Serum insulin and blood glucose levels in breast-fed and formula-fed infants in the first week of life.

Serum insulin and blood glucose levels were measured in newborns aged four to eight hours and those aged seven days who were either breast fed or formula fed. With both types of feeding, the maximum serum insulin levels occurred 60 minutes postprandially in four- to eight-hour-old infants and 30 minutes postprandially in seven-day-old babies. Between breast-fed and formula-fed groups, no statistically significant difference was found in postprandial serum insulin levels or (except for the 90-minute values on the seventh day) in blood glucose levels. It may be necessary to examine the metabolic-endocrine responses to formula administered as the only feeding over a long period to determine whether formula feeding alters such physiologic mechanisms as pancreatic function and immunity in early life and thereby affects the development of the child.

Peripheral neuropathy in children with insulin-dependent diabetes mellitus.

Peripheral somatic nerve function was studied in 38 unselected diabetic children and 31 age and sex-matched healthy controls. Thirteen of the 38 diabetics had abnormal peripheral somatic nerve function tests (more than 3 SD below the mean for normals). Five of the 13 diabetic children had only abnormal peripheral nerve function (early asymptomatic neuropathy); seven of these 13 were abnormal both in neurologic examination and peripheral nerve function (asymptomatic neuropathy). Only one of the 13 patients showed neuropathic symptoms as well as an abnormal neurologic examination and impaired peripheral nerve function tests (symptomatic neuropathy). Both motor and sensory peripheral somatic nerve abnormalities were related to poor glycemic control (HbA1c) and duration of diabetes. Individual peripheral nerve tests correlated with HbA1c (fibular motor, p < 0.001; sural sensory, p < 0.05) or duration of diabetes (fibular motor, p < 0.01; median motor, p < 0.01). These results emphasize the importance of metabolic control and duration of diabetes in the pathogenesis of diabetic neuropathy. The findings suggest that peripheral neuropathy is common in young, insulin-dependent diabetics. Being easy to conduct and sensitive, regular follow-up of nervous function test results may help to achieve good metabolic control and prevent diabetic complications.

Effects of methylprednisolone pulse therapy on insulin injections in patients with insulin-dependent diabetes mellitus.

In this study we evaluated 31 insulin-dependent diabetes mellitus (IDDM) patients (ages 12.1 +/- 3.4 years, 18 males/13 females) who started on multiple subcutaneous insulin injections (MSII) within six weeks of diagnosis and achieved either complete (CR: no insulin requirement and near-normoglycemia for at least two weeks) or incomplete (ICR: minimum 50% decline in insulin requirement while maintaining near-normoglycemia for two weeks or more) remissions within the first 12 weeks of the MSII trial. Methylprednisolone pulse therapy (MP) was administered four times per day by i.v. bolus at a dose of 30 mg/kg (max. 1000 mg) on alternative days. Eleven patients did not accept "MP-pulse" therapy; therefore, we followed these cases (7 males/4 females) as the control group. During the first year of follow-up, 13 patients from the "MP pulse" group achieved CR (3 males/1 female) or ICR (5 males/4 females) in 3.5 to 14 months. Remission occurred in only two of the control group cases (1 male CR for 17 days and 1 female CR for 7 months). Of those with CR in the "MP-pulse" and control groups, all were greater than 12 years of age, and all but one in the "MP-pulse" group were males. The stimulation capacity of beta cells (as defined by percentage increase in serum C-peptide levels after glucagon injection) among CR cases was found to be higher than that of non-remitted (NR) cases (p < 0.05 at onset, p < 0.001 during MSII-induced remission and p < 0.05 at the end of the first year of follow-up). Although patients with CR or ICR had higher beta cell reserves than NR cases at onset, only CR cases could sustain this capacity during the MSII-induced remission phase and one year after "MP-pulse" therapy. From this preliminary study, we conclude that "MP-pulse" therapy, may lead to prolonged near-normal beta cell function or partly preserved residual beta cell reserve during the MSII-induced remission phase of IDDM, The beneficial effects of MP could be seen clearly in patients diagnosed during the late childhood years.

The type 1 diabetes and HLA-DR in Turkey.

Studies of various insulin-dependent diabetes mellitus (IDDM) populations have shown that certain HLA antigens confer a high risk of developing disease. There is very little information concerning the distribution of HLA antigens in type 1 diabetes in the Turkish population. In this study, the HLA types of 75 patients and 50 controls were investigated. HLA-DR3 and HLA-DR4 were found more frequently in the IDDM cases (p = 0.0018 and 0.0119, respectively). DR3/DR4, although more frequent, did not achieve statistical significance. The decreased frequencies of DR1 and DR2 in the IDDM population were not significant whereas the DR7 was found to be significantly decreased (p = 0.025). The younger age of onset was strongly associated with DR4 (p = 0.0029). DR3 was more common among the male and DR4 in the female patients. However, the differences were not significant.