Further Observations on the Diurnal Variation in Oral Glucose Tolerance

Diurnal variation in oral glucose tolerance was studied in 122 male volunteers aged 40 yearsand over who participated in a screening health examination. In those with screening blood sugar levels exceeding 110 mg./100 ml. the degree of diurnal variation was least in those with the highest morning glycaemia; the latter also tended to have lower afternoon fasting bloodsugar levels.In a group of 40 control subjects, afternoon glucose tolerance tests yielded significantly higher post-glucose blood sugar levels. The degree of diurnal variation was significantly and inversely related to the degree of obesity.     

Insulin secretory responses in patients with glucose intolerance due to extra-pancreatic causes. Comparison with idiopathic diabetes mellitus

Insulin responses during 100 g glucose tolerance tests (GTT) were compared between three groups of patients with varying degrees of glucose intolerance. Patients who had no disease known to be associated with secondary diabetes were classified as patients with idiopathic diabetes mellitus. Those whose present and past fasting blood glucose (FBG) exceeded 140 mg/100 ml were assigned to Group A, and the rest of the patients to Group B. Group C included patients with liver disease, thyrotoxicosis, or myocardial infarction, or those treated with corticosteroids or who had undergone gastrectomy. Patients in Group A were found to have consistently subnormal insulin responses whether glucose tolerance was normal (i.e. previous abnormality of glucose tolerance), borderline, or diabetic. In contrast, patients in Group C without fasting hyperglycemia had enhanced rather than decreased insulin responses when glucose tolerance was the more impaired. Patients in Group B had insulin responses similar to those either of Group A or of Group C. The relationship between the sum of six insulin and six blood glucose values during GTT (sigma IRI and sigma BG) was examined. The sigma BG-sigma IRI plot revealed distinctly different distribution zones for Group A and Group C (Zones A and C). In Group A, sigma IRI values were below 300 microU/ml irrespective of sigma BG values. In Group C, sigma IRI tended to increase, paralleling the increase in sigma BG values in the range of sigma BG values lower than 1400 mg/100 ml. In patients whose sigma BG rose above 1400/100 ml during corticosteroid treatment, the sigma IRI values decreased and entered into Zone A. After the cessation of corticosteroids in a few of these patients, the sigma IRI values recovered and reentered Zone C, concomitant with an improvement in glucose tolerance. Similar recovery of insulin response from Zone A to Zone C was also observed after the treatment of two obese diabetic patients. Thus, patients with glucose intolerance due to extra-pancreatic causes may secrete insulin at a higher rate than normal so long as the FBG level remains below 120 mg/100 ml, but a further deterioration in glucose metabolism may lead to a failure of insulin secretory mechanisms.     

Does random blood glucose sampling outdate testing for glycosuria in the detection of diabetes during pregnancy?

A random blood glucose concentration was determined in 2403 pregnant women attending an antenatal clinic at between 28 and 32 weeks'' gestation. The calculated 99% cut off values were 6.1 mmol/l (110 mg/100 ml) within two hours after a meal and 5.6 mmol/l (101 mg/100 ml) more than two hours after a meal. Patients with a blood glucose concentration in excess of these values were referred for a 75 g oral glucose tolerance test. Of 59 referred, four were found to have previously unsuspected but unequivocal diabetes mellitus and another four to have impaired glucose tolerance on the basis of the World Health Organisation''s criteria. Screening all antenatal patients by randomly measuring blood glucose concentrations is not only cheap and efficient but also does not interfere with the routine of busy antenatal clinics.     

The chemistry of insect hemolymph; organic components of the hemolymph of the silkworm,Bombyx mori,and two other species

1. Hemolymph was collected for analysis from the silkworm, Bombyx mori, in a series of developmental stages ranging from the second molt to the late pupa. The mean pH of larval hemolymph after collection was found to be 6.45, that of pupal hemolymph, 6.57; in vivo values may be slightly lower. Total dry solids ranged from 5.4 to 10.6 per cent. Total protein ranged from 1.2 to 5.3 per cent, increasing rapidly during the fifth instar. 2. Free amino acids were separated chromatographically and estimated. Of 19 amino acids identified, amounting collectively to 823 to 1497 mg. per 100 ml., glutamine, histidine, and lysine generally occurred in greatest amount. Tryptophan was not detected, and cystine (or cysteine) was found in only one sample. The total free amino acids account for 35 to 55 per cent of the non-protein nitrogen of the plasma. 3. Free sugars, estimated semiquantitatively on chromatograms, comprise glucose, fructose, and sucrose in total amount ranging from about 5 to 40 mg. per 100 ml. Total acid-soluble, ultrafiltrable carbohydrate, estimated as glucose by the anthrone reaction, ranged from 166 to 635 mg. per 100 ml., indicating the presence of low molecular weight sugar derivatives. 4. Inorganic phosphate amounted to 5 to 15 mg. per 100 ml., and acid-soluble organic phosphate to 100 to 200 mg. per 100 ml. The latter fraction includes several substances, of which one was tentatively identified as glucose-6-phosphate and the remainder are as yet unidentified. 5. Single samples of hemolymph were also taken from larvae of the wax moth, Galleria mellonella, and the spruce sawfly, Diprion hercyniae. These contained even higher concentrations of solutes than the silkworm samples, but with a generally similar distribution. The proportions of the free amino acids were different in each species.     

The chemistry of insect hemolymph. II. Trehalose and other carbohydrates

α,α-Trehalose, a sugar previously regarded as a product characteristic of certain lower plants, has been identified as a major blood sugar of insects. Trehalose has been isolated in pure form from the blood of pupae of the silk moth, Telea polyphemus, and has been recognized chromatographically in all the insects examined, which comprise 10 species belonging to 5 different orders. Trehalose has been determined quantitatively with anthrone after either chromatographic separation or chemical degradation of other sugars. In larvae and pupae of 4 species of Lepidoptera it ranges from 0.2 to 1.5 gm. per 100 ml. of blood and makes up over 90 per cent of the blood sugar; in larvae of a sawfly, about 80 per cent of the blood sugar is trehalose. In Bombyx mori and Platysamia cecropia, the pupal blood trehalose level is about half that in the mature larva, suggesting utilization of trehalose for glycogen synthesis during pupation. Small amounts of glucose and apparent glycogen are also present in the plasma of these insects. In Bombyx larval plasma there is also 0.04 to 0.12 gm. per 100 ml. of glucose-6-phosphate and smaller amounts of an apparent ketose phosphate.     

Absence of Feeding-Induced Variations in Plasma Insulin in Hypoglycaemic-Ketonaemic Cows

The effects of food intake on plasma insulin levels were studied in 38 cows with plasma sugar ranging from 41 to 86 mg/100 ml and acetoacetate (Acac) ranging from 0.2 to 18 mg/100 ml, measured before morning feeding. The animals were fed concentrates, silage and hay. Blood samples were taken immediately before feeding in the morning and at intervals of % to 1 hr. during the following 4 hrs. In animals with low blood Acac, plasma insulin concentrations began to increase as early as 1/2 hr. after the start of feeding and reached maxima after 2 hrs. Simultaneously Acac increased and sugar decreased markedly. Animals with Acac levels > 1 mg/100 ml had low pre-feeding insulin concentrations, and the level of the hormone did not increase after feeding. They did not show systematic changes in Acac. But plasma sugar tended to decrease when food was given, even in the absence of insulin increments in peripheral blood. Glucose was infused at a low rate (0.9 g/min.) for 18 hrs. into a hypoglycaemic, ketonaemic cow. As her glucose and ketone levels became normalized, she also responded to feeding with insulin increments. But throughout the experiment her plasma insulin remained considerably lower than in an identically treated control animal which had low Acac levels before the infusion. It appears that the endocrine adjustments during ketonaemia in cows include, beside low basal (pre-feeding) insulin levels, an inhibition of the normally occurring elevation of plasma insulin after feeding.     

Antidiabetic effect of a glycoside of pelargonidin isolated from the bark of Ficus bengalensis Linn.

The antidiabetic effect of a dimethoxy derivative of perlargonidin 3-O-alpha-L rhamnoside (250 mg/kg, single dose study and 100 mg/kg/day long term study) isolated from the bark of Ficus bengalensis Linn. has been compared with that of glibenclamide (2 mg/kg and 0.5 mg/kg/day respectively) in moderately diabetic rats. The single dose glycoside treatment decreased fasting blood glucose by 19% and improved glucose tolerance by 29%. The corresponding effects of glibenclamide were 25% and 66% respectively over the control values. On one-month treatment the fasting blood glucose levels went down almost to half of the pretreatment levels in both the groups and their glucose tolerance improved by 41% in glibenclamide group and by 15% in glycoside treated group. Urine sugar decreased to traces in both the groups and they appeared healthy. In vitro studies showed that insulin secretion by beta-cells was more in presence of the pelargonidin derivative than in presence of a leucocyanidin derivative, reported to be a good anti-diabetic agent.     

Nocturnal hypoglycaemia in patients receiving conventional treatment with insulin.

The prevalence of nocturnal biochemical hypoglycaemia--that is, blood glucose concentrations below 3 mmol/l (55 mg/100 ml)--was evaluated in a random sample of 58 insulin dependent diabetics receiving twice daily insulin. Seventeen patients had at least one blood glucose value below 3 mmol/l (55 mg/100 ml) and five a value below 2 mmol/l (36 mg/100 ml) during the night. Both bedtime (2300) and fasting morning (0700) blood glucose concentrations were significantly lower in the group with nocturnal hypoglycaemia compared with the group without (p less than 0.00001). If the bedtime blood glucose concentration was below 6 mmol/l (108 mg/100 ml) the risk of nocturnal hypoglycaemia was 80% (95% confidence limits 51-96%). If the bedtime blood glucose concentration was above 6 mmol/l the likelihood of hypoglycaemia not occurring during the night was 88% (74-96%). The mean glycosylated haemoglobin A1c (HbA1c) concentration in the group with nocturnal biochemical hypoglycaemia (8.2 (range 5.0-12.4)%) was significantly lower than that in the group without (9.4(7.0-14.2)%) (p less than 0.02). The prevalence of nocturnal hypoglycaemia in the patients receiving twice daily insulin (29%) was compared with that in 15 patients receiving thrice daily insulin (47%) and was not found to be significantly different. The likelihood of this risk being greater with thrice daily insulin was, however, 88%. No patient with nocturnal biochemical hypoglycaemia woke up during the night with symptomatic hypoglycaemia. Nocturnal biochemical hypoglycaemia is common during twice daily treatment with insulin, and low values of HbA1c might be associated with a higher risk of such hypoglycaemia. The blood glucose concentration at bedtime is a significant predictor of nocturnal biochemical hypoglycaemia, and HbA1c values might be of help in identifying patients at risk.     

Home blood glucose concentrations in maturity-onset diabetes.

Blood glucose concentrations during normal daily activities were measured in 106 patients with maturity-onset diabetes from capillary blood samples collected on to filter paper. Samples were taken before and two hours after main meals, before going to bed, and, in 51 cases, during the night. Fasting and mid-morning values were closely correlated with the mean values over 24 hours irrespective of the type of anti-diabetic treatment being given. Postprandial blood glucose concentrations remained below 11.5 mmol/l (207 mg/100 ml) when the fasting blood glucose value was 7.0 mmol/l (126 mg/100 ml) or less, and repeated fasting blood glucose values exceeding 7.0 mmol/l were associated with raised blood glycosylated haemoglobin concentrations. Diabetic control in maturity-onset diabetes may be satisfactorily monitored by regular measurement of fasting or mid-morning blood glucose values.     

Significance of Hyperamylasaemia and Abdominal Pain in Diabetic Ketoacidosis

An analysis of 35 consecutive episodes of diabetic ketoacidosis confirmed the frequent high levels of serum amylase in this condition. Serum amylase was raised during 21 episodes (60%), and in six instances (17%) the peak level exceeded 1,000 Somogyi units per 100 ml. Hyperamylasaemia was more often found when the initial blood sugar exceeded 500 mg/100 ml, or when the onset of the episode had been relatively acute (less than 48 hours). There was no conclusive evidence in any patient to support a diagnosis of acute pancreatitis and other explanations for the hyperamylasaemia are discussed. Even grossly raised amylase levels were not associated with increased mortality or morbidity.     

Isolation of Conduritol A from Gymnema sylvestre and Its Effects against Intestinal Glucose Absorption in Rats

A compound was isolated in crystal form from an extract of Gymnema sylvestre dried leaves. The compound was identified to be conduritol A by chemical methods, and the physicochemical characteristics also coincided with the data in the literature. Conduritol A was tested for its effect on intestinal glucose absorption orglcose tolerance in rats. The results show that the absorption of glucose in vitro was completely inhibited in the presence of 0.2 mg/ml of conduritol A and that the blood sugar level was effectively depressed by administering conduritol A at 10mg/kg of rat body weight     

Intermediate acting insulin given at bedtime: effect on blood glucose concentrations before and after breakfast.

Six C-peptide deficient diabetics receiving twice daily mixtures of short and intermediate acting insulins were selected for study because of persistently raised blood glucose concentrations before and after breakfast. They were investigated to assess the effect of moving their evening injection of intermediate acting insulin to bedtime. The patients'' usual twice daily insulin treatment was optimised and compared with the bedtime regimen during inpatient metabolic studies and an outpatient crossover study. With the conventional injection regimen blood glucose concentration rose sharply from 0500 to reach a fasting mean value of 10 +/- SE 1 . 6 mmol/l (180 +/- 29 mg/100 ml) and 16 . 8 +/- 2 . 2 mmol/l (303 +/- 40 mg/100 ml) after breakfast. By contrast, when the evening dose of intermediate acting insulin was delayed until bedtime the nocturnal rise in blood glucose concentration started later and was significantly lower both fasting (7 . 5 +/- 1 . 1 mmol/l (135 +/- 20 mg/100 ml); p less than 0 . 02) and after breakfast (13 . 2 +/- 1 . 4 mmol/l(238 +/- 25 mg/100 ml); p less than 0 . 02). Fasting blood concentrations of ketone bodies (3-hydroxybutyrate) were also significantly decreased. Plasma free insulin concentrations showed the predicted changes in five of the six patients. Blood glucose profiles collected over four months during the outpatient study confirmed the beneficial effect of giving intermediate acting insulin at bedtime.     

Time-motion and physiological assessments of ice hockey performance.

Ice hockey performance was studied during 10 contests to assess time-motion characteristics and associated physiological changes that occur for each position. Depending on the position played, the actual playing time per game for forwards and defensemen ranged between 20.7 and 28.0 min. The number of shifts ranged from 14 to 21 with an average playing time of 85.4 s/shift. Further analysis of each shift indicated that there was an average of 2.3 play stoppages which averaged 27.1 s, producing a continuous playing time of 39.7 s. Telemetered recordings of heart rate during each shift revealed sustained rates of between 170 and 174 beats/min over the three periods of the game. For both the forwards and defensemen, values for blood lactates were highest during the first and second periods (x = 78.0 and 66.1 mg/100 ml), then declined considerably during the third period (x = 44.5 mg/100 ml). Blood glucose showed a similar tendency (x = 139.3, 133.7, 114.1 mg/100 ml), while hematocrit and total protein showed little tendency to change.     

Fever and Blood Sugar in Pinottii Malaria of Pigeons*

SYNOPSIS. Plasmodium pinottii is an avian malaria parasite originally isolated from the Brazilian toucan, and maintained chiefly in the pigeon, in which it is extremely pathogenic. Infections must be transferred by blood inoculation, since gametocytes are no longer produced (and, in any event, the vector is unknown). Unlike most forms of avian malaria, pinottii malaria in the pigeon is characterized by fever, often high, with peaks at the time of parasite reproduction. Blood sugar levels vary considerably even in healthy birds, in which the mean was found to be 267 ± 9.2 SEm mg per 100 ml plasma (range 208–335, based on examination of 14 individuals. Values during fasting approximated those when feeding was ad libitum. Levels tended to rise in the early stages of the infection, reaching a mean of 305 ± 14.5 mg per 100 ml plasma (based on 10 cases) while parasitemia was 20-49%. At death the mean (determined from 46 birds) had dropped to 155.8 ± 15.5 mg per 100 ml. However there is little reason to think that parasite demand on the host's glycogen reserves was a significant factor in causing death, despite the very high parasitemias often reached.     

Home blood sampling for plasma glucose assay in control of diabetes.

Estimation of plasma glucose in home blood samples is needed to improve diabetic control. Sufficiently precise measurements on capillary blood were obtained by (a) storing Reflotest glucose-oxidase strips in a desiccant container before reading and (b) collecting blood samples into a simple vacuum bottle containing potassium fluoride (assay of sodium content indicating volume of plasma collected). The precision of the methods (+/- 1 SD) was +/-0.35 mmol/1 (+/-6.3 mg/100 ml). Clinical reliability was assessed by measuring the basal plasma glucose concentration at home on different mornings in patients with maturity-onset diabetes, the day-to-day variation (+/- 1 SD) being +/-0.73 and +/-0.92 mmol/1 (+/-13.2 and +/-16.6 mg/100 ml) respectively. The mean basal plasma glucose concentration in all 84 patients with maturity-onset diabetes from three general practices was 8 mmol/1 (144 mg/100 ml), 44 of the values exceeding 6 mmol/1 (108 mg/100 ml). Improving control by monitoring the basal plasma glucose concentration in maturity-onset diabetes might help to prevent diabetic complications.     

Potentiation of hypoglycemic response of glibenclamide by piroxicam in rats and humans.

Influence of piroxicam (PX) on glibenclamide (GL) induced hypoglycemia has been studied in rats, healthy human volunteers and diabetics. GL per se has significantly reduced blood sugar levels in rats and in humans. PX per se has significantly reduced BSLs, in diabetics, while having no significant influence on blood sugar level in rats and healthy human volunteers. Prior administration of PX has potentiated the hypoglycemic effect of GL in rats, healthy human volunteers and diabetics. GL, PX + GL administration have also significantly influenced the glucose tolerance test (GTT) in healthy human volunteers.     

The influence of mildronate on peripheral neuropathy and some characteristics of glucose and lipid metabolism in rats with the streptozotocin model of diabetes mellitus

Rats with the streptozotocin (STZ) model of diabetes mellitus were treated with mildronate (100 mg/kg daily, per os or intraperitoneally) for 6 weeks. Body weight, blood glucose, triglycerides, ketone body concentrations, percent of glycated hemoglobin (HbA1c%), glucose tolerance, and the development of neuropathic pain were monitored throughout the whole experiment. The mildronate treatment completely prevented the development of the diabetic neuropathy from the first week up to the end of experiment. In the group of diabetic animals treated with mildronate a significant decrease of blood glucose was observed on the fourth week of the treatment, the level of triglycerides decreased from the third to sixth weeks. Mildronate also decreased accumulation of glycated hemoglobin on the sixth week and improved glucose tolerance compared with untreated animals. The data obtained confirm applicability of mildronate for therapy of diabetes mellitus and its complications.     

Fasting plasma magnesium concentrations and glucose disposal in diabetes.

Fasting plasma concentrations of magnesium were measured by neutron activation analysis in 30 non-diabetics and 87 diabetics (55 non-insulin-treated, 32 insulin treated). Plasma concentrations of magnesium were lowest in the insulin treated group (mean 0.84 (SEM 0.01) mmol/1; 2.0 (0.02) mg/100 ml), intermediate in the non-diabetics (mean 0.89 (SEM 0.01) mmol/1; 2.2 (0.02) mg/100 ml), and highest in the non-insulin-treated diabetics (mean 0.95 (SEM 0.02) mmol/1; 2.3 (0.05) mg/100 ml). In all diabetics plasma magnesium concentrations were inversely related to plasma glucose values (rs = -0.33; p less than 0.01) and in non-insulin-treated patients to plasma insulin concentrations (rs = -0.28; p less than 0.05), the former confirming previous observations. In 67 of the diabetics the KG constant for disposal rate of glucose during a standard intravenous glucose tolerance test was directly related to fasting plasma magnesium concentrations, and this relation persisted after controlling for age, sex, body mass index, type of treatment, and glucose and insulin values. This direct relation of plasma magnesium concentration with glucose disposal was unexplained by its influence on insulin secretion but was related to insulin sensitivity; hence magnesium may be an important determinant of insulin sensitivity in maturity onset diabetes.     

Bile salts promote the absorption of insulin from the rat colon

The absorption of insulin mixed with sodium deoxycholate (DOC) or sodium cholate from the rectal mucosa of diabetic and non-diabetic rats was measured by the effect on blood glucose levels. Blood sugar was lowere by 50% one hour after administration of 12 u soluble insulin mixed with 1–10 mg/ml DOC, or 2–20 mg/ml sodium cholate. There was a linear correlation between the reduction in blood glucose and the amount of insulin administered (1–64 units) when mixed with 5 mg/ml DOC. Radioimmuno-assay of plasma insulin showed an increase from 16.2 μu/ml to 3335 muuu/ml after rectal administration of 12 u soluble insulin. We conclude that insulin when mixed with bile salts can be absorbed by the intestine to reach the circulation in a biologically active form.     

Self-monitoring of blood glucose in diabetic pregnancy.

Admission to hospital is usually recommended to achieve the best possible diabetic control during pregnancy. We have used blood glucose monitoring at home to find out if patients can achieve equally good control outside hospital. Twenty-five consecutive diabetic patients were studied, of whom 20 had taken insulin before pregnancy. Six of their 14 previous pregnancies had ended in perinatal death. The 25 women performed 4247 blood glucose measurements during their pregnancies. Overall the mean blood glucose concentration was 7.1 mmol/l (128 mg/100 ml); before meals the mean was 6.5 mmol/l (117 mg/100 ml). Mean concentrations were lower in the third trimester, but at no stage was control in hospital significantly better than at home. The mean hospital stay before delivery was 22 days, and all patients had live babies. Monitoring blood glucose concentrations at home produces greater understanding and motivation among patients, improves control early in pregnancy, and shortens time spent in hospital.