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.     

Role of residual insulin secretion in protecting against ketoacidosis in insulin-dependent diabetes.

The role of preserved beta-cell function in preventing ketoacidosis in type I insulin-dependent diabetes was assessed in eight patients with and seven patients without residual beta-cell function as determined from C-peptide concentrations. After 12 hours of insulin fatty-acid, and glycerol concentrations were all significantly higher in patients without beta-cell function than in those with residual secretion. Mean blood glucose concentrations reached 17.2 +/- SE of mean 1.3 mmol/l (310 +/- 23 mg/100 ml) in the first group compared with 8.8 +/- 1.4 mmol/l (159 +/- 25 mg/100 ml) in the second (P less than 0.01), while 3-hydroxybutyrate concentrations rose to 5.5 +/- mmol/l (57 +/- 5 mg/100 ml) and 1.4 +/- 0.3 mmol/l (15 +/- 3 mg/100 ml) in the two groups respectively (P less than 0.01). Individual mean C-peptide concentrations showed a significant inverse correlation with the final blood glucose values (r = -0.91; P less than 0.02). These findings strongly suggest that even minimal residual insulin secretion is important for metabolic wellbeing in diabetes and may prevent the development of severe ketoacidosis when insulin delivery is inadequate.     

High-carbohydrate diets and insulin-dependent diabetics.

A high-carbohydrate-(HC)-modified fat diet was compared with a standard low-carbohydrate (LC) diabetic diet in 11 insulin-dependent diabetics. Basal and preprandial plasma glucose concentrations were appreciably lower when the patients received the HC diet derived chiefly from readily available cereal and vegetable sources (mean (+/- SE of mean) basal concentrations 6.7 +/- 1.2 mmol/l (121 +/- 22 mg/100 ml) with the LC diet and 4.3 +/- 0.7 mmol/l (77 +/- 13 mg/100 ml) with the HC diet; mean preprandial concentrations 11.1 +/- 1.2 mmol/l (200 +/- 22 mg/100 ml) LC diet and 8.9 +/- 1.3 mmol/l (160 +/- 23 mg/100 ml) HC diet). total and low-density lipoprotein cholesterol concentrations were lower when patients took the HC diet (mean 4.4 +/- 0.2 and 2.4 +/- 0.2 mmol/l (189 +/- 8 and 124 +/- 8 mg/100 ml) respectively), and the ratio of high-density lipoprotein cholesterol to total cholesterol tended to rise. The average percentage of glycosylated haemoglobin did not differ between the two diets. Thus several measures of carbohydrate and lipid metabolism appear to be more satisfactory when patients receive a HC diet, which is an acceptable alternative to that still recommended to most insulin-requiring patients.     

Serum fructosamine in patients with diabetes mellitus

Serum fructosamine was compared with other measures of blood glucose control in 11 non-diabetic volunteers, 14 type 1 and 14 type 2 diabetic patients. Estimates of mean plasma glucose concentrations for the 28 diabetic patients were made by nine physicians, based on their interpretation of historical data, home capillary blood glucose profiles, fasting and random plasma glucose and plasma lipid levels. Significant differences between estimated and measured mean glucose levels were apparent with a tendency for physicians to underestimate mean blood glucose in the hyperglycaemic range (glucose greater than 11 mmol/l). Fructosamine results on the same patients correlated linearly both with mean plasma glucose concentrations (r = 0.86, p less than 0.001) and with glycosylated haemoglobin (HbA1c) levels (r = 0.93, p less than 0.001) and correctly classified diabetes control in most patients. Despite marked fluctuations of plasma glucose concentration, serum fructosamine levels measured at different times of the day did not alter significantly. We conclude that a random serum sample analysed for fructosamine provides a simple and reliable means to measure the efficacy of therapy and often provides information superior to clinical assessment of diabetic control.     

Hypothermia: a complication of diabetic ketoacidosis.

During 1969-77, 20 episodes of severe hypothermia occurred in 19 diabetic patients in Nottingham. Thirteen were associated with ketotic hyperosmolar coma, two with lactic acidosis, and one with hypoglycaemia, while in four there was no loss of diabetic control. Ketoacidosis accounted for 11.8% of all admissions for severe accidental hypothermia and was a commoner cause than hypothyroidism (8%). Patients with ketoacidosis were younger and developed hypothermia as often during the summer as during the winter. The metabolic disturbance was characteristic, with severe acidosis (mean pH 7.04), a high blood glucose concentration (mean 56.6 mmol/l; 1020 mg/100 ml), and high plasma osmolality (mean 379.7 mmol (mosmol)/kg). Eight of the 13 episodes proved fatal. Hypothermia may aggravate ketoacidosis and complicate treatment and should be sought in all patients with severe diabetic coma.     

Beta-adrenoceptor-blocking drugs and blood sugar control in diabetes mellitus.

The effects on diabetic control of the relative cardioselective beta-blocker metoprolol and the non-selective drug propranolol were compared in 20 hypertensive diabetic patients receiving diet alone or diet and oral hypoglycaemic agents. Each drug was given for one month in a double-blind, cross-over study. Fasting, noon, and mid-afternoon blood sugar concentrations rose by 1.0-1.5 mmol/l (18-27 mg/100 ml). The rise with propranolol was not significantly greater than with metoprolol. In a few patients the rise was clinically important. The small overall change observed in diabetic control should not deter the use of beta-blockers in non-insulin-dependent diabetics, provided control is carefully monitored at the onset of treatment.     

针灸联合耳穴贴压治疗2型糖尿病性腹泻的护理

目的探讨针灸联合耳穴贴压治疗2型糖尿病性腹泻的护理要点,以进一步提高本院治疗2型糖尿病的临床效果,提高患者康复率。方法对2010年7月～2012年3月在本院接受针灸联合耳穴贴压治疗的30例2型糖尿病性腹泻患者提供全面的护理服务。结果治疗后平均空腹血糖和平均口服糖耐量试验2h后的血糖分别为（7．1±1．2）mmol／L、（8．3±1．9）mmol／L,均明显低于治疗前的血糖值。20例治疗具有显著疗效,8例治疗有效果．治疗总有效率为93．3％．所有患者均未出现不良反应。结论针灸联合耳穴贴压治疗法应用于2型糖尿病腹泻治疗中的临床效果显著,以有效地提高临床治疗成功率、患者康复率及满意度,改善患者的生活质量,值得临床推广。     

Insulin clearance from plasma in type I (insulin-dependent) diabetic patients: influence of glycaemic level

The influence of the actual glycaemic level on the kinetics of insulin disappearance from plasma was studied in 16 type I diabetic patients. Constant intravenous infusion of insulin (1-5 mU.kg-1.min.-1) was used to achieve different levels of steady state plasma free insulin concentrations, while the blood glucose level was clamped at normoglycaemia, 4.1 +/- 0.1 mmol/l (mean +/- S.E.M.), and mild hyperglycaemia, 8.2 +/- 0.1 mmol/l. The experimentally determined data were compared using a previously validated model of first order kinetics for insulin disappearance from plasma in diabetic patients. At the physiological insulin concentration range the median clearance rate of insulin was 23 ml.kg-1.min-1 (range 16-26) at normoglycaemia and 23 ml.kg-1.min-1 (19-35) at hyperglycaemia (P = 0.45). At supraphysiological levels, insulin was cleared at a lower rate at normoglycaemia than at hyperglycaemia. No correlation was observed between the insulin clearance rate and the duration of diabetes or the haemoglobin A1C level (both Spearman's rho = 0.08). In conclusion, the insulin clearance rate from plasma is independent of the actual glycaemic level and hardly influenced by the long-term glycaemic level in type I diabetic patients.     

Acebutolol, atenolol, and propranolol and metabolic responses to acute hypoglycaemia in diabetics.

In a double-blind crossover study the symptomatic and metabolic effects of propranolol, acebutolol, and atenolol were studied during insulin-induced hypoglycaemia in diabetics treated with diet or hypoglycaemic tablets. All the drugs prevented tachycardia, but did not affect the other symptoms of hypoglycaemia. Propranolol delayed the recovery of the blood glucose concentration and impaired the secondary rise in the concentrations of blood lactate and non-esterified fatty acids in diet-treated diabetics. Acebutolol potentiated the hypoglycaemic effect of insulin in tablet-treated diabetics (mean difference of blood glucose concentration 0.7 mmol/l (12.6 mg/100 ml)) and this difference was maintained during the recovery phase4 the blood lactate response was also impaired. Atenolol did not differ perceptibly from placebo in its effect on the metabolic responses to acute hypoglycaemia. The results may be explained by differences in the known pharmacological actions of these drugs. They support the hypothesis that beta-adrenoreceptor blocking drugs that are highly beta1 specific and without membrane-stabilising activity should be safer than the non-selective drugs when used in diabetic patients at risk from hypoglycaemia.     

Fructosamine in a diabetic clinic

Serum fructosamine concentrations were measured in 660 adults attending the diabetic clinic at Auckland Hospital over a 12 month period. Only 44 (6.6%) patients had results within the physiological range whereas 237 (35.9%) patients had values greater than 3.7 mmol/l consistent with poor blood glucose control. Moreover, patients with elevated frustosamine values had a much higher frequency of retinopathy than the normal fructosamine group. When frustosamine values were compared with physician's assessment of control and with random glucose results, we found weak correlations suggesting that poor control in many patients was not previously recognised. We conclude that fructosamine measurement in a diabetic clinic provides important clinical information complementing traditional assessments of metabolic control.     

The effect of urapidil and ramipril on hyperglycemia in streptozotocin diabetic rats

Angiotensin-converting enzyme inhibitors and alpha1-adrenoceptor antagonists improve glucose disposal in diabetes mellitus. We compared the effect of the antihypertensive hybrid drug urapidil [alpha1-adrenoceptor antagonist serotonin 1A (5-hydroxytryptamine 1A, 5-HT1A) receptor agonist] on hyperglycemia in streptozotocin diabetic rats with the angiotensin-converting enzyme inhibitor ramipril. 5-HT1A receptor agonists induce hyperglycemia. This could be an important disadvantage during treatment of diabetes mellitus with urapidil. Diabetes was induced by streptozotocin (70 mg/kg i.p.). Treatment for 7 days (ramipril 10 mg/kg p.o.; urapidil 20 mg/kg p.o.) significantly decreased mean blood glucose values (urapidil: 15.7+/-0.9 mmol/l, P=0.007; ramipril: 15.0+/-0.8 mmol/l, P=0.038 vs. diabetic control group: 18.7+/-1.0 mmol/l). Both drugs reduced significantly blood pressure, urinary glucose, water consumption, and food requirement. Serotonin concentration in the brain (medulla oblongata, pituitary) was not affected. A normalization comparable with healthy control rats was observed only in a diabetic control group with insulin therapy. In conclusion, our results demonstrate that the antihypertensive drug urapidil has no detrimental effect on hyperglycemia compared with the angiotensin-converting enzyme inhibitor ramipril in experimental diabetes mellitus despite its 5-HT1A receptor agonistic properties.     

应用碘造影剂前后停用二甲双胍对糖尿病患者血糖水平的影响

目的探讨使用碘造影剂前后停用二甲双胍对糖尿病患者血糖水平的影响。方法研究对象选自2012年1月1日至12月31日在北京大学第一医院住院的糖尿病患者,入选标准为使用含二甲双胍方案治疗后血糖水平基本达标并维持平稳、应用碘造影剂前后48h内停用二甲双胍且有停药前后空腹、早餐后2h、午餐后2h、晚餐后2h和睡前血糖水平监测记录。停用二甲双胍期间调整降糖治疗方案者纳入调整组,未调整治疗方案者纳入未调整组。收集2组患者的病历资料进行回顾性分析。结果共收集到符合入选标准的患者80例,其中未调整组62例（87．5％）,调整组18例（22．5％）。二甲双胍停药时间为2—4d。未调整组停药后空腹、早餐后2h、午餐后2h、晚餐后2h和睡前血糖水平与停药前比较,均有不同程度的升高[（7．7±1．4）mmol／L比（7．0±1．2）mmol／L,（9．5±1．7）rnmol／L比（9．0±1．8）mmol／L,（10．9±2．3）mmol／L比（8．6±1．9）mmol,／L,（9．9±1．7）mmol／L比（8．6±1．7）mmol／L,（9．1±1．9）mmol／L比（8．5±1．6）mmo]／L],其中空腹、午餐后2h和晚餐后2h血糖水平与停药前比较差异有统计学意义（P=0．01,P=0．00,P=0．00）;调整组停用二甲双胍前后5个时间点血糖水平差异均无统计学意义[（7．9±1．2）mmol．／L比（8．1±1．8）mmol／L,（8．0±2．2）mmol／L比（8．5±2．4）mmo]／L,（9．2±2．9）mmol／L比（10．3±1．9）mmoL／L,（9．4±2．1）mmol／L比（9．1±2．4）mmol／L,（10．0±2．3）mmol／L比（9．3±2．2）mmol／L,均P〉0．05]。结论使用碘造影剂前后停用二甲双胍可导致停药期间未调整降糖治疗方案的糖尿病患者血糖水平出现有统计学意义的升高,调整降糖治疗方案有利于患者血糖水平控制更平稳。     

降糖保肾方对早期糖尿病肾病患者氧化应激的影响

目的：研究降糖保肾方对早期糖尿病肾病氧化应激的影响,探讨降糖保肾方治疗早期糖尿病肾病的作用机制。方法：将符合纳入标准的72例患者,随机分为西药组（X组）,中药组（Z组）。分别予厄贝沙坦150mg/次,1次/d,口服;降糖保肾方（免煎剂）每日2剂,口服;维持治疗8周,观察治疗前后血糖、蛋白尿、血清超氧化物岐化酶（SOD）、过氧化氢酶（CAT）、丙二醛（MDA）变化。结果：治疗8周后,降糖保肾方组空腹血糖显著下降至（8.4±1.0）mmol/L、餐后2h血糖显著下降至（12.1±1.4）mmol/L、HbA1c显著下降至（8.0±0.3）%（P〈0.05）;24h尿蛋白显著下降至（185.6±17.7）mg,24h尿微量清蛋白排泄率显著下降至（54.2±7.9）μg/min（P〈0.05）;SOD显著升高至（80.0±8.7）nU/ml、CAT显著升高至（26.4±2.4）nU/ml,MDA显著下降至（5.1±0.4）nmol/ml（P〈0.05）。结论：降糖保肾方具有抗氧化作用,可能通过抑制氧化应激发挥保护糖尿病肾病的作用。     

格列吡嗪控释片对2型糖尿病患者血糖控制的临床效果

目的探讨格列吡嗪控释片对2型糖尿病患者血糖控制的临床意义。方法参照WHO诊断标准,选择2011年1月至2013年1月在我院诊治的2型糖尿病患者1 042例。在早餐前立即服用格列吡嗪控释片(5 mg/片,瑞易宁),服药12周。在服用前后,测定患者的肝、肾功、血压、2hPG、FPG、HbA1c、C肽、胰岛素水平、ISI。根据血糖测定的结果调整服用药物的剂量,每2周1次;若FPG>7.0 mmol/L,增加服药剂量,增加5 mg/次,最大剂量为10 mg/d。结果给药后,患者的FPG、2hPG、HbA1c、C肽与胰岛素均降低,ISI显著升高,与治疗前比较差异有统计学意义(P<0.05)。结论格列吡嗪控释片对2型糖尿病患者血糖控制疗效显著,具有重要的临床价值。     

Pregnancy in patients presenting with hyperprolactinaemia

Ninety-two pregnancies occurred in 76 hyperprolactinaemic patients treated with bromocriptine. Half conceived within three months of attempted conception. There was no evidence of an increased rate of spontaneous abortion, fetal abnormality, or multiple pregnancy; the three twin pregnancies occurred in women who were additionally treated with clomiphene and human chorionic gonadotrophin. Thirty-one patients had radiological evidence of a pituitary tumour; 14 with major radiograph changes in the pituitary fossa or serum prolactin concentrations greater than 100 ng/ml received pituitary irradiation before conception. None of the latter showed evidence of enlargement of the tumour during pregnancy. In contrast two of the four patients with similar tumours but who were not irradiated developed visual field defects, one with gross destruction of the pituitary fossa. Prophylactic treatment to limit subsequent tumour expansion during pregnancy in patients with prolactinomas is indicated, and pituitary irradiation before conception appears to be a safe and effective method to achieve this goal.     

Serum fructosamine: a parameter for monitoring metabolic control in diabetes.

The aim of this study was to determine serum fructosamine in a non-diabetic population and to evaluate the usefulness of fructosamine in the routine management of diabetic patients. The range of serum fructosamine in the non-diabetic population was 2.00-3.08 mmol/l (n = 300, mean 2.54 +/- 0.27). The mean level of fructosamine in the diabetic patients was 5.4 +/- 1.1 mmol/l at the beginning of the study and 3.5 +/- 0.4 mmol on the 12th week visit of the study. Significant differences in serum fructosamine levels were observed during the first visit and the 12th week visit p < 0.002. Serum fructosamine concentrations were significantly correlated with glycosylated haemoglobin at each subsequent visit (p < 0.001). No significant correlation between plasma glucose and fructosamine was found, suggesting the two parameters are markets for different time metabolic control. Routine use of serum fructosamine in management of diabetes is recommend.     

血糖仪与生化分析仪测定血糖的比对分析

目的:探讨血糖仪与生化分析仪测定血糖的比对情况,为合理选择血糖检测方法提供参考。方法:选择2009年2月～2012年8月在我院门诊住院患者糖尿病人员共120例,上肢肘静脉和手指末端分别采血进行生化分析仪与血糖仪检测。结果:经过检测,生化分析仪检测的血糖值为(6.30±0.22)mmol/L,血糖仪检测的血糖值为(6.25±1.89)mmol/L,两种方法检测值对比无明显差异(P>0.05)。但是血糖仪检测的重复性不强,导致s值比较大。结论:血糖仪在糖尿病患者的血糖监测中有很大的局限性,在临床中要将血糖仪的监测和医院血糖检测结合使用,才能达到良好的血糖控制目的。     

胰岛素泵在2型糖尿病强化治疗中应用观察

目的 探讨采用胰岛素泵持凶⑸湟鹊核厍炕瘟贫?型糖尿病患者胰岛β细胞功能、血糖控制的影响.方法 63例空腹血糖≥12mmol/L的2型糖尿病患者,不合用其他口服降糖药,给予胰岛素泵强化治疗,观察达到目标血糖(FPG≤7mmol/L,CBG≤10mmol/L)天数以及胰岛素的基础量和餐前追加量,分析比较其治疗前后FPG、CBG、HbAlc、FINS/FPG、ISI、Homa-B和Homa-IR等.结果 达目标血糖的平均天数为(5.4±1.6)d,所用胰岛素量为(0.6±0.2)U/kg,其中基础率占38%,在血糖控制后,胰岛素用量显著减少.发生低血糖反应(0.6±0.2)次.与治疗前相比,胰岛素泵强化治疗后FPG[(16.0±3.2)mmol/L,(6.5±0.8)mmol/L]、CBG[(18.0±2.0)mmol/L,(7.5±1.3)mmol/L]、HbAlc[(11.6±1.8)%,(8.6±1.2)%]、HOMA-IR[(0.3±0.1),(0.3±0.2)]均明显下降(均P<0.01);FINS/FPG[(1.2±0.5),(1.5±0.6)]、HOMA-B[(0.8±0.2),(1.7±0.2)]、ISI[(3.4±0.5),(3.9±0.3)]均明显升高(均P<0.01).结论 对伴明显高血糖的2型糖尿病患者,短期胰岛素泵持续注射胰岛素强化治疗具有快速控制血糖和显著改善患者胰岛β细胞功能的作用.     

The Levels of Serum Growth Hormone and Immunoreactive Insulin after Administration of Antipyretic Analgetics

Abstract: The effects of indomethacin (100 mg) and phenylbutazone (250 mg) suppositories and acetylsalicylic acid (1000 mg) as well as placebo tablets on serum growth hormone, serum immunoreactive insulin and blood glucose concentrations were studied in young male volunteers after an overnight fast. Peak drug concentration in serum was reached 60, 120, and 180 minutes after indomethacin (2.1 ± 0.3 μg/ml), acetylsalicylic acid (88.0 ± 13.4 μg/ml) and phenylbutazone (30.8 ± 2.2 μg/ml), respectively. Blood glucose rose from 4.2 ± 0.1 mmol/l to 5.0 ± 0.1 mmol/l (P < 0.001) (n = 21) at 120 minutes after indomethacin and the rise was significant throughout the study. No significant changes in blood glucose were seen after the administration of the other drugs. The levels of serum growth hormone were also significantly increased after indomethacin throughout the study, but not after the other drugs. The mean of the peak serum growth hormone concentration of the subjects (11.7 ± 1.2 ng/ml) (n = 19) was significantly higher after indomethacin than after the other drugs, which did not not differ from each other significantly. There were no significant changes in serum immunoreactive insulin levels after the drugs. However, after acetylsalicylic acid the levels tended to increase and the serum immunoreactive insulin remained significantly higher at 30, 60, and 120 minutes after acetylsalicylic acid (18.5 ± 1.6, 19.1 ± 3.4, and 20.2 ± 3.2 μU/ml) (n = 13) than after placebo (11.2 ± 2.2, 10.1 ± 2.0, and 10.6 ± 1.5 μU/ml) (n = 13) (P < 0.05).     

Long-term effects of pinacidil in hypertensive dialysis patients

Summary In an open study, thirteen chronic dialysis patients with nonvolume dependent uncontrolled hypertension were treated with pinacidil for a mean period of 43 weeks. Seven patients were taking concomitant antihypertensive therapy. Twelve patients achieved long-term blood pressure control on a mean dose of 33 mg/day. The baseline supine blood pressure was 184/116 mmHg. After 1 week it had fallen to 161/95 mmHg and blood pressure control was maintained over the study period.Patient weight remained stable. The baseline reading was 61.6 kg and at the end of the study it was 59.7 kg. Pulse rate did not change significantly. For the eight patients not taking beta-blockers the mean change in pulse rate was 7.6 beats/min supine and 6.3 beats/min erect (NS). Pretrial urea and creatinine were 27.6 mmol/l and 1027 µmol/l and after 25 weeks they were 29.6 mmol/l and 1087 µmol/l, respectively (NS). Four patients had ECG evidence of left ventricular hypertrophy before the study and one on completion of the trial. Five patients showed correction of T-waves on their ECG's. Six patients experienced side effects, none of which warranted withdrawal of treatment. These findings suggest that pinacidil is a valuable alternative treatment for hypertensive dialysis patients.