Diabetic foods and the diabetic diet: A British Diabetic Association Discussion Paper

The role of special ‘Diabetic’ foods in the diabetic diet is considered and the following conclusions are drawn.

• 1 Most diabetic foods provide slightly, but not substantially, less energy than comparable non-diabetic products.
• 2 Many diabetic foods have a higher fat content than their non-diabetic equivalents. This is contrary to the requirements of the 1984 Food Labelling Regulations.
• 3 Many diabetic products have a relatively high content of protein.
• 4 In percentage terms, the greatest difference between diabetic and non-diabetic foods remains that of carbohydrate content, particularly carbohydrate other than fructose or sorbitol. On a per portion basis (for instance per teaspoon of jam) the difference is relatively small and likely to be of minimal practical significance.
• 5 Diabetic foods cost between 1.5 and 4 times as much as their non-diabetic equivalents.
• 6 Some ordinary reduced-sugar/low-calorie products are preferable to diabetic products in terms of fat and energy content and cost.
• 7 The promotion and widespread availability of diabetic foods tend to delude patients into believing that these products are advantageous, or even necessary. Their existence also undermines current dietary teaching by implying that diabetics cannot eat normal foods.
• 8 Diabetic foods offer no significant physiological or psychological benefits to diabetic patients and can even be counterproductive to good diabetic control. There is no longer a need for special diabetic foods in the modern dietary management of diabetes.

     

Effect of doxazosin on insulin sensitivity in hypertensive non-insulin dependent diabetic patients

Summary The effect of doxazosin, an a,-adrenoceptor blocking drug, on blood pressure, sensitivity to insulin and serum lipids has been evaluated in 14 hypertensive, non-insulin dependent diabetic patients. The dose was titrated individually upwards from 1 mg until the diastolic blood pressure was below 90 mm Hg, side-effects precluded further dosage increase or the maximum daily dose of 16 mg was achieved.After 12 weeks of treatment (mean doxazosin dose 5.6 ± 5.1 mg daily), the supine and standing diastolic blood pressure of the patients had declined by about 7 mmHg, whereas their systolic blood pressure and heart rate were not significantly changed. The metabolic clearance rate of glucose increased from 2.35 to 3.37 ml - min^–1 - kg^–1 during treatment, suggesting improved sensitivity to insulin. Fasting plasma glucose was 11.9 mmol·1^–1 before and 10.9 mmol·l^–1 after doxazosin therapy (NS). Serum electrolytes and lipids did not change significantly but serum uric acid decreased from 305 to 281 mol · 1^–1 Doxazosin may be a useful alternative for the treatment of hypertension in NIDDM patients.     

Devices for the treatment of diabetes: today

Although single or multiple daily subcutaneous injections of insulin with syringes are the mainstay of insulin delivery techniques for the treatment of diabetes mellitus, several other methods are now available. The present paper will review the main problems occurring with the classical subcutaneous insulin therapy and the possible solutions given by the use of new devices, including more particularly insulin jet injectors, pens, and portable pumps. This review has to be considered as an introduction to the presentations of this symposium devoted to implantable pumps, glucose sensors, and artificial pancreas, respectively.     

Erythrocyte sodium-lithium countertransport is not different in Type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy

Summary We studied erythrocyte sodium-lithium countertransport in 33 patients with Type 1 (insulin-dependent) diabetes mellitus with diabetic nephropathy, 18 patients with Type 1 diabetes without diabetic nephropathy and in 42 nondiabetic patients with various other renal diseases. No significant differences were found in sodium-lithium countertransport between these three groups (median (range) 322 (162–676) vs 321 (189–627) vs 300 (142–655) mol·1 cells^–1·h^–1). We conclude, that sodium-lithium countertransport cannot be used as a marker for diabetic nephropathy.     

Health and unhealth in chronic disease

When health is defined from a holistic view, traditional measures of control in diabetes, such as analysis of blood glucose or HbA1c, are of limited use as indicators of health and unhealth. On the other hand, evaluation of attitudes and certain personality variables might provide guidance both in discovering unhealth and in creating individual self-care programmes for its treatment. In the present study the subjective experience of health and unhealth was studied in a defined population of patients with insulin dependent diabetes mellitus (IDDM). The patients could be divided into three categories: a) those not abandoning important goals because of their diabetes, b) "adapted abandoners" and, c) those abandoning vital aspects of life. On the basis of the findings, the question of how "problem patients" can be identified and treated is discussed.     

Stoffwechseluntersuchungen unter ergometrischer Belastung bei total duodenopankreatektomierten Patienten

Zusammenfassung Ein Jahr nach totaler Duodenopankmatektomie wurde bei 6 Patienten die exokrine Pankreainsuffizienz geprüft. Diese kann durch orale Gabe von wenigstens 10 g Pankreatin kompensiert werden. Gegenüber 7 Normalpersonen und 6 Typ 1-Diabetikern hatten die Duodenopankreatektomierten unter körperlicher Belastung höhere arterielle Spiegel von Lactat und freiem Glycerin als Ausdruck einer gestörten hepatischen Gluconeogenese bei fehlendem pankreatischem Glucagon. Ihre körperliche Leistungsfähigkeit war auffallend schlecht. Catecholamine stiegen unter körperlicher Belastung nur gering an, Wachstumshormone gar nicht. Diese Resultate sprechen gegen die totale Duodenopankreatektomie als Therapie der chronischen Pankreatitis.

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Metabolic investigations under ergometric strain in patients with total duodenopancreatectomy

Summary One year after total duodenopancreatectomy a clinical and laboratory evaluation including exhaustive bicycle ergometry was performed in 6 male patients. The insufficiency of the exocrine pancreas can be compensated by at least 10 g pankreatin per day. During physical exercise patients had higher arterial values of lactate and free glycerol after duodenopancreatectomy than 7 healthy individuals and 6 diabetic patients type 1. This metabolic overreaction was due to a deficiency of pancreatic glucagon and resulted in an impaired hepatic gluconeogenesis. There was no detectable increase in growth hormones and only a small one in catecholamines. The physical condition of patients after duodenopancreatectomy was clearly worse.

Diese Arbeit ist Herrn Prof. Dr. Dr. h.c. Hans Erhard Bock zum Geburtstag gewidmet     

No evidence for linkage between hla and maturity onset type of diabetes in young people

Summary Studies with 20 different genetic marker systems were performed in a large kindred including 18 members affected with maturity onset type of diabetes of young people. Linkage closer than 0.1 could be excluded for ABO and Gm, and linkage closer than 0.05 for HLA GLO, and haptoglobin. No significant positive lod scores were found.     

Behaviour of glibenclamide on repeated administration to diabetic patients

Summary Six maturity onset diabetic patients took glibenclamide 5 mg by mouth, every morning 10 min before a standard breakfast. Serum levels of immunoreactive glibenclamide, glucose and immunoreactive insulin were measured repeatedly on the first and 15th days of treatment. Measured glibenclamide blood levels were in close agreement with an analogue computer simulation of data obtained from healthy volunteers: there was no accumulation of drug in the blood, but there was strong evidence for the existence of a slowly equilibrating deep compartment. Considerable insulin release and correction of the breakfast-induced hyperglycaemia were observed immediately after administration of the drug, as well as 5 h later, at lunch time. The clinical significance of blood levels of glibenclamide, as well as the correlation of pharmacokinetics with pharmacodynamics, are discussed in the light of these results.Glossary of symbols IR- immuno-reactive - GLI glibenclamide - IRI immuno-reactive insulin - GLU glucose - AK 1 values obtained with patient AK on the first day of treatment - AK 15 values obtained with patient AK on the 15th day of treatment - b serum level - b_max maximal serum level - t time after dose - t_max time of maximal serum level - G gastro-intestinal system - B central compartment (blood) - T peripheral compartment (tissue) - E excreta - M,N coefficients of the equation of a bi-exponential decay curve - µ, v exponents of the equation of a bi-exponential decay curve - e base of natural logarithms - K_BG K_EB K_TB K_BT first order rate constants (e. g. K_BG means: into B, from G) - K_BG first order rate constants - etc. not corrected for the volume of distribution     

Differential regulation of neuropeptide Y mRNA expression in the arcuate nucleus and locus coeruleus by stress and antidepressants

In rats, circulating corticosterone and insulin are involved in regulation of the hypothalamic neuropeptide Y (NPY) system, which in turn, is involved in regulation of the hypothalamic-pituitary-adrenal (HPA) axis. Since the HPA axis and stress responsivity is altered in diseases such as depression, we investigated interactions between the effects of stress and antidepressant drug treatment on arcuate nucleus and locus coeruleus NPY mRNA expressions using in-situ hybridization histochemistry. After acute (2 h) and repeated immobilization (2 h daily, for 14 days), plasma concentrations of corticosterone increased, and those of insulin decreased. The expression of NPY mRNA was significantly increased in the arcuate nucleus, but was unchanged in the locus coeruleus following acute and repeated immobilization. Adrenalectomized rats with systemic corticosterone replacement (ADX+CORT), whose corticosterone concentration was maintained at approximately 50-100 ng/ml during repeated stress, showed a decrease in plasma insulin and an increase in arcuate nucleus NPY mRNA similar to that observed in sham rats, suggesting that changes in NPY mRNA levels are more closely tied to circulating insulin than to circulating corticosterone. In contrast, locus coeruleus NPY mRNA expressions in ADX+CORT rats were significantly higher than those in sham rats after repeated stress. Desmethylimipramine (DMI) treatment for 24 days did not affect basal plasma concentrations of corticosterone or insulin, or arcuate nucleus NPY mRNA expressions, but significantly decreased basal levels of locus coeruleus NPY mRNA compared to saline-treated rats. After repeated immobilization (2 h daily, for 4 days), DMI significantly reduced the stress-induced rise in locus coeruleus NPY mRNA levels, but potentiated the stress-induced rise in arcuate nucleus NPY mRNA expression. These results demonstrate that: (1) the increase in arcuate nucleus NPY mRNA expressions in stressed rats closely follows the decrease in plasma concentrations of insulin; (2) increases in NPY mRNA expressions occur in the absence of changes in plasma corticosterone; and (3) desipramine treatment potentiated the effect of stress on arcuate nucleus NPY mRNA expressions, but blocked the repeated stress-induced increase in locus coeruleus NPY mRNA expressions. Thus, NPY mRNA expression in the arcuate nucleus and the locus coeruleus is sensitive to the effects of stress and to the antidepressant drug desipramine, but the arcuate nucleus NPY system is regulated by different mechanisms than the locus coeruleus NPY system. The results provide further evidence for the importance of circulating insulin in the regulation of the arcuate nucleus NPY system.     

30例糖尿病合并冠心病患者的心率变异性分析

目的：研究2型糖尿病（DM）合并冠心病（CHD）与单纯2型DM对心率变异性（HRV）的影响，方法：对66例2型DM患者，其中30例合并CHD，36例为单纯2型DM，进行24h HEV时域及频域分析，同时与年龄，性别相当的20例健康成年人HRV资料比较。结果：（1）2型DM患者各时域及频域分析指标均较正常组降低（P＜0．05或P＜0．01），但VLF和LF／HF增高（P＜0．05或P＜0．01），（2）与单纯2型DM患者比较，有CHD合并症的2型DM患者，HRV各参数也明显降低（P＜0．05，P＜0．01），但VLF和LF／HF增高（P＜0．05），结论：2型DM患者存在着HRV异常，其异常程度与病变轻重成正比，合并CHD者异常更显著，提示2型DM患者的HRV分析有助于预测恶性心血管疾病的发生。