received 0.4 U of each insulin per kg body weight injected subcutaneously in the triceps area of the arm. To prevent severe hypoglycemia, the test persons were connected to a "GCIIS Biostator" with blood glucose clamp at the 60 mg/dl level. Peripheral blood was sampled at regular intervals for glucose, insulin, and C-peptide determination. More elevated insulin levels were measured after application of both NPH human insulin and "Depot-A" insulin than after NPH porcine insulin. A more rapid decrease in the blood glucose concentration was observed after injection of both human insulin preparations than after porcine insulin. The dextrose output of the "GCIIS Biostator" was more pronounced in both human insulins than after the porcine preparation. After the injection of NPH human and NPH porcine insulin, significant differences were calculated between the concentrations of these two insulins in the blood, from the 2nd to the 10th hour (P less than 0.05-P less than 0.005) and between the dextrose output of the "GCIIS Biostator" from the 3rd to the 8.5th hour (P less than 0.05). The fall of the C-peptide concentration to the lower detection limit of the assay reflects suppression of the endogenous B-cell secretion and confirms the measure of peripheral insulin concentrations as a result of the exogenously applied insulin. Although all investigations were performed under identical experimental conditions and equal dosages of each insulin were injected, higher insulin concentrations and a stronger biologic effect, shown by larger amount of dextrose delivered, were observed in both human insulins than in porcine insulin. Why this phenomenon occurs is as yet unclear. The clamp technique used with the "GCIIS Biostator" enables establishment of the biologic profile of any insulin, and thus represents a valuable tool in comparative studies.

[Surgical operations in diabetics]. / Wenn Ihr Diabetespatient unters Messer muss. Strikte Blutzuckereinstellung entscheidet über OP-Erfolg.

In view of the increasing incidence of diabetes, in particular in the second half of life, the number of patients in need of surgery will in the future grow disproportionately. In the pre-operative period, adequate metabolic control must have been achieved, and must be maintained intraoperatively and postoperatively. Peri-operative blood sugar levels of between 100 and 140 mg/dl improve outcome and reduce wound healing disorders. Only in the case of minor surgical procedures is it acceptable, depending on prior treatment, initially merely to keep the operative and postoperative course of the blood sugar level under observation, so as, in the event of an increase, to initiate controlled glucose-insulin-potassium (GIK) therapy, which must always be applied for major surgery and in type I diabetics. An increase in blood sugar concentrations above 140 mg/dl is undesirable, and a rise exceeding 180 mg/dl must be avoided at all costs.

Effects on bone mineral density of low-dosed oral contraceptives compared to and combined with physical activity.

A cross-sectional study was designed to examine the influence of exercise compared to and in combination with low-dosed oral contraceptives (OCs) on bone mineral density (BMD). One hundred twenty-eight women (20 to 35 years of age) were assigned to four groups with respect to the years of exercise and OC intake. Influence factors were determined by a detailed questionnaire and interview. BMD for L2-4 and the femoral neck was assessed by DXA. The highest BMD values were found in the group of women characterized by long-term exercise (9.45 +/- 4.32 yr) and short use of OC (1.6 +/- 1.69 yr). No beneficial effect of exercise on BMD was found in the group with a long exercise period (10.4 +/- 4.14 yr) and long-term intake of OC (8.2 +/- 4.14 yr). Differences in mean BMD values between the two groups were significant in all regions assessed (p < 0.05). No differences in mean BMD were found in the groups with short-term exercise but long or brief histories of OC. The question arises as to whether active women taking low-dosed OC at an earlier age will develop an adequate BMD.

[Effects of the beta-adrenergic blocking agent propranolol on the carbohydrate- and lipometabolism (author's transl)]. / Beeinflussung des Kohlenhydrat- und Fettstoffwechsels bei der Hyperthyreose durch Betarezeptorenblockade.

Intravenous glucose tolerance tests were performed in 17 patients suffering from hyperthyreosis before and after a week of treatment with propranolol. The blood taken until the 125. minute after the glucose load was used for the determination of serum glucose, the free fatty acids (FFA), the free glycerol and the radioimmunologically measurable insulin (IRI). The following results were received: After the treatment with propranolol the glucose tolerance decreased significantly. The insulin secretion was diminished showing a significant difference for the fifth minute after glucose injection. The concentration of the FFA remained unchanged. The levels of the free glycerol were significantly lower after the propranolol treatment than before. Though an inhibition of lipolysis was possible by the propranolol treatment the glucose tolerance did not improve due to the inhibition of insulin secretion under propranolol. Beta-adrenergic blocking agents do not lead to an essential change in the carbohydrate- and lipometobolism. Therefore, their use in hyperthyroidism is mainly justified because of the cardial symptomatology.

[Diabetes mellitus and arterial hypertension. In search of the connecting link]. / Diabetes mellitus und arterielle Hypertonie. Auf der Suche nach dem Bindeglied.

Late diabetic effects are the sequelae of for a long time super elevated blood sugar levels. The diabetic nephropathy is the cause of the secondary arterial hypertension. The investigation seeks for the connections between the diabetes mellitus and the essential, that is primary hypertension. The two diseases frequently appear and clearly increase in the second half of life. Moreover, they are above average frequently associated with each other. Among brothers and sisters of diabetic hypertensives in comparison to normal cohorts clearly increased high blood pressure prevalences were found. The insulin resistance which could be proved in a great number of hypertensive and which has been known since more than two decades might be the connecting link between hypertension and diabetes mellitus. Like the obesity the essential hypertension can be associated with all degrees of an insulin hyposensitiveness. The sodium-retaining effect of the insulin might explain the increased sodium content of the body in hypertensives. The differential diagnostics of the essential hypertension should therefore seek for conditions of an insulin resistance. The type II diabetic lacks a release of bradykinin during muscle work. Thus the glucose uptake into the cell is unfavourable influenced and demands an increased insulin excretion. This genetically (?) fixed defect is found also in essential hypertensives. It could be the connecting link between the two diseases. ACE-inhibitors have via a kininase II inhibition an effect also on the bradykinin decomposition and can favourable influence the glucose uptake into the muscle. An improved insulin effect among the ACE-inhibitors was described. Therefore, they should be preferred in the treatment of hypertensive diabetics.