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Latest & greatest articles for insulin
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Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes. 36 patients with insulin-dependent diabetes mellitus who had 'Albustix'-negative urine but raised urinary albumin excretion (30 to 300 mg/24 h) were randomly assigned to either remaining on conventional insulin treatment or continuous subcutaneous insulin infusion and followed up for 2 years. The insulin-infusion group showed a significant, sustained improvement in metabolic (...) control, with a median glycosylated haemoglobin of 7.2% (range 5.9-8.8), but there was no change in the conventional-treatment group (median 8.6%, range 7.2-13.4) (p less than 0.001). Clinical diabetic nephropathy (a urinary albumin excretion rate above 300 mg/24 h in at least two of three 24 h urine collections) developed in 5 patients in the conventional-treatment group, but not in the insulin-infusion group (p less than 0.05, two-tailed). Fractional albumin clearance (mean and range X 10(7
A randomized clinical trial of the insulin pump vs intensive conventional therapy in diabetic pregnancies. Improved perinatal outcome is associated with the prevention of hyperglycemia during pregnancy in diabetic women. To determine whether the method of insulin administration influences the degree of diabetic control obtained, we randomized 22 pregnant diabetic women to intensive conventional insulin therapy (N = 11) and insulin pump therapy (N = 11). Frequent outpatient visits; home glucose
Effects of tolazamide and exogenous insulin on insulin action in patients with non-insulin-dependent diabetes mellitus. To determine whether sulfonylureas and exogenous insulin have different effects on insulin action, we studied eight patients with non-insulin-dependent diabetes mellitus before and after three months of treatment with tolazamide and exogenous semisynthetic human insulin, using a randomized crossover design. Therapy with tolazamide and therapy with insulin resulted in similar (...) improvement of glycemic control, as measured by a decrease in mean glycosylated hemoglobin (+/- SEM) from 9.4 +/- 0.7 percent to 7.7 +/- 0.5 percent with tolazamide and to 7.1 +/- 0.2 percent with exogenous insulin (P less than 0.01 for both comparisons). Therapy with either tolazamide or exogenous insulin resulted in a similar lowering (P less than 0.05) of postabsorptive glucose-production rates (from 2.3 +/- 0.1 to 2.0 +/- 0.2 and 1.8 +/- 0.1 mg per kilogram of body weight per minute, respectively
Effect of blood glucose control on increased glomerular filtration rate and kidney size in insulin-dependent diabetes. To investigate the relation between blood glucose control on the one hand and an increased glomerular filtration rate and enlarged kidneys on the other, we studied 12 patients with insulin-dependent diabetes and an increased glomerular filtration rate for a year after they were randomly assigned either to continuous subcutaneous insulin infusion or to unchanged conventional (...) . At the end of a year, a return to conventional insulin treatment in the pump group resulted in both metabolic deterioration and a significant rise in the mean glomerular filtration rate toward base-line values. We conclude that in patients with established insulin-dependent diabetes, strict glycemic control normalizes the glomerular filtration rate, although the kidneys may remain enlarged.
Aggravation by propranolol of hyperglycaemic effect of hydrochlorothiazide in type II diabetics without alteration of insulin secretion. 14 hypertensive men with type II diabetes sequentially received, in random order, hydrochlorothiazide 50 mg twice a day, propranolol 80 mg twice a day, and both drugs in combination. The 3-week treatment periods were separated by a 1-week washout period. Hydrochlorothiazide significantly increased fasting glucose by 31% (p less than 0.05) and glycosylated (...) haemoglobin (HbA1c) by 6.0% (p less than 0.10). A similar treatment period of propranolol 80 mg twice a day caused no significant increases. However, when both drugs were taken in combination, fasting glucose rose by 56% and HbA1c by 14.7% (p less than 0.01). The hyperglycaemic effect of hydrochlorothiazide and its potentiation by propranolol were independent of serum potassium and of endogenous insulin secretion as measured by urine C-peptide excretion. The combination of hydrochlorothiazide
Poor reproductive outcome in insulin-dependent diabetic women associated with later development of other endocrine disorders in the mothers. In a prospective study of insulin-dependent diabetic women who in the 1950s were involved in a drug trial, 13 (14%) of those who were still alive 27 years later were reported to have acquired thyroid disease or pernicious anaemia during the follow-up period. This suggests that their diabetes mellitus was a manifestation of a more generalised polyendocrine (...) disorder. The pregnancy history of these 13 women differed strikingly from that of the other 82 insulin-dependent diabetic women: in the diabetic women who subsequently acquired other endocrine disease 69% of pregnancies resulted in a fetal or infant death, compared with 44% in other insulin-dependent diabetic women (p less than 0.01). This risk increased with pregnancy order, the odds ratio of an unfavourable outcome in women who later acquired thyroid disease or pernicious anaemia, compared
Specific thromboxane synthetase inhibition and albumin excretion rate in insulin-dependent diabetes. Albumin excretion rates (AER) were measured in 30 insulin-dependent diabetics during a 16-week double-blind, randomised, placebo-controlled study of the specific thromboxane synthetase inhibitor UK-38,485.6 of 15 subjects in the active group had microalbuminuria (defined as mean pretreatment AER 20-150 micrograms/min); in these patients AER fell from 32 +/- 3 micrograms/min to 11 +/- 1
Effect of 1 year of near-normal blood glucose levels on retinopathy in insulin-dependent diabetics. 30 insulin-dependent diabetic patients with background retinopathy were randomised to conventional treatment (UCT) or treatment with continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 1 year with fortnightly seven-sample home blood glucose measurements and retinal examinations every 6 months. Mean blood glucose and stable haemoglobin A1c during months 3-12 were
Prevention of deterioration of renal and sensory-nerve function by more intensive management of insulin-dependent diabetic patients. A two-year randomised prospective study. 74 insulin-dependent diabetic patients with background retinopathy were randomised to continue with usual diabetic care (group U) or to a more intensive programme (group A) using ultralente insulin as basal cover and soluble insulin at mealtimes. Group A attended the clinic more frequently, received closer dietary
Effect of 6 months of strict metabolic control on eye and kidney function in insulin-dependent diabetics with background retinopathy. Steno study group. The effect of 6 months of strict metabolic control upon eye and kidney function was studied in 32 insulin-dependent diabetics randomised either to unchanged conventional treatment (UCT) or to continuous subcutaneous insulin infusion (CSII). Retinal function was assessed by means of the macular recovery time (measured with nyctometry
Biosynthetic human insulin in the treatment of diabetes. A double-blind crossover trial in established diabetic patients. 94 diabetic patients established on treatment with porcine (n = 47) or bovine (n = 47) insulin took part in a double-blind crossover trial, in which 6-week periods of treatment with the appropriate animal insulin were compared with periods of treatment with biosynthetic human insulin (BHI). 6 patients withdrew during the trial, in 3 cases because of hypoglycaemia while (...) taking BHI. In bovine-insulin-treated patients, the mean glucose level (mean of seven capillary-blood samples over 1 day), the modified M index, and total daily insulin requirement were the same on BHI and bovine-insulin treatment. For porcine-insulin-treated patients, mean glucose level and the modified M index were slightly higher on BHI than on porcine-insulin treatment (9.7 vs 9.0 mmol/l and 79.6 vs 65.0, respectively), despite an average increase of 2.3 units/day of BHI after 6 weeks
Low incidence of chlorpropamide-alcohol flushing in diet-treated, non-insulin-dependent diabetes. 50 diet-treated, non-insulin-dependent diabetics were tested subjectively and objectively for chlorpropamide-alcohol flushing (CPAF) with a single challenge test. Of the 12 (24%) who reported a subjective flush, 9 (18%) also flushed when a placebo was given instead of chlorpropamide, so the true incidence of chlorpropamide-alcohol flushing was 4% (1 patient was not retested with placebo (...) ). In a control group of 21 non-diabetics, 2 showed the specific CPAF phenomenon. Temperature measurement did not improve discrimination, but it did show a faster rise in facial temperature in CPAF-positive subjects than in alcohol flushers. This study does not confirm previous higher estimates of the incidence of the CPAF phenomenon in non-insulin-dependent diabetes.
Comparative study of subcutaneous, intramuscular, and intravenous administration of human insulin. Human insulin derived from porcine insulin was given subcutaneously (s.c.), intramuscularly (i.m.), and intravenously (i.v.) to normal men. The dosage for all three routes was 0 . 075 IU/kg body weight. Diluting medium was administered by s.c. injection to obtain control values. Somatostatin (100 microgram/h) was given to inhibit pancreatic beta cell secretion. The plasma glucose responses to s.c (...) . injection of this insulin into the anterior abdominal wall and to i.m. injection into the thigh were similar with respect to the extent, onset, and duration of effect. Plasma glucose fell from mean (+/- SE) pre-injection values of 4 . 3 +/- 0 . 15 and 4 . 4 +/- 0 . 27 mmol/l, to 3 . 06 +/- 0 . 25 and 2 . 98 +/- 0 . 16 mmol/l by 90 to 105 min for s.c. and i.m. studies, respectively, thereafter returning to mean basal level by 6 h after i.m. injection, but remaining about 0 . 5 mmol/l below basal level
Human insulin produced by recombinant DNA technology: safety and hypoglycaemic potency in healthy men. Human insulin synthesised by recombinant DNA technology was compared with highly purified porcine insulin in healthy men. Intracutaneous injection over a wide range of concentrations of both insulins into five subjects gave rise to no local reactions over a 48 h period. The glycaemic response to standard subcutaneous injection at high and low dose levels was measured with both insulins in each (...) of six men. Plasma glucose decrement with the two insulins was similar but human insulin was perhaps slightly more potent than porcine insulin at the low dose, and slightly less so at the high. The glycaemic response to the isulins, each infused intravenously at high and low concentrations for 1 h in a further six subjects, showed a similar trend. Depression of glycaemia with human insulin slightly exceeded that with porcine insulin at the low concentration infusion and fell slightly short
Effect of cardioselective and non-selective beta-blockade on the hypoglycaemic response in insulin-dependent diabetics. The response to intravenous insulin was studied in seven diabetics after a dose of placebo, propranolol (40 mg), or metoprolol (50 mg). Two of the seven subjects also had a week's course of each of the same agents taken three times daily. Neither of the beta-blockers potentiated the effect of insulin as judged by the rate of reduction in blood-glucose. However, blood-glucose
Depletion and disruption of dietary fibre. Effects on satiety, plasma-glucose, and serum-insulin. Ten normal subjects ingested test meals based on apples, each containing 60 g available carbohydrate. Fibre-free juice could be consumed eleven times faster than intact apples and four times faster than fibre-disrupted purée. Satiety was assessed numerically. With the rate of ingestion equalised, juice was significantly less satisfying than purée, and purée than apples. Plasma-glucose rose (...) to similar levels after all three meals. However, there was a striking rebound fall after juice, and to a lesser extent after purée, which was not seen after apples. Serum-insulin rose to higher levels after juice and purée than after apples. The removal of fibre from food, and also its physical disruption, can result in faster and easier ingestion, decreased satiety, and disturbed glucose homoeostasis which is probably due to inappropriate insulin release. These effects favour overnutrition
Diabetic ketoacidosis: low-dose insulin therapy by various routes. Since in normal persons the hypoglycemic effect of low-dose intramuscular exceeds that of subcutaneous insulin we studied the effect of routes of insulin therapy in diabetic ketoacidosis. Forty-five patients with diabetic ketoacidosis entered a randomized prospective protocol with insulin administered either intravenously, subcutaneously or intramuscularly. Initial priming dose of insulin had to be repeated in two of 15, three (...) insulin therapy for diabetic ketoacidosis and indicate that the optimal route of insulin administration is by initial intravenous combined with subcutaneous or intramuscular.
Insulin in the management of the diabetic surgical patient: continuous intravenous infusion vs subcutaneous administration. A prospective randomized study comparing constant intravenous infusion of regular, low-dose insulin versus conventional subcutaneous administration of neutral protein Hagedorn (NPH) insulin in insulin-requiring patients undergoing orthopedic procedures under general anesthesia was undertaken. The degree of diabetic control was better in those receiving constant 2 units (...) /hour of regular insulin than in those receiving two thirds of daily maintenance doses of NPH insulin. However, in two of eight patients receiving 2 units/hour, decreased insulin infusion rates and increased dextrose infusion rates were required to avoid hypoglycemia. Preoperative NPH insulin and 1 unit/hour insulin administration resulted in equivalent diabetic control.