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  • 1
    Electronic Resource
    Electronic Resource
    Long-term metabolic control after pancreas transplantation with enteric exocrine diversion (1991)
    Springer
    Diabetologia 34 (1991), S. S76 
    Details
    ISSN: 1432-0428
    Keywords: Glucose ; Lipids ; Lipoproteins ; Pancreatic graft rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Long-term metabolic control after pancreatic transplantation with enteric exocrine diversion was evaluated in 42 Type I (insulin-dependent) diabetic pancreas recipients with functioning grafts for 1 to 7 years. Glycaemic control (fasting blood glucose, glycosylated haemoglobin A1c, oral and intravenous glucose tolerance tests) was normal or near-normal in most patients, and showed no deterioration with time. In ten patients with functioning grafts for 5 years there was a small, but significant, improvement in the glucose control at 3 to 5 years as compared with that at 6 months post-operatively. In the latter recipients the number of acute rejection episodes correlated negatively with the intravenous glucose tolerance at 6 months (r=−0.64, p〈0.01) and at 5 years (r=−0.60, p〈0.01) after transplantation, respectively. The glycaemic control at 6 and 12 months after transplantation was similar whether segmental (n=35) or whole-organ (n=7) pancreatic grafts had been used. In six non-uraemic recipients who had received a pancreas transplant alone the serum cholesterol increased in all but one patient (0.05〈p〈0.1), and the LDL/HDL-cholesterol ratio was significantly higher (p〈0.005) one year after transplantation than before. Conversely, in six diabetic patients who had lost the function of their single pancreatic grafts the lipid and lipoprotein profiles remained unaltered. It is concluded that the long-term glycaemic control after segmental or whole-organ pancreatic transplantation with enteric exocrine diversion remains essentially normal in most recipients, and it may even improve with time. The short- and long-term glucose control seems to be adversely influenced by the number of acute rejections. Moreover, in non-uraemic pancreas transplant recipients the lipoprotein profile changed towards a more atherogenic pattern. The latter findings are probably attributable to the immunosuppressive therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587625
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  • 2
    Electronic Resource
    Electronic Resource
    Impaired intrarenal dopamine production following intravenous sodium chloride infusion in Type 1 (insulin-dependent) diabetes mellitus (1991)
    Springer
    Diabetologia 34 (1991), S. 114-118 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 (insulin-dependent) diabetes mellitus ; sodium retention ; dopamine ; atrial natriuretic peptide ; proximal tubule
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Type 1 (insulin-dependent) diabetes mellitus is characterized by impaired sodium excretion following NaCl infusion. To investigate the possible role of dopamine in the impaired natriuresis in diabetes, intrarenal sodium handling, sodium excretion and urinary dopamine output, reflecting intrarenal dopamine formation, were studied following a 2 h 0.9% NaCl infusion (25 ml/kg) in eight diabetic patients and nine control subjects. The increase in sodium excretion in response to NaCl infusion was significantly (p〈0.01) reduced in diabetic patients (19±7%) as compared with control subjects (46±8%). Fractional proximal tubular sodium reabsorption (determined by lithium clearance) decreased in the control group (p〈0.001) following NaCl infusion but not in the diabetic group. Fractional distal tubular reabsorption decreased similarly in both groups. In response to NaCl urinary dopamine excretion increased by approximately 15% (p〈0.01) in the control group but did not change in the diabetic group. The mean urinary dopamine excretion above basal was significantly greater in the control group (8.4±2.1 nmol/h) than in the diabetic group (−2.2±2.1 nmol/h; p〈0.01). The urinary sodium/dopamine excretion ratio did not differ significantly between the two groups in the basal state or following NaCl. Baseline plasma levels of atrial natriuretic peptide did not differ between control and diabetic patients. In the control group atrial natriuretic peptide levels increased significantly (p〈0.01) in response to NaCl whereas atrial natriuretic peptide levels did not change in the diabetic group. The results of this study show that patients with Type 1 diabetes have a blunted natriuresis in response to isotonic NaCl. This abnormality seems mainly to be due to impaired inhibition of proximal tubular sodium reabsorption, which may be the result of defective intrarenal dopamine mobilisation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00500382
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  • 3
    Electronic Resource
    Electronic Resource
    The Stockholm experience with pancreatic transplantation using enteric exocrine diversion (1991)
    Springer
    Diabetologia 34 (1991), S. S21 
    Details
    ISSN: 1432-0428
    Keywords: Pancreatic transplantation ; Human ; Enteric diversion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Between April 1974 and June 1990, 128 pancreatic transplantations were performed. Of these 117 were with pancreatico-enterostomy. In four consecutive series of combined transplantations in uraemic diabetic patients the 1-year graft survival rate have successively improved (27%, 65%, 68% and 73%). In three similar series of single pancreatic transplantations the results also improved but still remained inferior (0%, 33% and 33%). In a series of combined transplantations performed in preuraemic diabetic patients the 1-year actuarial graft survival rate was only 25%. The results with pancreatic transplantation with pancreatico-enterostomy are now satisfactory. However, immunological loss graft function still constitute a major problem in the non- or preuraemic recipients. The metabolic control in patients with functioning grafts is normal or near-normal in the majority of patients followed for at least 1 year.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587613
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  • 4
    Electronic Resource
    Electronic Resource
    Stimulation of adipose tissue lipolysis following insulin-induced hypoglycaemia: evidence of increased beta-adrenoceptor-mediated lipolytic response in IDDM (1996)
    Springer
    Diabetologia 39 (1996), S. 845-853 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Microdialysis ; glycerol ; non-esterified fatty acids ; adrenoceptors ; adipose tissue blood flow.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The adrenergic regulation of adipose tissue lipolysis in response to insulin-induced hypoglycaemia (intravenous infusion of soluble insulin 0.10 IU · kg body weight−1· h−1 until the arterial plasma glucose fell below 2.8 mmol/l) was investigated directly in vivo in 11 insulin-dependent diabetic (IDDM) patients and 12 control subjects, using microdialysis of the extracellular space of abdominal subcutaneous adipose tissue. The tissue glycerol level (lipolysis index) and the escape of ethanol from the perfusion medium (blood flow index) were continuously monitored. During insulin infusion the arterial glucose level was reduced in parallel and the hypoglycaemic nadir was almost identical in the two groups (diabetic patients 2.2 ± 0.1 and control subjects 2.3 ± 0.1 mmol/l). While the maximum response of plasma epinephrine to hypoglycaemia was 30 % lower in diabetic patients than in the control subjects (p 〈 0.05), the glycerol levels in adipose tissue and in plasma, as well as in serum non-esterified fatty acids, increased twice as much in the former as in the latter group following hypoglycaemia (p 〈 0.01). Addition of the beta-adrenoceptor blocker propranolol (10−4 mol/l) to the tissue perfusate almost completely prevented the hypoglycaemia-induced increase in the adipose tissue glycerol level in both groups, whereas in situ perfusion with 10−4 mol/l of the alpha-adrenoceptor blocker phentolamine resulted in an additional increase in the tissue glycerol levels; during alpha-blockade, the glycerol response to hypoglycaemia remained enhanced by threefold in the diabetic patients (p 〈 0.01). In both groups local adipose tissue blood flow increased transiently in a similar way after hypoglycaemia; the increase being inhibited by in situ beta-adrenoceptor blockade. We conclude that both alpha- and beta-adrenergic mechanisms regulate adipose tissue lipolysis in response to hypoglycaemia. In IDDM, lipolysis is markedly enhanced following hypoglycaemia, despite a reduced catecholamine secretory response, because of increased beta-adrenoceptor action in adipose tissue. [Diabetologia (1996) 39: 845–853]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050519
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  • 5
    Electronic Resource
    Electronic Resource
    Protracted glucose fall in subcutaneous adipose tissue and skeletal muscle compared with blood during insulin-induced hypoglycaemia (1997)
    Springer
    Diabetologia 40 (1997), S. 1320-1326 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Hypoglycaemia ; insulin ; carbohydrate metabolism ; microdialysis ; tissue blood flow.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The absolute glucose concentrations in subcutaneous adipose tissue and skeletal muscle were determined with microdialysis in 10 normal-weight, healthy subjects during a standardized hyperinsulinaemic hypoglycaemic clamp. The concentration of tissue dialysate glucose was measured in 15-min fractions and compared with that in arterialized venous plasma. Insulin (0.15 U · kg-1· h−1) was infused i. v. to lower the plasma glucose level to 2.5 mmol/l over 30 min. This level was maintained for 30 min by using a variable glucose infusion. Thereafter, the insulin infusion was stopped and the plasma glucose level was gradually increased to baseline levels over 120 min. During a 60-min basal period, the glucose levels in muscle were 0.6 mmol/l lower than those in plasma (p = 0.002), whereas the levels in adipose tissue and plasma were similar. The glucose nadirs in muscle (1.6 ± 0.1 mmol/l) and adipose tissue (2.0 ± 0.1 mmol/l) were significantly lower than that in plasma (2.4 ± 0.1 mmol/l) (p = 0.001 and 0.02, respectively), and the time-to-nadir was substantially longer in muscle (69 ± 5 min) and adipose tissue (57 ± 2 min) than in plasma (39 ± 3 min) (p = 0.0004). When the insulin infusion was stopped, the increases in adipose tissue and muscle glucose concentrations were delayed by approximately 25 and 45 min, respectively, as compared to the increase in plasma glucose. Thus, it seems that glucose measurements in adipose tissue and muscle more adequately reflect overall tissue homeostasis than do measurements in blood and that clinically relevant tissue glucopenia may be overlooked by conventional blood glucose measurements. [Diabetologia (1997) 40: 1320–1326]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050827
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  • 6
    Electronic Resource
    Electronic Resource
    Binding and molecular weight properties of the insulin receptor from omental and subcutaneous adipocytes in human obesity (1984)
    Springer
    Diabetologia 27 (1984), S. 447-453 
    Details
    ISSN: 1432-0428
    Keywords: Insulin receptor ; obesity ; adipocyte ; subcutaneous fat ; omental fat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The insulin binding properties and the molecular weights of the insulin receptor and its insulin binding subunit were studied in omental and subcutaneous adipocytes prepared from obese- and normal-weight subjects. Insulin binding by such adipocytes was decreased in obesity when the binding activity was expressed per unit of cell surface area. No significant difference from the lean controls was evident, however, when binding was calculated on a per cell basis, indicating that the total receptor content of the cells from the obese subjects was not altered. In addition, the normal difference in the receptor binding affinities previously reported between omental and subcutaneous cells from lean individuals was unaffected by the obese condition. Studies of the molecular weight of the non-reduced insulin receptor in fat cell membranes prepared from pieces of omental and subcutaneous fat demonstrated a major receptor species of 390–425K Mr. In contrast, adipocytes isolated by collagenase treatment of the fat had heterogenous non-reduced receptor species of Mr 355K, 285K and small amounts of 427K and 182K. Although different non-reduced receptor species were evident depending on the adipocyte receptor preparation (e.g. isolated adipocytes or fat cell membranes), no differences were found between obese and lean controls or between subcutaneous and omental receptors when the appropriate comparisons were made. Upon sulphydryl reduction, all receptor preparations had a major binding subunit of 125K Mr. In conclusion, obesity is characterized by a dilution of the insulin receptor over the adipocyte cell surface in the absence of a change in total cellular content of receptors. The difference in insulin binding affinities between omental and subcutaneous adipocytes could not be explained by an alteration in receptor molecular weight.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00273909
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  • 7
    Electronic Resource
    Electronic Resource
    Effects of insulin on renal haemodynamics and the proximal and distal tubular sodium handling in healthy subjects (1992)
    Springer
    Diabetologia 35 (1992), S. 1042-1048 
    Details
    ISSN: 1432-0428
    Keywords: Exogenous insulin infusion ; sodium excretion ; lithium clearance ; renal haemodynamics ; renal dopamine ; atrial natriuretic peptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effects of insulin on renal haemodynamics and renal sodium handling were studied in 10 healthy males. Using the euglycaemic insulin clamp technique, insulin was infused on separate days resulting in two levels of hyperinsulinaemia (41 ± 3 and 90 ± 7 mU/1, respectively). Renal haemodynamics and the proximal and distal tubular sodium handling were studied using inulin, para-amino-hippuric acid, sodium and lithium clearances. Low- and high-dose insulin infusions were followed by a fall in sodium clearance from 1.6 ± 0.1 ml/min to 1.2 ± 0.1 and 1.0 ± 0.1 ml/min, respectively. Both levels of hyperinsulinaemia resulted in increased distal tubular sodium reabsorption. The distal antinatriuretic effect of insulin was associated with dose- and time-dependent decline in proximal tubular sodium reabsorption. The changes in proximal tubular sodium handling occurred without any significant changes in natriuretic factors, such as renal dopamine and plasma atrial natriuretic peptide levels. However, hyperinsulinaemia resulted in time- and dose-dependent increases in renal plasma flow, and renal vasodilatation could, possibly via changes in renal interstitial pressure, have contributed to the fall in the proximal tubular sodium reabsorption. The results also suggest that decreased proximal sodium reabsorption may be a compensatory mechanism counteracting the insulin-induced sodium retention.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02221679
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  • 8
    Electronic Resource
    Electronic Resource
    Skin microvascular reactivity in fingers of diabetic patients after combined kidney and pancreas transplantation (1991)
    Springer
    Diabetologia 34 (1991), S. S135 
    Details
    ISSN: 1432-0428
    Keywords: Combined kidney and pancreas transplantation ; Skin microvascular reactivity ; Capillaroscopy ; Laser Doppler fluxmetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nine patients with severe late diabetic complications were investigated 2 and 38 months after successful combined kidney and pancreas transplantation. Nine healthy subjects served as controls. Blood cell velocity in single capillaries was evaluated by videophotometric capillaroscopy, and total skin microcirculation of the same area by laser Doppler fluxmetry. The measurements were performed during rest, and post-occlusive (1 min) reactive hyperaemia. Laser Doppler flux was also recorded during venous occlusion. The basal capillary blood cell velocity and laser Doppler flux values increased significantly (p〈0.05) during the observation period. The time to maximal capillary blood cell velocity during hyperaemia was prolonged 2 months after combined kidney and pancreas transplantation (p〈0.05), and still more so at 38 months (p〈0.05). The ability to decrease blood flow during venous occlusion was impaired at 2 months, and was not significantly better at reinvestigation. The results indicate a succesive increase of basal blood flow in the skin microcirculation after successful combined kidney and pancreas transplantation, but no improvement of the impaired microvascular reactivity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587640
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  • 9
    Electronic Resource
    Electronic Resource
    Preface (1991)
    Springer
    Diabetologia 34 (1991), S. A3 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587605
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  • 10
    Electronic Resource
    Electronic Resource
    Effect of insulin on human adipose tissue metabolism in situ. Interactions with beta-adrenoceptors (1992)
    Springer
    Diabetologia 35 (1992), S. 664-670 
    Details
    ISSN: 1432-0428
    Keywords: Microdialysis ; glucose ; glycerol ; lactate ; pyruvate ; isoproterenol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effects of insulin, and its interactions with catecholamines through beta-adrenoceptors, on human adipose tissue glucose utilization and lipolysis were investigated in vivo. Microdialysis of the extracellular compartment of abdominal subcutaneous adipose tissue was performed in healthy subjects of normal weight, before and during a 2-h hyperinsulinaemic (61±3 mU/l), euglycaemic clamp. The tissue was perfused with or without the beta-adrenergic agonist isoproterenol (10−mol/l), and the tissue dialysate concentrations of glucose, glycerol (lipolysis index) lactate and pyruvate were determined. During the insulin infusion, glucose in adipose tissue decreased by 20% (p〈0.001), despite arterial steady-state normoglycaemia. The concentrations of lactate and pyruvate increased gradually to a steadystate plateau of twice the basal level in adipose tissue and arterial blood. Insulin-induced suppression of glycerol (lipolysis index) was, if anything, more marked in adipose tissue than in plasma (65% vs 50% decrease from baseline levels, p〈0.05). In situ perfusion of adipose tissue with isoproterenol, starting either at the beginning of the study period or at 45 min after initiation of the insulin infusion, resulted in marked and rapid elevations of all the investigated metabolites in the adipose tissue extracellular compartment (p〈0.05–0.005).Itis concluded that insulin action on glucose uptake and lipolysis in human adipose tissue in vivo is counteracted by beta-adrenoceptor stimulation. In contrast, insulin and beta-adrenoceptors have synergistic effects on non-oxidative glucose metabolism in human adipose tissue in situ.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400260
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