B-CELL RESPONSE TO EXERCISE IN DIABETIC AND NON-DIABETIC CHILDREN

Abstract. Heding, L. G. and Ludvigsson, J. (Novo Research Institute, DK-2880 Bagsvaerd, Denmark and the Department of Pediatrics, Linköping University, S-581 85 Linköping, Sweden). B-cell response to exercise in diabetic and non-diabetic children. Acta Pediatr Scand, Suppl. 283: 57, 1980.—20 non-diabetic and 11 insulin dependent diabetic (IDD) children underwent short time (20 min) bicycle ergometer exercise followed by a 10 min rest period. Glucose, IRI, C-peptide and proinsulin were determined prior to and at the end of the exercise, and again after 10 min rest. While no significant change in mean glucose was observed during exercise in the non-diabetics, significant decreases were observed in IRI, C-peptide and proinsulin. After 10 min rest glucose as well as the three B-cell secretory products increased significantly. The change in glucose was Significantly ( p <0.001) correlated to the change in IRI. In the resting period IRI rose more than C-peptide in some subjects. IRI even rose without simultaneous rise in C-peptide indicating a release of tissue bound IRI. The group of IDD children did not show any significant changes in glucose and total IRI, while the endogenous insulin, as measured by C-peptide, did show a fall during exercise. The same was found for proinsulin. The lack of increased endogenous secretion during the rest period was most likely due to suppression of B-cell due to hyperinsulinism and lack of increased glucose concentrations during the rest period.     

PHYSICAL EXERCISE IN RELATION TO DEGREE OF METABOLIC CONTROL IN JUVENILE DIABETICS

Abstract. Ludvigsson, J. (Department of Pediatrics, University Hospital, Linköping, Sweden). Physical exercise in relation to degree of metabolic control in juvenile diabetics. Acta Paediatry Scand, Suppl. 283: 45, 1980.—Physical exercise in considered to be one of the basic principles in the management of diabetes, but the evidence to support the long-term benefit of exercise in insulin dependent diabetes is limited. The aim of this study was to analyse the influence of physical activity on the degree of metabolic control, and different groups of diabetics were studied, the largest including 143 children and adolescents with an age at onset between 1–16 years (mean ± S.D. 7.3±3.9) and duration of diabetes 1–17 years (7.8±4.6). In the first part of the study there was a highly significant correlation (r=0.54, p<0.001) between degree of physical activity based on a weekly history and index of metabolic control (proportion of daily urine tests without glucosuria), when other factors of importance for metabolic control were kept constant. With a statistical technique it was possible to show that the observed correlation had its direction from physical exercise to degree of metabolic control. The positive correlation between degree of exercise and metabolic control could be confirmed in a follow-up during two other years. However, it was also evident that in many single patients the correlation between degree of physical exercise and metabolic control was rather negative. Several explanations are possible. The importance of adequate insulin treatment for a positive effect of exercise is stressed.,     

EFFECT OF METABOLIC CONTROL AND DURATION ON EXERCISE - INDUCED ALBUMINURIA IN DIABETIC TEEN-AGERS

ABSTRACT. Nineteen type I diabetic teen-agers without clinical signs of nephropathy with a duration of diabetes varying from 3 to 16.8 years were examined by a standardized exercise test for analysis of urinary excretion of albumin and β₂-microglobulin. The patients were studied both in poor and improved (but not perfect), metabolic control as defined by HbA₁ and blood glucose profiles, and the values were compared to those of 14 age-matched healthy controls. The controls showed no increase in albumin excretion rate during excercise as was found in diabetic patients. The albumin excretion rate during exercise was significantly correlated ( p <0.05) to systolic blood pressure in the diabetic patients. Blood pressure in the diabetic patients was, however, similar to that of controls both at rest and during exercise. Urinary β₂-microglobulin did not change during exercise. The urinary albumin excretion during exercise decreased significantly with improved metabolic control in diabetic patients, but the albumin excretion rate was not correlated with either blood or urinary glucose or diuresis during the exercise test. When metabolic control was unproved there was a significant correlation between the increase in albumin excretion rate during exercise and the duration of diabetes, indicating that part of the exercise-induced albumin excretion might reflect irreversible morphological changes in the diabetic kidney. This test might therefore have a predictive value for diabetic nephropathy if performed during strict metabolic control.     

CARDIOVASCULAR, HORMONAL AND METABOLIC RESPONSES TO GRADED EXERCISE IN JUVENILE DIABETICS WITH AND WITHOUT AUTONOMIC NEUROPATHY

Abstract. Hilsted, J., Galbo, H. and Christensen, N. J. (Institute of Medical Physiology B, University of Copenhagen, Hvidøre Hospital and Medical Department F, Herlev Hospital, Denmark). Cardiovascular, hormonal and metabolic responses to graded exercise in juvenile diabetics with and without autonomic neuropathy. Acta Paediatr Scand, Suppl. 283: 95, 1980.—Thirteen juvenile diabetics were studied in order to determine if decreased beat-to-beat variation during deep respiration, indicating abnormal autonomic nerve function, imply that cardiovascular, hormonal and metabolic responses are impaired. Patients with decreased beat-to-beat variation had to be more heavily stressed during exercise to reach a certain heart rate or catecholamine level. The relation between other metabolic and hormonal response is discussed.     

ATTITUDES TOWARDS PHYSICAL EXERCISE IN JUVENILE DIABETICS

Abstract. Ludvigsson, J., Larsson, Y. and Svensson, P. G. (Department of Pediatrics, University Hospital, Linköping and Department of Pedagogics, Linköping University, Sweden). Attitudes towards physical exercise in juvenile diabetics. Acta Paed Scand, Suppl. 283: 106, 1980.—Contrary to our recommendations many juvenile diabetics are inactive and rather negative to physical exercise. We have tried to estimate the attitudes towards and motivation for regular physical exercise among juvenile diabetics by interviewing, giving questionnaires to and using a special attitude test. Different groups have been studied, the largest including 138 diabetics aged 1–21 years with age at onset between 1–16 years (7.3±4.0) and duration of diabetes 1–17 years (5.7±3.6). The results are somewhat divergent comparing different patient groups and when using different methods. Generally teenagers seem to be somewhat more negative. According to direct questions in questionnaires or interviews most patients seem to know that physical exercise is important and very few dislike this part of the treatment. However, the special attitude test reveals more mixed feelings. Many patients mean that it is easy to be theoretically positive, but quite another thing to really exercise regularly. Too often physical exercise becomes a medicine instead of a natural pleasant habit. It is important that the hospital staff inform the patients without nagging, and then support and stimulate the patients, and give them adequate responsibility.     

PHYSICAL EXERCISE AND JUVENILE DIABETES—SUMMARY AND CONCLUSIONS

Abstract. Larsson, Y. (Department of Pediatrics, University Hospital, Linköping, Sweden). Physical exercise and juvenile diabetes.—Summary and conclusions. Acta Paediatr Scand, Suppl. 283: 120, 1980.—The various metabolic effects of physical exercise in ketotic diabetics, non-ketotic diabetics and non-diabetics are summarized. A favorable metabolic effect is only observed during optimal insulin administration, while in ketotic diabetics exercise may aggravate the metabolic situation. The use of exercise as a tool in the routine treatment of young diabetics is described. Activity-produced hypoglycemia should be prevented through an adequate food intake and through patient education. Regular exercise may postpone the appearance of diabetic microangiopathy.     

SERUM APOLIPOPROTEINS A-I, A-II AND B IN DIABETIC CHILDREN AND MATCHED HEALTHY CONTROLS

ABSTRACT. Serum concentrations of apolipoprotein (apo) A-I, A-II and B were determined in 28 diabetic children (age 3–16 years) and 14 healthy matched controls. In the healthy children the serum apo A-I concentration was 120 ± 20 arbitrary units (A. U.) (mean ± S. D.), apo A-II 111 ± 14 A. U. and apo B 100 ± 34 A. U. (100 A. U. =mean concentration in adult blood donors). The apo A-I concentration was significantly higher in the diabetic children (134 ± 13; p <0.02) than in the healthy controls. In diabetics apo A-II was 116 ± 14 A. U. and apo B 106 ± 21 A. U., values not significantly different from those in the controls. The serum cholesterol concentration in the healthy children correlated strongly to apo A-I and apo A-II, which was not the case in the diabetics. The differences between diabetic and healthy children with respect to correlations between the apolipoproteins and the serum lipids might indicate a different apolipoprotein/lipoprotein lipid relationship in diabetics.     

FREE FATTY ACID AND KETONE BODY METABOLISM DURING EXERCISE IN DIABETES

Abstract. Wahren, J. and Hagenfeldt, L. (Department of Clinical Physiology, Huddinge Hospital, Stockholm, and Department of Clinical Chemistry, Karolinska Hospital, Stockholm, Sweden). Acta Paediatr Scand, Suppl. 283: 39, 1980.—In diabetic patients the metabolic response to physical exercise is to a large extent determined by the degree of insulin deficiency at the onset of exercise. Thus, in well-controlled insulin-treated patients with mild hyperglycaemia and no or minimal ketonemia the utilization of FFA, blood glucose and glycogen by working muscle is similar to that of healthy subjects, and exercise is accompanied by a fall in blood glucose levels. In contrast, patients in poor metabolic control with marked hyperglycaemia, elevated FFA levels and hyperketonemia may respond to exercise with a further rise in FFA, ketone levels and blood glucose, reflecting augmented rates of adipose tissue lipolysis and hepatic ketogenesis. The accelerated rate of ketogenesis seen during exercise continues unabated in diabetics but not in healthy subjects during the post-exercise recovery period, thereby contributing to the development of post-exercise ketosis. These considerations underscore the importance of adequate insulin administration in connection with exercise in diabetic patients.,     

THE INFLUENCE OF THE METHOD OF DELIVERY AND THE CLAMPING TECHNIQUE ON THE RED CELL VOLUME IN INFANTS OF DIABETIC AND NON-DIABETIC MOTHERS

The red cell volume has been investigated in 35 infants of diabetic mothers and in 18 infants of non-diabetic mothers. It is shown that not only the clamping technique but also, the method of delivery has an influence on the red cell volume of the infant. Thus the red cell volume is less in infants delivered vaginally with early clamping, compared with infants delivered by caesarean section with early clamping. These findings support the theory that during vaginal delivery a temporary change in It is suggested that IDM during vaginal delivery with early clamping deposit more blood in the placenta than do the non-IDM, since we found a smaller red cell volume per kg the distrfbution of. the foeto-placental blood volume between placenta and child occurs.     

MUSCLE SUBSTRATE LEVELS, MUSCLE ENZYME ACTIVITIES AND MUSCLE MORPHOLOGY IN THE VASTUS LATERALIS AND DELTOIDEUS MUSCLES IN NORMAL CHILDREN AND IN CHILDREN WITH COARCTATION OF THE AORTA

ABSTRACT. Muscle biopsies from the deltoideus dx and vastus lat. dx muscles were taken in 17 children with coarctation of the aorta, aged 5.0 to 13.8 years, prior to surgery. Higher concentrations of glycogen, ATP and CP were found in the vastus lat. muscle compared to the deltoideus muscle. The same differences between these two muscles were also found in healthy controls. No differences were found between the patients with coarctation of the aorta and the control group. Nor were any differences found for the other variables studied; glucose, glucose-6-phosphate, lactate, muscle enzyme activities (SDH, LDH and phosphorylase), muscle fibre composition or fibre sizes. It seems reasonable to assume that the differences in muscle substrate levels found between the vasus lat, and the deltoideus muscles in the two groups were due to a higher degree of activity during daily life for the legs as compared to the arms. Patients with coarctation of the aorta do not seem to be influenced by the altered haemodynamic situation with regard to the studied variables.     

GLUCOSE INFUSION IN THE PREGNANT RABBIT AND ITS EFFECT ON GLYCOGEN CONTENT AND ACTIVITY OF FOETAL HEART UNDER ANOXIA1

The object of the present study was to determine the possibility of increasing the glycogen content of the foetal myocardium, and thus its ability to survive under anoxic conditions, by infusing glucose in the mother animal before delivery. The material consisted of 41 rabbits; 23 were given a glucose infusion, and 18 served as controls. On the 29th day of pregnancy, a solution of 30% glucose was infused over a 6-hour period. Immediately after the infusion, the mother was sacrificed, and the foetuses delivered abdominally. They were maintained at 37°C, but without the possibility of lung aeration. The ECG of one foetus in each litter was recorded until no heart activity remained. Concurrently, the other foetuses were sacrificed at irregular intervals, and studied with respect to the glycogen content of heart and liver, blood pH and blood glucose. These parameters were correlated to foetal heart activity. It was found that glucose infusion in the mother did, in fact, increase the glycogen content of the foetal heart. This, in turn, seemed to increase the ability of the foetal heart to continue its activity under anoxic conditions.     

THE EFFECT OF EXERCISE ON DIABETIC CONTROL AND HEMOGLOBIN A1 (HbA1) IN CHILDREN

Abstract. Dahl-Jørgensen, K., Meen, H. D., Hanssen, Kr. F. and Aagem, O. (Department of Paediatrics and Department of Internal Medicine, Aker Hospital and the Norwegian College of Physical Education and Sports, Oslo, Norway). Acta Paediatr Scand, Suppl. 283: 53, 1980.—14 children with juvenile diabetes mellitus (mean age 11 years, mean diabetes duration 5 years) were enrolled in a one-hour twice weekly supervised exercise program for 5 months. A group of 8 diabetic children of same age and diabetic duration served as control group. Maximum oxygen uptake was within normal range for all children. With this exercise program the maximum oxygen uptake of the training group did not change significantly compared with the control group. The physicians rating of degree of the metabolic control based on blood-glucose measurements and urinary glucose excretion did not change in any of the groups. The insulin dosage per kilo body weight remained unchanged in both groups. In the training group the HbA, values decreased during the exercise period from 15.1±2.2 (mean HbA₁%±1 S.D.) to 13.8±1.9 (2 p <0.001). In the control group the HbA₁ values did not change significantly (13.4± 1.9 to 12.9± 1.6; 2 p =0.20). In a co-study the effect of freezing and storage of hemolysates, resulting in increased levels of HbA₁, was demonstrated.     

CONCENTRATIONS OF CSF PROTEINS AS A MEASURE OF BLOOD BRAIN BARRIER FUNCTION AND SYNTHESIS OF IgG WITHIN THE CNS IN 'NORMAL' SUBJECTS FROM THE AGE OF 6 MONTHS TO 30 YEARS

ABSTRACT. Eeg-Olofsson, O., Link, H. and Wigertz, A. (Departments of Neurology and Pediatrics, University Hospital, Linköping, Sweden). Concentrations of CSF proteins as a measure of blood brain barrier function and synthesis of IgG within the CNS in 'normal' subjects from the age of 6 months to 30 years. Acta Paediatr Scand, 70:167, 1981. –Concentrations of proteins in cerebrospinal fluid (CSF) and serum have been studied in 105 'normal' subjects divided into age groups 0.5–5, 6–15, 16–20, and 21–30 years in order to obtain reference values for information concerning blood brain barrier damage and synthesis of immunoglobulins within the central nervous system (CNS). CSF/serum albumin ratio is superior to CSF total protein as a test of the blood brain barrier function. The IgG synthesis rate per 24 hours and IgG index [CSF/serum IgG ratio]: [CSF/serum albumin ratio] reflect the presence of IgG synthesis within the CNS. The variables reflecting the blood brain barrier function increased with age, the upper values of the CSF/serum albumin ratio being 4.0, 4.9, 6.7, and 6.5 for the mentioned age groups respectively. The upper values for the CSF IgG index reamined rather constant in relation to age at 0.62,0.68,0.64, and 0.63 respectively. An index value of less than 0.70 and an IgG synthesis of less than 10 mg/24 hours seem to be appropriate upper values as refereneces. Only about 1–2 ml of CSF and 0.5 ml serum are required for the analyses including cell counting and determinations of IgA and IgM index values as well as of glucose and lactate.     

THE ROLE OF NUTRITIONAL STATUS, AIRWAY OBSTRUCTION, HYPOXIA, AND ABNORMALITIES IN SERUM LIPID COMPOSITION IN LIMITING EXERCISE TOLERANCE IN CHILDREN WITH CYSTIC FIBROSIS

Abstract. Coates, A. L., Boyce, P., Muller, D., Mearns, M. B. and Godfrey, S. (Department of Paediatrics, Hammersmith Hospital, Queen Elizabeth Hospital, and the Institute of Child Health, London, England). The role of nutritional status, airway obstruction, hypoxia, and abnormalities in serum lipid composition in limiting exercise tolerance in children with cystic fibrosis. Acta Paediatr Scand, 69:353, 1980.—Previous work has shown that impaired exercise tolerance in children with cystic fibrosis (C.F.) is related to the severity of airway obstruction without elucidating the possible roles of hypoxia or malnutrition. It has been suggested that poor nutrition leads to abnormalities in serum fatty acids composition, which may lead to tissue hypoxia. We investigated the roles of hypoxia, pulmonary mechanics, nutritional status, and serum fatty acid composition in limiting exercise tolerance in C.F. In 20 children with C.F., exercise tolerance, while breathing air and while breathing oxygen, was evaluated on a cycle ergometer and compared to pulmonary function tests, anthropometric data, serum lipid composition, and clinical condition. The mean percent work expected from height (W_max) was 75, and was unchanged by 0_z. W_max correlated significantly with the degree of respiratory impairment, the discrepancy between height and weight, and the clinical score but not serum fatty acid composition. Where measured, no child at any time had an elevated end tidal CO₂(P_etCO2). We conclude that nutritional status and airway obstruction are closely correlated with exercise tolerance in C.F. and that, unlike the case in adults with chronic obstructive pulmonary disease, exercise-limiting dyspnea occurs in the presence of a normal P_etCO2.     

PERSONALITY CHANGES AND SOCIAL ADJUSTMENT DURING THE FIRST THREE YEARS OF DIABETES IN CHILDREN

ABSTRACT. Ahnsjö, S., Humble, K., Larsson, Y., Settergren-Carlsson, G. (?) and Sterky, G. (Departments of Paediatrics and Child and Youth Psychiatry, the Karolinska Institute, Stockholm, the Department of Paediatrics, University Hospital, Linköpin, and the Department of Psychology, University of Stockholm, Sweden). Personality changes and social adjustment during the first three years of diabetes in children. Acta Paediatr Scand, 70:321, 1981.–Two groups of 64 diabetic and 30 carefully selected and matched non-diabetic control children 4–17 years old were studied with regard to psychological and social adaptation. Four sets of psycho-social methods were used: (a) psychiatric assessment of the mental state, (b) evaluation of the social situation, (c) measurement of the intellectual capacity, and (d) a Rorschach test. A base-line study was done within 5 months after the onset of diabetes and a follow-up 3 years later with the same methods. The mental state was assessed with regard to 18 variables, and the Rorschach test utilized 12 variables. There were no significance differences as to mental state between diabetics and non-diabetics neither at base-line nor at follow-up. Within each group, however, the diabetics showed an increase with regard to symptoms of aggression while the non-diabetics showed a decrease in such symptoms. Diabetics with high or low glucosuria levels did not differ in this respect. When summarizing mental deviations from average in the two groups the diabetics showed more deviations both at base-line and at follow-up, and a tendency towards higher degrees of mental activity, emotional ability and social contact. In the Rorschach test the diabetics showed a higher level of anxiety concerning their own health than the non-diabetics, but there was a decrease in this variable over the 3-year period. However, in an attempt to summarize the degree of mental disturbance, as estimated in the Rorschach test, no significant differences were found between diabetics and non-diabetics. Nor were any significant differences found between the groups with regard to social problems or intellectual capacity. It is concluded that the few abnormal patterns of raction that were observed may well be explained by the traumatic experience of the onset of a serious chronic disorder such as diabetes, and that a relatively strict care given to diabetic children does not seem to disturb their own or their parents' coping ability or psycho-social adjustment. The strictness might even have a supportive effect.