Human insulin and porcine insulin in the treatment of diabetic children: comparison of metabolic control and insulin antibody production.

Semisynthetic human insulin and highly purified porcine insulin were compared in a double blind crossover study in 21 diabetic children. Glycosylated haemoglobin values at the end of four month treatment periods were higher after treatment with human insulin than after treatment with porcine insulin (mean 15.7% (SD 2.3%) v 14.2% (2.3%); p less than 0.01). Higher fasting blood glucose concentrations occurred during treatment with human insulin than with porcine insulin (mean 12.0 (SD 2.1) v 11.0 (2.4) mmol/1; mean 216 (SD 38) v 198 (43) mg/100 ml; p less than 0.05), but there were no significant differences at other time points during the day. The incidence of hypoglycaemia was similar for both treatment groups. Concentrations of antibody reactive with porcine and human insulins were similar for the two treatment groups, although greater fluctuation was observed in the amount of antibody reactive with human insulin. Semisynthetic human insulin is safe and effective in diabetic children, although further work is needed to devise regimens which achieve optimal blood glucose control.     

Comparison of the subcutaneous absorption of insulin glargine (Lantus) and NPH insulin in patients with Type 2 diabetes.

The aim of this study was to compare the subcutaneous absorption characteristics of insulin glargine with NPH insulin in patients with Type 2 diabetes. In this single-dose, double-blind, randomized, two-way crossover study, 14 patients with Type 2 diabetes (aged 40-70 years) previously untreated with insulin were randomized to receive in a fasting state either a single subcutaneous injection of 0.3 U/kg 125I-insulin glargine or 0.3 U/kg 125I-NPH insulin. The disappearance of radioactivity was monitored for forty-eight hours. The median time for 25%, 50% and 75% of the radioactivity to disappear from the injection site was significantly longer for insulin glargine compared with NPH insulin (T75% 15.0 and 6.5 h, p=0.009; T50% 26.3 and 13.4 h, p=0.009; T25% 42.4 and 26.6 h, p=0.019, respectively). The mean residual radioactivity remaining at 24, 36 and 48 h after injection remained significantly higher than NPH insulin (54.4 and 27.9%, p=0.0001; 35.0 and 17.0%, p=0.003; 19.2 and 9.2%, p=0.01, respectively). Mean plasma glucose levels reached a minimum after 14.6 and 9 h in response to insulin glargine and NPH insulin, respectively. The subcutaneous absorption of insulin glargine in fasting Type 2 diabetes patients was significantly (2-3 times) slower compared with NPH insulin in patients with Type 2 diabetes. The slower absorption of insulin glargine correlated with the fall in plasma glucose levels over a 24 h period compared with the faster insulin absorption and more rapid decrease in plasma glucose levels observed in response to NPH insulin. Both insulin glargine and NPH insulin were well tolerated.     

Comparison of the effect of semisynthetic human insulin and porcine insulin on glucose kinetics, plasma free fatty acid and amino acid levels in man

The effect of semisynthetic human insulin on hepatic glucose output, peripheral glucose clearance, plasma levels of C-Peptide, free fatty acids and amino acids was compared with purified pork insulin using the glucose clamp technique. 8 normal overnight-fasted subjects received intravenous infusions of either human or porcine insulin at 20 mU/m2.min(-1) during 120 min achieving plasma insulin levels of approximately equal to 50 mU/l. Plasma glucose levels were maintained at euglycaemia by variable rates of glucose infusion. Hepatic glucose production measured by continuous infusion of 3-(3) H-glucose was similarly suppressed by both insulins to rates near zero. The metabolic clearance rate of glucose increased during infusion of human insulin by 120%, C-peptide levels decreased by 41% and plasma FFA concentrations fell by 74%. The respective changes during infusion of pork insulin were similar, 118%, 48% and 72%. Both insulins decreased the plasma levels of branched-chain amino acids, tyrosine, phenylalanine, methionine, serine and histidine similarly. Thus, the results demonstrate that semisynthetic human and porcine insulin are aequipotent with respect to suppression of hepatic glucose output, stimulation of glucose clearance, inhibition of insulin secretion, lipolysis and proteolysis.     

Comparison of high fibre diets,basal insulin supplements,and flexible insulin treatment for non-insulin dependent (type II) diabetics poorly controlled with sulphonylureas.

OBJECTIVE--To compare high fibre diet, basal insulin supplements and a regimen of insulin four times daily in non-insulin dependent (type II) diabetic patients who were poorly controlled with sulphonylureas. DESIGN--Run in period lasting 2-3 months during which self monitoring of glucose concentration was taught, followed by six months on a high fibre diet, followed by six months'' treatment with insulin in those patients who did not respond to the high fibre diet. SETTING--Teaching hospital diabetic clinics. PATIENTS--33 patients who had had diabetes for at least two years and had haemoglobin A1 concentrations over 10% despite receiving nearly maximum doses of oral hypoglycaemic agents. No absolute indications for treatment with insulin. INTERVENTIONS--During the high fibre diet daily fibre intake was increased by a mean of 16 g (95% confidence interval 12 to 20 g.) Twenty five patients were then started on once daily insulin. After three months 14 patients were started on four injections of insulin daily. ENDPOINT--Control of diabetes (haemoglobin A1 concentration less than or equal to 10% and fasting plasma glucose concentration less than or equal to 6 mmol/l) or completion of six months on insulin treatment. MEASUREMENTS AND MAIN RESULTS-- No change in weight, diet, or concentrations of fasting glucose or haemoglobin A1 occurred during run in period. During high fibre diet there were no changes in haemoglobin A1 concentrations, but mean fasting glucose concentrations rose by 1.7 mmol/l (95% confidence interval 0.9 to 2.5, p less than 0.01). With once daily insulin mean concentrations of fasting plasma glucose fell from 12.6 to 7.6 mmol/l (p less than 0.001) and haemoglobin A1 from 14.6% to 11.2% (p less than 0.001). With insulin four times daily concentrations of haemoglobin A1 fell from 11.5% to 9.6% (p less than 0.02). Lipid concentrations were unchanged by high fibre diet. In patients receiving insulin the mean cholesterol concentrations fell from 7.1 to 6.4 mmol/l (p less than 0.0001), high density lipoprotein concentrations rose from 1.1 to 1.29 mmol/l (p less than 0.01), and triglyceride concentrations fell from 2.67 to 1.86 mmol/l (p less than 0.05). Patients taking insulin gained weight and those taking it four times daily gained an average of 4.2 kg. CONCLUSIONS--High fibre diets worsen control of diabetes in patients who are poorly controlled with oral hypoglycaemic agents. Maximum improvements in control of diabetes were achieved by taking insulin four times daily.     

Blood glucose and free insulin levels after the administration of insulin by conventional syringe or jet injector in insulin treated type 2 diabetics

The levels of blood glucose and free insulin were compared in 20 diabetic subjects (type 2) receiving one dose of a combination of fast-acting and intermediary-acting insulins in the morning by means of a needle syringe or a jet injector (SICIM, Italy), using minimum possible injecting power. A shift to the left in the free insulin profile, consequential to different pharmacokinetic characteristics of insulin when administered by means of a jet injector, was observed, although no significant differences were seen for free insulin levels. Statistically significantly higher blood glucose values (P less than 0.05) were recorded 6 and 9 h after insulin administration by means of a jet injector, as well as statistically significant higher MBG values (P less than 0.05), thus indicating a faster and shorter effect achieved in comparison to that produced by the syringe injected insulin. Conclusions: 1. When switching the method of insulin administration in patients from needle syringe to jet injections the power of the jet injector should be increased (it can be set in three different levels). If that is not possible, because of patient skin characteristics then the dose of intermediary acting insulin should be slightly increased. 2. No local or general side-effects were registered using minimum injecting power of jet injector. 3. The results of the controlled poll have shown that this method of insulin administration is less painful and simpler for patients. The great majority of the patients would like to possess a jet injector.     

The effect of pivalate treatment of pregnant rats on body mass and insulin levels in the adult offspring

Pivalic acid is used as a prodrug to increase gut absorption of a variety of different antibiotics. Pivalic acid is also known to induce a number of metabolic aberrations which may be in part explained by concurrent mild carnitine depletion. Rat pups (5 days old) born to mothers treated throughout their pregnancy and lactation period with sodium pivalate, showed an increase in liver and muscle triglycerides and elevated plasma ketone bodies, compared to controls. A reduction of free carnitine content in liver, muscle and plasma was also observed in the pivalate treated group. In a second study, pups were treated with either pivalate for 24 days (females), or pivalate for 120 days (males). Both groups were fed standard diets. In both groups (male and female), the pivalate treatment showed a statistically significant hyperinsulinaemia and an increase of body mass compared with that of age- and sex-matched control groups. In addition, after a glucose loading, significantly higher levels of insulin in the pivalate-treated group (male) with respect to controls were observed. In conclusion, our data suggest that maternal pivalate treatment may predispose adult offspring to developing insulin-resistance and obesity.     

Intraorganic venous bed of the stomach cardia in children during the first 3 years of life

The intraorganic venous bed of the gastric cardial part has been studied in 27 organs, obtained from children corpses of both sex beginning from birth up to three years of life. They died from causes that were not connected with gastric or vascular system pathology. The results of the investigation prove the presence of mucous, submucous, muscular and serous-subserous venous plexuses in the wall of the gastric cardial part in children of the first three years of life. Every membrane of the stomach wall has its specific structure of the venous link in the microcirculatory bed. In the stomach mucous membrane already in a newborn there are complexly built microcirculatory pathways. Age changes are mostly expressed in the venous link of the gastric mucous membrane; this is probably connected with functional activity of the given layer of the organ. The largest venous vessels are situated in the gastric submucous base. By the end of the newborn period and, especially fully, during the successive age periods immune protection of the gastric wall is formed as an accumulation of lymphoid tissue to an antigenic effect of food. In these age groups certain structural mechanisms of blood outflow from the gastric wall appear.     

Impact of a single insulin treatment (imprinting) applied during liver regeneration on hepatic insulin receptor development, blood glucose level and liver function parameters in adult rats.

Rats subjected to partial hepatectomy (surgical removal of two thirds of the liver) showed no appreciable change in serum cholesterol, bilirubin, albumin, total protein and A/G values at 2, 5, 12 and 21 days after the intervention. The enzyme activities characteristic of liver damage (GOT, GPT, LDH, AP) were high in the control group and low in the insulin-imprinted group at 2 days, tended to normalize in both groups at 5 days and changed slightly at 12 days. The blood glucose level was markedly decreased in the control group and to a lesser degree also in the experimental group at 2 and 5 days of sampling. Insulin treatment (loading) performed at 2 and 5 days accounted for a drop of blood glucose which was followed by normalization within 2 h. Starving value and response to insulin loading uniformly fell into the physiological range at 21 days, whereas at 12 days no normalization occurred in either group within 2 h of insulin loading, although the starving value was physiological. The binding capacity of the insulin receptor was markedly low in the control group as long as 12 days, and tended to normalize by 21 days. In the insulin-imprinted group the binding capacity increased over the control at 2 and 5 days and normalized by 12 days.     

Comparison of several insulin sensitivity indices derived from basal plasma insulin and glucose levels with minimal model indices.

Some techniques for the evaluation of insulin resistance (IR), such as the clamp technique, are not viable for the study of large populations; and for this reason, alternative approaches based on fasting plasma glucose (FPG) and plasma insulin (FPI) have been proposed. The aim of this study was to compare the IR calculations obtained from FPI and FPG values with the insulin sensitivity (IS) index derived from the minimal model. Eighty-seven healthy subjects with a wide range of body mass index (18 - 44 kg x m -2) and 16 DM2 non-obese patients were included in the study. All of the patients underwent a frequently sampled intravenous glucose tolerance test (FSIGTT), and the minimal model of glucose was used for the estimation of insulin sensitivity (IS MINIMAL ). The HOMA-IR index, the Avignon index, and the quotient FPG/FPI were used to calculate basal steady-state IR. The basal IR value that best correlated with IS was Log (1/HOMA-IR) (r = 0.70, p < 0.001). All of the basal indices showed a high correlation with each other. In conclusions, insulin sensitivity indices as determined from the basal glycaemia and insulinemia values are not good estimators for metabolic reality from the perspective of the minimal model. Nevertheless, they might well have an IR screening value for epidemiological studies, as long as there is no pancreatic beta-cell dysfunction.     

Influence of neonatal treatment with porcine insulin (hormonal imprinting) on the receptor binding of insulins of porcine, rat and human origin

A single neonatal insulin treatment in the male rat decreases, whereas in the female rat it increases, the number of insulin receptors detected at the age of one month. No difference could be observed in affinity. The extent of the binding of rat, porcine and human insulin is different (the binding of human insulin is the most pronounced), meanwhile the alterations evoked by neonatal treatment are basically identical.     

Immunohistochemical and ultrastructural study of adult porcine endocrine pancreas during the different steps of islet isolation

 Treatment of diabetes mellitus by transplantation of isolated pancreatic islets could constitute an alternative to human pancreas allograft. Before transplantation, porcine islets are submitted to a procedure of isolation and purification. The quality of islets through these different steps may be assessed by morphological and functional studies. The aim of this work was the histological characterization of the four main cell types of porcine adult endocrine islets during the different steps of the isolation procedure using immunohistochemistry (IHC) applied in light (LM) and electron microscopy (EM). In fresh pancreas, islets were various sizes and shapes in LM. The number was not found different between the different portions of the pancreas. In IHC, insulin (Ins)-secreting cells accounted for the majority of the islet cells, while glucagon(Glu)-somatostatin (Som)- and polypeptide(PP)-immunoreactive cells, in decreasing number, were found in the mantle around the core of Ins-cells. In EM, B-cells contained polyhedric granules with a dense central core and clear halo. Glu granules were spherical and very dense. D-cells and PP-cells were characterized by numerous granules, rather spherical and of inequal density for Som and more ellipsoidal for PP granules. After purification in Euroficoll, in EM, the four cellular types remained recognizable, but underwent vacuolization, mitochondrial swelling, and enlargment of intercellular spaces. After 3 days of culture on plastic dishes, as on Biopore membranes in a Millicell insert, microvilli appeared and vacuolization increased in EM. At the seventh day of culture, in EM, most of the cells were lysed in contrast to LM where at the same time, the four cell types were clearly identified by IHC but only in collagen matrix. Important discrepancies were noticed between LM and EM. This fact emphasizes the complementarity of morphological and functional studies in assessment of the quality of an islet isolation. Accepted: 11 June 1996     

Differentiation of 3T3-L1 fibroblasts to adipocytes. Effect of insulin and indomethacin on the levels of insulin receptors

Differentiating (3T3-L1) and nondifferentiating (3T3-C2) fibroblastic cell lines possess two classes of insulin receptors, high affinity (KD = 1.0 to 3.7 X 10(-9) M) and low affinity (KD = 2.0 to 3.6 X 10(-8) M). Confluent cultures of 3T3-L1 cells induced to differentiate by insulin (1.74 x 10(-6) M) or indomethacin (1.25 x 10(-4) M) exhibit a 3-fold increase in the number of high affinity and low affinity receptors per cell or a 1.5- to 1.8-fold increase in the number of receptors per micron2 of surface area. In contrast, nondifferentiating 3T3-C2 cells treated with insulin or indomethacin lose almost completely the high affinity insulin receptors while retaining the same levels of low affinity receptors. The loss of high affinity receptors of the 3T3-C2 cells is accompanied by the disappearance of the stimulatory effect of insulin on the production of CO2 from glucose and on the uptake of aminoisobutyrate. The levels of high affinity insulin receptors appear to be regulated by different mechanisms in the differentiating (3T3-L1) and nondifferentiating (3T3-C2) cell lines. The mode of this regulation may have a bearing on the ability of a particular cell line to differentiate.     

Temporal and spatial evolution of brain network topology during the first two years of life

The mature brain features high wiring efficiency for information transfer. However, the emerging process of such an efficient topology remains elusive. With resting state functional MRI and a large cohort of normal pediatric subjects (n = 147) imaged during a critical time period of brain development, 3 wk- to 2 yr-old, the temporal and spatial evolution of brain network topology is revealed. The brain possesses the small world topology immediately after birth, followed by a remarkable improvement in whole brain wiring efficiency in 1 yr olds and becomes more stable in 2 yr olds. Regional developments of brain wiring efficiency and the evolution of functional hubs suggest differential development trend for primary and higher order cognitive functions during the first two years of life. Simulations of random errors and targeted attacks reveal an age-dependent improvement of resilience. The lower resilience to targeted attack observed in 3 wk old group is likely due to the fact that there are fewer well-established long-distance functional connections at this age whose elimination might have more profound implications in the overall efficiency of information transfer. Overall, our results offer new insights into the temporal and spatial evolution of brain topology during early brain development.