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  • 1
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Psychiatry Research 15 (1985), S. 351-360 
    ISSN: 0165-1781
    Keywords: Depression ; dexamethasone pharmacokinetics ; dexamethasone suppression test ; weight loss
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0428
    Keywords: Hyperinsulinaemia ; insulin resistance ; insulin degradation ; haemochromatosis ; cirrhosis ; insulin ; glucagon ; C-peptide ; gastric inhibitory polypeptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study investigated early alterations of glucose metabolism in idiopathic haemochromatosis. Circulating concentrations of glucose, insulin, C-peptide, glucagon, and gastric inhibitory polypeptide (GIF) were measured after a 100-g oral glucose load in 10 men with idiopathic haemochromatosis in the non-cirrhotic stage of the disease. All had normal glucose tolerance and normal body weight. Ten matched healthy subjects were studied as controls. Insulin concentrations increased to significantly higher levels in patients with idiopathic haemochromatosis than in the control subjects from 30 to 180min after the glucose load (p〈0.01), while fasting insulin concentrations were not significantly different (p〉 0.05). Concentrations of glucose, glucagon, C-peptide, and GIF were not significantly different at any time (p〉 0.05). Thus, patients with idiopathic haemochromatosis show hyperinsulinaemia and hence insulin resistance without impaired glucose tolerance in the non-cirrhotic stage. Since pancreatic insulin secretion (C-peptide), glucagon secretion, and the entero-insulinar axis (GIP) are not impaired in these non-cirrhotic patients with idiopathic haemochromatosis, iron accumulation in the hepatocytes may be responsible for the impaired insulin effect and may cause impaired hepatic insulin extraction.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0428
    Keywords: Juvenile type diabetes ; muscular exercise ; blood glucose ; ketosis ; free fatty acids ; amino acids ; insulin ; glucagon ; growth hormone ; cortisol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Metabolic and hormonal effects of muscular exercise were studied in juvenile-type diabetics in relation to the prevailing degree of metabolic control and compared with those in healthy control subjects. Two groups of diabetic patients, one in moderate metabolic control and one in ketosis due to insulin withdrawal, were subjected to a 3 hour bicycle ergometer test of comparable, mild work intensity. In both groups of diabetics the exercise-induced rise in blood lactate was similar, but was significantly higher than in control subjects. Blood alanine levels showed a transient, significant rise in both diabetic groups, but not in controls. Blood concentrations of branch-chained amino acids remained unchanged. In the moderately controlled diabetics, exercise induced a marked fall of blood glucose and increases in blood levels of free fatty acids (FFA), ketone bodies and glucagon, which were comparable to the exercise effects in normal controls. In ketotic diabetics, however, exercise led to an additional rise in blood glucose concentration and to increases in ketone body, glucagon and cortisol levels. Significant correlations were found between the exercise effect on blood glucose and initial blood levels of glucose, FFA, ketone bodies and branch chained amino acids: pre-exercise values of above 325 mg/dl glucose, 1173 μmol/l FFA, 2.13 mmol/l ketone bodies and 0.74 mmol/l branch chained amino acids led to increased blood glucose levels on exercise, whereas below these limits glucose fell during the exercise test. These findings seem to be, at least in part, explained by the hypothesis of a permissive effect of insulin during stimulation of muscle glucose uptake by exercise. The increased circulating levels of glucagon and cortisol during exercise in ketotic diabetics might represent additional hyperglycaemic and, probably more important, lipolytic and ketogenic stimuli. The results suggest that in moderately controlled, non-ketotic diabetics blood glucose falls during exercise; in ketotic, relatively insulin deficient patients, muscular activity has adverse metabolic and hormonal effects: a further increase in blood glucose, plasma glucagon and cortisol and a rapid aggravation of ketosis.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0428
    Keywords: Diabetes education ; Type 1 diabetes ; severe hypoglycaemia ; diabetes care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In two hospitals an identical diabetes teaching and treatment programme (in-patient, Monday to Friday, group teaching) was set up. Seventy-eight consecutive, conventionally treated Type 1 diabetic patients (duration of diabetes 10±6 years), referred during a certain period, were reinvestigated after 1 year, and again (for assessment of metabolic control only) 22 months after the teaching and treatment programme. Initially, mean glycosylated haemoglobin was 2.6%, after one year 1.0%, and after 22 months 1.5% above the upper limit of the normal range (p〈0.001). Hospital admissions were reduced from a mean of 10 to a median of 1 day per patient per year (p〈0.001). The long-term quality of diabetes care achieved by the diabetes teaching and treatment programme was unrelated to intelligence quotient, diabetes duration, or diabetes-related knowledge. Patients with normal levels of glycosylated haemoglobin on follow-up (33% of all patients) had particularly good compliance rates, and significantly lower initial values of glycosylated haemoglobin than patients with glycosylated haemoglobin levels ⩾10%. The data indicate that the diabetes teaching and treatment programme resulted in a substantial long-term improvement of metabolic control and a striking reduction of hospital admissions. The study substantiates the feasibility of applying this teaching and treatment programme on a large scale to other hospitals, so as to improve the quality of diabetes care and decrease health care costs.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; insulin therapy ; severe hypoglycaemia ; ketoacidosis ; patient education
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It has been questioned whether aiming at near-normoglycaemia by intensified insulin treatment regimens is feasible and safe for the majority of patients with insulin-dependent diabetes. In this study, intensified insulin injection therapy (including blood glucose self-monitoring and multiple insulin injections) based upon a 5-day inpatient group teaching programme was evaluated in Type 1 (insulin-dependent) diabetes mellitus in the centralised health care system of Bucharest. One hundred patients (group A, initial HbA1 12.5%) were followed for 1 year on their standard therapy (individual teaching, no metabolic self-monitoring), and thereafter for 1 year on intensified therapy. Another 100 patients (group B, HbA1 12.3%) were followed for 2 years on intensified therapy. A third 100 patients (group C, HbA1 11.7%) were assigned to a basic 4-day inpatient group teaching programme with conventional insulin therapy (including self-monitoring of glucosuria and acetonuria) and followed for 1 year. Mean HbA1 remained unchanged after standard treatment (group A: 12.8% at 12 months), but decreased during intensified therapy (group A: 10.1% at 24 months; group B: 9.3% at 12 months, 9.5% at 24 months; p〈0.0001). In group C, no change was found compared to standard treatment (i.e. group A at 12 months). Incidence rates of ketoacidosis were 0.16 episodes per patient per year during standard treatment, 0.01 during intensified treatment (p〈0.01) and 0.04 in group C (p〈0.025). Hospitalisation rates were reduced by 60% during intensified therapy and by 40% in group C. Frequency of severe hypoglycaemia was not significantly different between the three treatment regimens. Thus, under the condition that insulin treatment is based upon a structured and comprehensive training of the patient, intensified insulin injection therapy performed as routine treatment of Type 1 diabetes significantly lowers HbA1 levels without increasing the risk of severe hypoglycaemia.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 4 (1968), S. 262-267 
    ISSN: 1432-0428
    Keywords: Human adipose tissue ; insulin ; antilipolytic effect ; lipolysis ; catecholamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les auteurs ont étudié l'effet antilipolytique de l'insuline sur le tissu adipeux humain en utilisant un milieu d'incubation ne contenant pas de glucose. L'activité lipolytique a été mesurée d'après la production de glycérol et d'acides gras libres, et calculée par g de poids humide de tissu. Des coupes de tissu adipeux obtenu à partir de 25 sujets à jeun depuis la veille au soir et n'ayant pas de maladies métaboliques ou endocriniennes, libéraient 0.57 ± 0.20 μmol de glycérol/g de tissu en 2 h, et 2.6 ±0.8 μEq d'acides gras libres/g de tissu en 2 h. La lipolyse était augmentée par addition de 0.01 μg ou plus d'adrénaline ou de noradrénaline par ml, l'augmentation produite par 0.1 ou 1.0 μg de catécholamine/ml étant environ de 100% par rapport au taux de base. Cependant, l'effet de la noradrénaline était significativement plus grand que celui de l'adrénaline. L'addition d'insuline au milieu inhibait la lipolyse. 33 μU d'insuline par ml réduisaient la libération de glycérol à 66± 21 % et la libération d'acides gras libres à 67 ± 24% du taux de base. Une réduction de la lipolyse d'environ 1/3 a été également observée quand la lipolyse était stimulée par 0.1 ou 1.0 μg de catécholamine par ml. La relation effet-dose de l'insuline sur la lipolyse stimulée a été étudiée sur des coupes de tissu adipeux de 14 sujets normaux. Une inhibition significative de la lipolyse a été constatée avec 1.0 μU d'insuline par ml. L'effet lipolytique de 0.1 ou 1.0 μg de catécholamine par ml était complètement inhibé par 100 μU d'insuline par ml. La sensibilité marquée de la lipolyse à l'insuline dans le tissu adipeux humain in vitro serait en accord avec l'idée que la mobilisation des graisses en dépôt dans les conditions physiologiques in vivo est régulée par l'insuline indépendamment du métabolisme du glucose.
    Abstract: Zusammenfassung Am menschlichen Fettgewebein vitro wurde die Hemmung der Lipolyse durch Insulin in glucosefreiem Medium untersucht. Als Parameter der lipolytischen Aktivität wurde die Produktion von Glycerin und freien Fettsäuren bezogen auf Gewebe-Feuchtgewicht gemessen. Die Metabolitfreisetzung durch Fettgewebsschnitte von 25 Normalpersonen betrug in glucosefreiem Medium unter basalen Bedingungen 0.57 ± 0.20 μMol Glycerin/g Gewebe-Feuchtgewicht/2 Std und 2.6 ± 0.8 μEq freie Fettsäuren/g Gewebe-Feuchtgewicht/2 Std — Die Lipolyse wurde durch Zusatz von Noradrenalin oder Adrenalin in Konzentrationen von 0.01 μg/ml oder mehr stimuliert. Bei Konzentrationen von 0.1 und 1.0 μg Katecholamin/ml ergaben sich submaximale Steigerungen der Metabolitfreisetzung auf rund das Doppelte des Basalwertes. Die mit beiden Hormonkonzentrationen erzielten Effekte waren nicht signifikant unterschiedlich, jedoch bei Noradrenalin signifikant größer als bei Adrenalin. — Zusatz von Insulin zum Inkubationsmedium hemmte die Lipolyse. Durch 33 μE Insulin/ml wurde bei Fettgewebsschnitten von 18 Normalpersonen die basale Produktion von Glycerin auf 66 ± 21% und von freien Fettsäuren auf 67 ± 24% reduziert. Auch bei gleichzeitiger submaximaler Stimulation durch Katecholamine betrug die Hemmung der Lipolyse rund 1/3. — Die Konzentration-sabhängigkeit des Insulineffekts auf die Katecholamin-stimulierte Lipolyse wurde an Fettgewebsschnitten von 14 Normalpersonen geprüft. Eine signifikante Lipolyse-hemmung wurde mit einer Konzentration von 1.0 μE Insulin/ml im Inkubationsmedium erzielt. Durch 100 μE/ml wurde die durch Katecholaminzusatz bedingte Stimulation der Lipolyse aufgehoben. — Diein vitro nachweisbare hohe Insulinempfindlichkeit der Lipolyse des menschlichen Fettgewebes läßt darauf schließen, daß die Fettmobilisation auch unter physiologischen Bedingungenin vivo unabhängig vom Glucosestoffwechsel durch Insulin reguliert wird.
    Notes: Summary The antilipolytic effect of insulin on human adipose tissue was studied employing glucose-free incubation medium. The lipolytic activity was measured by the production of glycerol and free fatty acids, and calculated per g wet weight of tissue. Slices of adipose tissue, which was obtained after an overnight fast from 25 subjects selected for lack of metabolic or endocrine diseases, released 0.57 ± 0.20 μmoles glycerol/g tissue/2 h, and 2.6 ± 0.8 μeq. free fatty acids/g tissue/2 h. — Lipolysis was increased by addition of 0.01 or more μg epinephrine or norepinephrine per ml of medium, the increment produced by 0.1 or 1.0 μg catecholamine/ml being about 100% of the basal rate. However, the effect of norepinephrine was significantly greater than the effect of epinephrine. — Addition of insulin to the medium inhibited lipolysis. 33 μU of insulin per ml decreased the release of glycerol to 66 ± 21 % and the release of free fatty acids to 67 ± 24% of the basal rate. A reduction of lipolysis by about 1/3 was also seen when lipolysis was stimulated by 0.1 or 1.0 μg catecholamine per ml. — The dose response of the insulin effect on stimulated lipolysis was studied in slices of adipose tissue from 14 normal subjects. A significant inhibition of lipolysis was demonstrated with 1.0 μU of insulin per ml. The lipolytic effect of 0.1 or 1.0 μg catecholamine per ml was completely inhibited by 100 μU insulin per ml. — The marked insulin sensitivity of lipolysis in human adipose tissuein vitro would be in agreement with the concept, that mobilization of depot fat under physiological conditionsin vivo is regulated by insulin, independent of glucose metabolism.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-0428
    Keywords: Keywords Type I diabetes ; severe hypoglycaemia ; risk factors ; hypoglycaemia awareness ; patient education ; social class ; behaviour ; attitude ; C-peptide.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The objective of this study was to identify possible risk factors of severe hypoglycaemia (SH) in a prospective population based study of adult Type I (insulin-dependent) diabetic patients. A representative sample of 684 patients (41 % women, mean ± SD age 36 ± 11, diabetes duration 18 ± 11 years), living in the district of Northrhine (9.5 million inhabitants), Germany, were examined in their homes using a mobile ambulance. A comprehensive baseline assessment of possible predictors of SH included sociodemographic and disease related variables, hypoglycaemia awareness, diabetes management, and attitudes and behavioural aspects as expressed by the patients. After a mean of 19 ± 6 months 669 (98 %) patients were interviewed about events of SH since the baseline examination. Using the multiple Cox proportional hazards model, five risk factors of SH were identified: SH during the preceding year [hazard ratio (HR) 2.7, 95 % confidence intervals (CI) 1.8–4.2], any history of SH (HR 1.9, CI 1.1–3.4), C-peptide negativity (HR 4.0, CI 1.2–12.7), social status (HR 0.8 for a difference of 5 units for a value range of 0–24, CI 0.6–0.9), and patients' determination to reach normoglycaemia (HR 0.7 for a difference of 1 unit for a value range of 1–6, CI 0.5–0.9), indicating that the lower the social status and the higher the patients' determination to reach normoglycaemia, the higher the risk of SH. After eliminating the history of hypoglycaemia from the model, impaired hypoglycaemia awareness and patients' inappropriate denial of SH as their particular problem became additional significant risk factors of SH. In conclusion, in this population based study of adult Type I diabetic patients, C-peptide negativity, a previous event of SH, patients' determination to reach normoglycaemia and social class were risk factors of SH. [Diabetologia (1998) 41: 1274–1282]
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 33 (1990), S. 384-386 
    ISSN: 1432-0428
    Keywords: Insulin action profiles ; timing of injection ; insulin ; pharmacodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Recombinant DNA technology allows the production of insulin analogues with faster absorption rates from subcutaneous tissue as compared to conventional human regular insulin. We report the time-action profiles of 12 U subcutaneously injected insulin analogues (B9Asp + B27Glu or B10Asp) as evaluated against human regular insulin by means of the euglycaemic clamp technique (blood glucose 5.0 mmol/l) in healthy men. After injection of 12 U of either insulin preparation identical values were found for maximal insulin action (maximal glucose infusion rate, time to peak action), total amount of glucose infused as well as area under the curve of glucose infusion rate. Half-maximal glucose infusion rate was reached significantly earlier after injection of modified insulins (mean ± SD 38 ±7 and 43±5 min) as compared to regular insulin (56 ±14 min, p 〈 0.01). Forty-five min after injection of both insulin analogues glucose infusion rate had increased by 7.4±1.8 or 6.1 ±1.8mg·kg−·min−, reflecting 83 ±27 or 67 ±15% of maximal regular insulin action. In conclusion, the two tested insulin analogues showed similar action profiles, but a significantly faster onset of action as compared to regular insulin.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-0428
    Keywords: Diabetes ; eye complications ; foot complications ; neuropathy ; hypertension ; quality of care ; patient education ; general practice ; hospitalisation ; severe hypoglycaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Using a mobile ambulance the quality of diabetes care was evaluated, according to the recommendations of the St. Vincent Declaration, in 95 % of all known diabetic patients (n = 395) in a geographically defined rural area of Austria with 7871 inhabitants. Fourteen of the 395 patients had Type 1 (insulin-dependent) diabetes with age at onset of diabetes below 30 years. Of the 375 patients examined (women 61%, age 66 ± 13 years, median diabetes duration 6 years) 16 % were treated with insulin and 47 % with oral agents; HbA1c levels were 7.3 ± 1.7 %. Prevalence of known hypertension was 54%; 68% of these patients had their blood pressure uncontrolled (systolic ≥ 160 and/or diastolic ≥ 95 mmHg); a further 15% of patients with previously unknown hypertension had blood pressure values of ≥ 160 and/or ≥ 95 mmHg. Urinary albumin concentrations of 〉 200 mg/l were found in 15% of patients, 2% had a serum creatinine level of 〉 177 μmol/l, no patient had renal replacement therapy. Six patients (1.5%) were blind. Screening for retinopathy identified six patients (out of 317 in whom the retina could be evaluated) for whom consultation with an ophthalmologist as soon as possible was recommended. Of the total patient group (n = 395) 20 patients (5%) had foot complications (amputations and/or ulcers): 14 patients had a total of 21 lower limb amputations (eight above knee, six below knee, seven below ankle); eight of these 14 patients lived in a nursing home; 11 patients had a total of 13 foot ulcers. In conclusion, in this diabetic population quality of diabetes care was satisfactory with respect to glycaemic control, whereas the high rates of uncontrolled hypertension and above ankle amputations appear amenable to improvement. This study shows that through systematic assessment of the quality of diabetes care specific local needs and deficiencies can be identified in order to propose respective interventions in health care practices.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Chronisches Müdigkeitssyndrom ; Depression ; Kognitive Verhaltenstherapie ; Übersichtsarbeit ; Key words Chronic fatigue syndrome ; Depression ; Cognitive behavioral therapy ; Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary This article reviews the chronic fatigue syndrome (CFS), a disorder whose etiology is unknown. The diagnostic criteria proposed in 1994 by the CDC and the International Chronic Fatigue Syndrome Study Group are introduced. In contrast to widespread belief, there are no laboratory tests available to underpin the diagnosis of CFS; the diagnosis is made solely on the basis of clinical criteria. In the differential diagnosis, the exclusion of other conditions that can cause chronic fatigue, such as neuropsychiatric or sleep disorders, is of critical importance. In this context, the question as to whether CFS is a clinical entity that can be differentiated from psychiatric diagnoses, such as depression, somatoform disorder, or neurasthenia, is discussed. At the moment, there is no specific therapy for CFS. Therefore, therapeutic approaches are limited to symptomatic management of the concomitant sleep disturbances, pain, or psychiatric symptoms, such as depression. Patients may benefit from cognitive behavioral therapy, as this may help then to identify and exclude factors contributing to and maintaining chronic fatigue. An integrated medical and psychological approach should be adopted, with the aim of preventing significant secondary negative results of the illness, such as interpersonal conflicts or chronic disability.
    Notes: Zusammenfassung Das „Chronische Müdigkeitssyndrom“ (CFS) ist eine Erkrankung, deren Pathogenese bis heute nicht geklärt ist. Diese Übersichtsarbeit stellt die neuesten diagnostischen Kriterien vor, die 1994 von den „Centers of Disease Control“ und der „International Chronic Fatigue Syndrome Study Group“ erarbeitet wurden. Im Gegensatz zu einer weitverbreiteten Meinung gibt es keine objektivierbaren Parameter, die die Diagnose eines CFS stützen oder sichern könnten. Die Diagnose wird nach rein klinisch-deskriptiven Kriterien gestellt. Dem Ausschluß anderer Erkrankungen, die zu chronischer Müdigkeit führen können, kommt im Rahmen der Diagnostik eine zentrale Bedeutung zu, wobei die Differentialdiagnose zu neuropsychiatrischen Erkrankungen einschließlich Schlafstörungen am wichtigsten ist. In diesem Zusammenhang wird diskutiert, ob das CFS eine Krankheitsentität darstellt oder in psychiatrischen Diagnosen, wie z. B. Depression, somatoformen Störungen oder Neurasthenie, aufgeht. Eine spezifische Therapie des CFS steht bisher nicht zur Verfügung. Medikamentöse Maßnahmen beschränken sich daher auf eine symptomatische Therapie z. B. von Schlafstörungen, Schmerzen und psychischen Begleitsymptomen. An einem CFS leidende Patienten können auch von einem verhaltensmedizinisch orientierten Vorgehen profitieren, das Faktoren aufdeckt und bearbeitet, welche die Symptomatik des CFS verschlimmern oder aufrechterhalten. Ziel aller therapeutischen Bemühungen ist es dabei, negativen Folgen der chronischen Erkrankung, wie z. B. interpersonellen Konflikten, sozialem Rückzug oder Arbeitslosigkeit, vorzubeugen.
    Type of Medium: Electronic Resource
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