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  • 1
    ISSN: 1432-0428
    Keywords: Artificial endocrine pancreas ; glucose clamping ; hyperglycaemia ; insulin-dependent diabetes ; blood glucose ; ketone bodies ; alanine ; lactate ; pyruvate ; ketogenesis ; insulin ; glucagon
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The metabolic and hormonal effects of stable hyperglycaemia (10–12 mmol/l) have been examined in five insulin-dependent diabetics and compared with the results of 8 h (1200 to 2000 h) normoglycaemic (5–6 mmol/l) clamping. Glucose levels were maintained using a glucose controlled insulin infusion system. Mean blood lactate, pyruvate, total ketone bodies, glycerol and plasma nonesterified fatty acids were similar during the period of stable glycaemia at the two glucose levels. In contrast mean blood alanine was markedly elevated during hyperglycaemic clamping (0.384 ± 0.008 vs 0.298 ± 0.021 mmol/l) and 3-hydroxybutyrate was slightly decreased (0.068 ± 0.007 vs 0.084 ± 0.008 mmol/l). Plasma glucagon levels were raised during hyperglycaemic clamping and growth hormone slightly decreased. There was a close positive correlation between mean blood alanine and mean blood glucose (r = 0.79, p 〈 0.01), and a negative correlation of alanine with the amount of insulin infused (r =-0.72, p 〈 0.01). It is suggested that the raised alanine results from increased peripheral glucose utilisation. In general a short period of stable hyperglycaemia is not associated with a worsening of metabolic abnormalities in insulin-dependent diabetic subjects.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0428
    Keywords: Growth hormone ; insulin ; insulin deficiency ; glucagon ; blood glucose ; ketone bodies ; ketogenesis ; lipolysis ; non-esterified fatty acids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The metabolic effects of acute (4 h) and prolonged (24 h) growth hormone excess at pathophysiological concentrations were studied by growth hormone administration to normal subjects with and without somatostatin induced insulin deficiency. Acute growth hormone excess produced mild hyperinsulinaemia, but blood glucose concentrations were unaltered whereas chronic growth hormone excess caused a small (0.5 mmol/l) but significant rise in overnight-fasting blood glucose concentration together with a similar rise in fasting insulin levels (Mean ± SEM 9 ± 1 v 4 ± 1 mU/l, p〈0.01). When insulin secretion was suppressed by somatostatin, a hyperglycaemic effect of acute growth hormone excess was unmasked, and the hyperglycaemic effect of chronic growth hormone excess was exaggerated. Acute growth hormone administration without somatostatin had a mild ketogenic action despite stimulated insulin secretion but no change in plasma non-esterified fatty acid or blood glycerol levels was observed. Somatostatin magnified the ketogenic effect of acute growth hormone excess, and unmasked a lipolytic action. Prolonged growth hormone excess had a lipolytic action that was increased by somatostatin, although the ketogenic effect of growth hormone was only seen during somatostatin induced insulin deficiency. The acute hyperglycaemic, lipolytic and ketogenic actions of growth hormone in normal subjects are limited by a compensatory rise in insulin secretion although with chronic exposure hyperglycaemic and lipolytic effects are seen. In insulin-deficient states, however, elevated growth hormone levels could be important in promoting hyperglycaemia and hyperketonaemia.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-5233
    Keywords: Apoproteins ; Atherosclerosis ; Cholesterol ; Lipoproteins ; Triglycerides
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patients with type 1 (insulin-dependent) diabetes mellitus in good metabolic control usually have normal plasma lipid levels yet they have an increased incidence of vascular complications. Abnormalities in the distribution and composition of lipoprotein subfractions might in part be responsible for the macroangiopathy seen in type 1 diabetes mellitus. The plasma lipids, lipoproteins and apolipoproteins were studied in 9 type 1 diabetic patients during conventional insulin therapy and in 14 healthy controls. Plasma lipoproteins were analysed by ultracentrifugation in a zonal rotor to evaluate their concentrations and flotation properties and for compositional analysis. In diabetic patients the mean glycosylated haemoglobin (HbA1c) was 9.44±1.02% and the plasma lipid concentrations were not significantly different from healthy controls. The very low density lipoprotein (VLDL) subclass cholesterol concentrations were no different in diabetic patients and control subjects, but the VLDL cholesterol/triglyceride ratio was significantly lower in diabetic patients than in control subjects (0.34±0.05 vs 0.85±0.14; p〈0.05). The flotation rate of LDL2, the major component of low density lipoprotein (LDL) was lower in the diabetic patients compared with the control subjects. The cholesterol concentrations of intermediate density lipoprotein and LDL3, the minor component of LDL, were significantly higher (0.17±0.03 and 0.83±0.14 mmol/l respectively) in diabetic patients than in control subjects (0.05±0.02 and 0.24±0.08 mmol/l). The flotation properties and cholesterol concentrations of the high density lipoprotein (HDL) subclass, and the protein-lipid composition of LDL2, HDL2 and HDL3, were no different in diabetic patients and control subjects. Diabetic patients had lower apoprotein AII and higher CII and E levels than control subjects. the plasma lipoproteins in type 1 diabetes mellitus are characterized by increased intermediate density lipoprotein and LDL3 concentrations and by abnormal LDL2 flotation properties. These lipoprotein abnormalities might have a role in atherogenesis in type 1 diabetic patients since similar alterations were associated in some recent epidemiological studies with an increased incidence of cardiovascular disease in non-diabetic patients.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-5233
    Keywords: Atherosclerosis ; Cholesterol ; Hypertension Risk factors ; Triglycerides
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hypertension and microalbuminuria are predictors of cardiovascular mortality in type 2 (non-insulin-dependent) diabetes independently of other conventional risk factors. The presence of high triglyceride levels with small and/or dense low density lipoprotein particles is associated with cardiovascular disease. The aim of this study was to analyse the plasma lipids, Na+/Li+ countertransport (a genetic marker of hypertension) and microalbuminuria in type 2 diabetic patients. Plasma lipids were determined in 15 normotensive normoalbuminuric (H−M−), 32 hypertensive normoalbuminuric (H+M−) and 22 hypertensive microalbuminuric (H+M+) type 2 diabetic patients and in 20 sex-and age-matched non-diabetic subjects. Plasma cholesterol was significantly higher in H+M+ patients than in controls (226±38 vs 192±38 mg/dl, mean ±SD). Plasma triglycerides were significantly higher in H+M+ patients than in either controls or H−M− patients (192±117 vs 104±59 and 115±52 respectively). The Na+/Li+ countertransport activity in red blood cells was significantly higher in H+M− and H+M+ patients than in controls, and in the type 2 diabetic patients it was directly related to plasma triglycerides (r=0.53,P〈0.0001) and inversely to high density lipoprotein (HDL) cholesterol (r=−0.43,P〈0.0001). Microalbuminuria, hypertension and elevated Na+/Li+ countertransport activity are thus associated with high triglyceride and low HDL cholesterol levels in type 2 diabetic patients. This atherogenic lipoprotein pattern might at least partially explain the association of microalbuminuria with cardiovascular disease in type 2 diabetes.
    Type of Medium: Electronic Resource
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