C-PEPTIDE IN JUVENILE DIABETES

Abstract. C-peptide can be used as a measure of endogenous insulin secretion in insulin treated diabetics with insulin antibodies. At the onset of juvenile diabetes insulin production is thought to be absent or minimal, but we have found rather high levels of C-peptide, even in ketoacidotic patients. The ketoacidosis does not mean an irreversible beta cell failure. In the postinitial remission period with stable metabolism many patients have normal or almost normal C-peptide levels and their beta cells have the capacity to respond to natural stimulation with an increased insulin secretion. For some unknown reason the metabolism becomes more labile coinciding with decreasing C-peptide values. However, even several years beyond the postinitial remission period many juvenile diabetics have some persistent beta cell function, and it has been shown that even trace remnants of beta cell function are of importance for stabilization of the metabolism. There is no reason to believe that the beta cell failure should be predetermined e.g. by genetic factors. However, little is known how to influence the progression and stop the increasing beta cell failure. Some of our results suggest that an early detection and an intensive treatment of diabetes before severe metabolic disturbances and pronounced insulin deficiency have appeared, may increase the possibility of preserving some beta cell function.     

SOCIAL ADAPTATION IN JUVENILE DIABETES

Abstract. Johansson, E., Larsson, Y. and Ludvigsson, J. (Department of Paediatrics, University Hospital, Linköping, Sweden). Social adaptation in juvenile diabetes. A sample of 36 juvenile diabetics, age 19–28 years, and with a duration of diabetes of 14–17 years were interviewed with regard to their social adaptation. Five patients could not be traced and six patients did not want to participate. Educational and professional careers were normal. However, none had received individual diabetes-oriented vocational guidance. A majority of patients was unsatisfied with the information given at the diabetic clinics, and a negative attitude towards society and its institutions was common. Patients often felt that as children they had been neglected by the diabetic team, while their parents received all information. It is concluded that diabetic children and adolescents require continuous socio-psychological support, that psychologists and/or social workers should be permanent members of the diabetic teams, and that paediatricians should follow diabetic patients until they are fully grown up.     

HEREDITARY TYROSINAEMIA AND DIABETES MELLITUS

The main features in hereditary tyrosinaemia are liver damage leading to cirrhosis, and renal tubular defects with hypophosphataemic rickets (4). Pain attacks in the abdomen and legs, similar to those seen in acute intermittent porphyria, and hypertensive crisis, have been reported in this disorder (4). We report here a boy with similar symptoms and signs but who also had diabetes mellitus.     

SELF-CONTROL WITH URINALYSIS IN JUVENILE DIABETES

Abstract. Urinary glucose excretion reflects the blood glucose levels and is therefore recommended and used as a relevant and practical method for self-control in juvenile diabetes. The purpose of this study was to estimate the attitudes of diabetic children and their parents towards such daily urinalysis. In 1975 69 juvenile diabetics 6–18 years old and their parents were studied and three years later another 69 patients were added. Standardized interviews and questionnaires were used. Only 3 out of 138 patients refused to test their urine regularly and to write down their results in the diary. The results indicate that a great majority of the patients and the parents easily accept the self-testing method and regard it as a valuable tool in the management of the disease. Almost nobody experienced the urine tests as a psychological problem.     

ASYMPTOMATIC DIABETES IN CHILDHOOD AND ADOLESCENCE

Abstract. An account is given of the present conception of asymptomatic (chemical) diabetes in the pediatric age group, which also has been named MODY (maturity-onset type of diabetes of young people). Long-term studies show that about 10% will eventually decompensate to overt diabetes. In contrast to classical juvenile-onset type of diabetes the inheritance of MODY seems to be autosomal dominant in many cases. Some authors have suggested that insulin resistance exists in non-obese patients with asymptomatic diabetes, but this view is not supported by observations of the author. Obese patients should reduce their body fat, but other therapeutic approaches are difficult to evaluate because of the normal fluctuation of the disease. There is no general agreement in the literature concerning the value of insulin treatment. The author supports the view that insulin treatment should be started in the late stages of chemical diabetes just before symptomatic disease emerges. In the long run this approach may ameliorate the condition due to the preservation of some beta-cell function for long periods. An unsettled question is whether early insulin treatment in asymptomatic diabetes will delay diabetic vascular complications.     

BLOOD PRESSURE IN CHILDREN WITH DIABETES MELLITUS

ABSTRACT. Blood pressure measurements were evaluated in 151 children aged 2–19 years old with insulin-dependent diabetes mellitus (DM) of a duration of few months to 15 ½ years. Compared with a reference group, the diabetic children had lower diastolic blood pressure (DBP) shortly after start of DM. There was no difference for the systolic blood pressure (SBP). After duration of diabetes of 5 years there were no significant differences in SBP and only significantly lower DBP in girls (median difference 5 mmHg, p <0.01), while the difference in boys is insignificant (median difference 2 mmHg, p =0.32). In a model describing the intraindividual variation in blood pressure and its dependence on age, weight and height it was found that age was insignificant when weight and height were included. For DBP height was also insignificant when weight was included. For the 9 children with retinal microaneurysms the average SBP was significantly higher than expected for diabetic children of that weight and height.     

MANNITOL OSMOLAR CLEARANCE IN DIABETES INSIPIDUS OF CHILDREN

ABSTRACT. A modified technique of mannitol-induced diuresis is described, in order to assess renal concentrating ability in infants and children. The infusion of 10% mannitol in 0.9% saline avoided the hypertonic saline overload and the fluid restriction period, both badly tolerated by infants and small children. In a control group of children aged from two months to seven years, the values of T_H2o plotted against C_osm allowed to calculate the adjustment curve y=0.80x^0.75, r=0.98 (p<0.0001). In six patients with pituitary diabetes insipidus (PDI), the test was used in order to quantify the degree of ADH deficiency and evaluate the carbamazepine and clofibrate effect, in the renal concentrating mechanism. The test was tolerated perfectly in every case, obtaining qualitative and quantitative data and avoiding the hyponatremia and hypokalemia produced by the mannitol.     

SOCIO-PSYCHOLOGICAL FACTORS AND METABOLIC CONTROL IN JUVENILE DIABETES

Abstract. The influence of exogenous and environmental factors on metabolic control was studied in 58 insulin treated juvenile diabetics, 6–17 years of age. Duration of diabetes varied between 3–14 years and age at onset of diabetes between 1–13 years. The social situation as well as knowledge about and attitudes towards diabetes among the patients and their parents were estimated by interviews, questionnaires and special tests. The quality of the diet, exercise and insulin treatment was assessed. An index of diabetic control was calculated on the basis of the patients daily urinalysis made at home. Multiple regression analysis and a special statistical “instrumental” variable technique were used in an effort to analyse the correlations between all variables. The social situation of the diabetic children was comparable with that of other Swedish children, but many parents felt the economic burden of the diabetic treatment as a problem. Knowledge tests showed that 25% of the parents and 62% of the patients above 12 years had unsatisfactory knowledge about diabetes. However, 93% of the patients seemed to have predominantly positive attitudes towards the treatment. Severe psychological problems had occurred in 7 cases. Food habits were appropriate among 21% of the patients and 26% had very regular exercise customs. Physical exercise seemed to be the most important of the exogenous factors for the diabetic control (p<0.001). Among teenagers knowledge was positively correlated to positive attitudes which in turn were positively correlated to physical exercise. Instrumental variable technique gave further indications of a positive influence of knowledge on control, and the correlation between diabetic control on one hand and knowledge combined with positive attitudes on the other was significantly positive. The results emphasize the importance of assisting young diabetic patients and their families in their socio-psychological adaptation to the strains of diabetic therapy.     

DIABETES MELLITUS AND ADDISON'S DISEASE IN AN ADOLESCENT FEMALE

Abstract. Matsaniotis, N., Tzortzatou-Stathopoulou, F., Thomaidis, Th., Karakatsani-Kerasioti, Z., Theodoridis, Ch. and Dacou-Voutetakis, C. (First Department of Paediatrics of Athens University, "Aghia Sophia" Children's Hospital, Athens, Greece). Diabetes mellitus and Addison's disease in an adolescent female. Acta Paediatr Scand, 70: 949, 1981.-This short report describes a 16-year-old female who presented with Addison's disease 6 years after diabetes mellitus had been diagnosed. The possibility of both conditions being present should be borne in mind whenever an unexplained reduction of insulin requirements is noted, especially if this is accompanied by cutaneous pigmentation. The metabolic interrelationships of the two conditions are briefly discussed.     

HYPERTHYROIDISM, DIABETES MELLITUS AND THE CONGENITAL RUBELLA SYNDROME

Abstract. Floret, D., Rosenberg, D., Hage, G. N. and Monnet, P. (Clinique Médicate Infantile B, Hopital E. Herriot, Lyon, France). Hyperthyroidism, diabetes mellitus and congenital rubella syndrome. Acta Paediatr Scand, 69: 259, 1980.—A male patient born to a mother who developed rubella during the tenth week of gestation presented a typical congenital rubella syndrome with mental retardation, neuro-sensory deafness, hypoplasia of the dental enamel and chorioretinitis. Hyperthyroidism occurred at the age of 3 10/12 years and was treated successfully with propylthiouracil for 4 years. The course was complicated by premature craniosynostosis and a craniectomy was performed at the age of 7 years. Overt diabetes mellitus developed at 17 years and was well controlled by insulin therapy. Histocompatibility (HLA) antigens were A2, B8, B40. Diabetes mellitus and thyroid disorders have previously been reported after congenital rubella, and recently after congenital cytomegalovirus infection. Our patient had both endocrinopathies. It is possible that HLA B8 antigens might be responsible for increased susceptibility to rubella infection.     

INFLUENCE OF DIABETES ON METABOLISM OF VASCULAR SMOOTH MUSCLE

Abstract. Glucose utilization and the conversion of glucose to lactate, CO₂, glycogen and lipids are decreased in the aorta from diabetic rats and rabbits. In addition the incorporation of amino acid into protein is reduced in diabetic rat aorta. The metabolic changes produced by diabetes are counteracted by insulin treatment, but there is a time lag of about 2 days before the effect of insulin treatment appears. The membrane transport of glucose in smooth muscle is carried out by a specific transport system of the facilitated diffusion type. A rate limiting influence of membrane transport on glucose metabolism is found in bovine mesenteric arteries and rabbit colon smooth muscle. In these preparations the influence of glucose concentrations on glucose metabolism is most pronounced in the range 0–11.1 mmol exhibiting saturation at higher glucose concentrations. Insulin in a high concentration (0.1 U/ml) has acute (≤3 h) metabolic effects in vitro on smooth muscle which are qualitatively similar to those in skeletal muscle, but are weaker and appear later. The threshold concentration for the acute metabolic effects of insulin on smooth muscle in vitro is 10–100 times above the physiological levels, indicating a low acute sensitivity to insulin.     

PROSTAGLANDIN SYNTHETASE INHIBITORS IN THE TREATMENT OF NEPHROGENIC DIABETES INSIPIDUS

Abstract. Monn, E. (Department of Paediatrics, Rikshospitalet, University of Oslo, Oslo, Norway). Prostaglandin synthetase inhibitors in the treatment of nephrogenic diabetes insipidus. Acta Paediatr Scand, 70:39, 1981.–Two boys with classical ND1 have been treated with prostaglandin synthetase inhibitors. A boy, 7 years old, was treated with low solute-load diet and diuretics from his first year of life. His main complaint was nocturnal enuresis. He responded within one day to indomethacin 25 nig twice daily, and the urine volume was reduced from 4½-6 litre/day to 2½-3 litre/day. There is almost no enuresis. A boy, 7 months old, had a basal daily urine volume of 1.6-1.8 litre. A low solute-load diet and diuretics reduced urine volume to 1 litre, but he still needed gastric tube feeding. With the addition of acetylsalicylic acid, 75 mg three times daily, the urine volume was reduced to 600 ml, and he needed no more tube feeding. Both boys are doing well on the above-mentioned regimens, and no side effects have been observed after 1 year of treatment.     

DIABETES MELLITUS IN A MONGOLOID CHILD WITH CHRONIC DIPHENYLHYDANTOIN THERAPY

ABSTRACT. A 10-year-old epileptic mongoloid child who developed an overt diabetes during chronic treatment with phenytoin in adequate doses is presented. Since mongoloid patients have a genetic predisposition for diabetes and the diabetogenic effect of phenytoin being known, this kind of drug should be used with caution in mongoloid patients.     

PARIETAL CELL ANTIBODIES AND GASTRIC SECRETION IN CHILDREN WITH DIABETES MELLITUS

Abstract. Kokkonen, J. (Department of Paediatrics, University of Oulu, Oulu, Finland). Parietal cell antibodies and gastric secretion in children with diabetes mellitus. Acta Paediatr Scand, 69:485, 1980.—Circulating parietal cell antibodies (PCA) were found in 8 (5.4 %) out of 147 diabetic children screened. Both sexes were equally represented, but the titres were higher in the girls. No clear relationship between the presence of these antibodies and age or the duration of diabetes was observed. Gastric studies were performed on 8 children with PCA (group A) and 41 without PCA (group B). Both basal (BAO) and maximal acid output (MAO) were significantly ( p < 0.05) lower and fasting serum gastrin elevated ( p < 0.01) in group A as compared with the control group. Two patients were achlorhydric. In group B, 17 patients out of the 41 studied had hyposecretion and one achlorhydria. The result became most obvious in the group with a duration of diabetes over 10 years, where MAO was significantly diminished ( p < 0.05). Gastric morphology revealed atrophic gastritis in 3 patients from seven biopsies in group A and one out of five biopsies for severe hyposecre Lion in group B. Two other children in group A had superficial gastritis. Serum ferritin levels decreased along with the duration of diabetes. Those with gastritis mucosa had the lowest values.