Jet injection of insulin during self-monitoring of blood glucose.

Insulin-dependent diabetes mellitus has been treated with four jet injections of insulin (regular insulin before each meal and intermediate insulin at bedtime) during self-monitoring of blood glucose levels. The blood glucose levels generally remain within 60 and 150 mg/dl.

Parameters of good control in diabetes mellitus.

Optimal control of diabetes should achieve not only euglycemia and normal levels of glycosylated hemoglobin but also absence of the reversible concomitants of diabetes such as red cell rigidity, hyperlipidemia, increased capillary permeability, enlargement of the kidneys, proteinuria, etc. Unfortunately, in most patients consistent euglycemia cannot be assured even with two daily injections of insulin. However, self-measurement of blood glucose as a guide to insulin taken before each meal and at bedtime can, in selected patients, increase the frequency of normal glucose levels without undue hypoglycemia.

Discrepancies between glycosuria and home estimates of blood glucose in insulin-treated diabetes mellitus.

Glycosuria can be a misleading indicator of blood or plasma glucose levels. Thus glycosuria may be present when blood glucose levels are within the normal fasting or postprandial range, and it may be absent when the blood glucose is distinctly above normal. In such patients the blood glucose must be measured, preferably by the patient, as a guide to insulin and other therapy. However, urine glucose tests are valid indicators in a minority of patients and are essential in all patients for the detection of acetone.

Remissions of diabetes mellitus after weight reduction by jejunoileal bypass.

Limited weight loss following jejunoileal bypass in 24 diabetic persons who were still distinctly overweight five to ten months after a mean weight decrease of 78 lbs. was accompanied by a return of normal fasting glucose and insulin levels, normal insulin responses, and a decrease in glucose intolerance. The glucose disappearance rate had improved in the majority of the subjects, but only three had attained values in the normal range. Concomitants of the undue hyperglycemia and/or obesity included labile and, rarely, sustained hypertension and/or cardiomegaly. The blood pressure returned to normal but heart size did not change. Electrocardiographic abnormalities noted in about one-half of the patients persisted after the operation. Triglyceride and cholesterol levels decreased. No patients had diabetic retinopathy visible on funduscopy. Proteinuria did not change in three patients. Neuropathy consisting of absent ankle reflexes and/or decreased vibration perception noted in one-half of the subjects persisted despite the improvement in carbohydrate metabolism.

Thyroid hormone-like effects without thyrotoxicosis during one year's therapy with NA-DT3 for hypercholesterolemia.

A thyroid hormone analogue, sodium dextro-triiodothyronine (NaDT3), at a dosage of 1 mg/day for 1 or 2 yr, decreased serum cholesterol levels about 30% in 26 hyperlipidemic adults. There were less sustained decreases in the serum phospholipids, and occasional lowering of the serum triglycerides, but no effects on body weight, blood pressure, or pulse rate. Changes recognized as variable concomitants of spontaneous or induced thyrotoxicosis, such as transient increases in fasting blood glucose, calcium, and globulin, persistent rises in alkaline phosphatase, and nonsustained decreases in hematocrit are consonant with the fact that Na-DT3 exerts about one tenth of the thyroid hormone activity of LT3. These changes, however, appear to represent actions of iodinated amino acids apart from those effects that result in clinical thyrotoxicosis.

Biochemical, endocrine, and other indices during quinestrol therapy.

PIP: The effect of .025 mg quinestrol twice daily for 6 months was studied in 8 menopausal and postmenopausal women. There was no change in mean body weight, blood pressure readings, pulse rate or electrocardiograms. Vaginal smears showed an estrogenic effect of the drug which included cornification of the vaginal epithelium. There was a slight decrease in beta lipoproteincholesterol and serum acid phosphatase. There was an increase in serum creatine between the third and sixth months of treatment with no change in serum creatinine. In non-diabetic women, glucose-induced hypophosphatemia was accentuated. In diabetic women, the glucose tolerance appeared to improve. In both groups, increases in serum insulin caused by a glucose load were less under quinestrol therapy than without.^ieng

Plasma cortisol following injection of 1-39 or 1-18 ACTH.

Forty units of 1-39 ACTH of animal origin or 0.4 mg of synthetic 1-18 ACTH administered at 8 A.M. via either the intramuscular route to 10 subjects with intact adrenocortical function produced comparable increases in plasma cortisol at 1, 2, and 6 hours. The increase in plasma cortisol lasted at least 6 hours but less than 12 hours after intravenous crystalline 1-39 ACTH and at least 16 hours but less than 24 hours after the same dose of 1-39 ACTH administered as a depot gel via the intramuscular route. However, neither intravenous nor the intramuscular injection of 1-39 ACTH produced increases that were still evident at 24 hours. Following either the intramuscular or intravenous injection of 0.4 mg of the synthetic 1-18 ACTH, the plasma cortisol increase was still evident at the 24th hour. Our findings indicate that the plasma cortisol responses to either 40 units of exogenous 1-39 ACTH of animal origin or to 0.4 mg of a synthetic 1-18 ACTH are most consistent in the first 6 hours following either intravenous or intramuscular injection.