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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 54 (1976), S. 539-542 
    ISSN: 1432-1440
    Keywords: Maltose infusion ; Diabetes mellitus ; Maltose utilization ; Parenteral nutrition ; Maltoseinfusion ; Diabetes mellitus ; Maltoseverwertung ; parenterale Ernährung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Maltose wurde als 10%ige Lösung bei stoffwechselgesunden Personen (n=9) und bei Diabetikern vom Erwachsenentyp (n=9) über 2 Std kontinuierlich infundiert (0,25 g/kg Körpergewicht/Std). Während und nach Infusion sind die Änderungen der untersuchten Parameter (Blutglucose, Seruminsulin, freic Fettsäuren, Laktat, Pyruvat, Harnsäure, Säure-Basenwerte, Ketonkörper) minimal. Nur bei Stoffwechselgesunden ist der Anstieg der Blutglucose signifikant. Die Maltosekonzentrationen im Serum steigen während der Maltosezufuhr stetig und in beiden Gruppen nahezu identisch bis auf Maximalwerte um 150 mg/100 ml an. Nach Infusionsende sind über weitere 7 Std abnehmende Maltosekonzentrationen im Serum sowie über 18 Std eine Maltoseausscheidung im Harn nachweisbar. Bei stoffwechselgesunden Personen werden innerhalb der ersten 3 Std 4% der zugeführten Maltosemenge (1,3% als Maltose und 2,7% als Glucose) im Harn ausgeschieden. Die Kohlenhydratausscheidung bei Diabetikern ist mit 14 (1,1–35,9) % höher und individuell variabler. Die gegenüber Glucose insbesonders bei Diabetikern geringen metabolischen Veränderungen sowie die Möglichkeit einer höheren Kalorienzufuhr sind günstige Effekte parenteral applizierter Maltose. Jedoch sprechen langsame Elimination sowie die je nach Untersuchungsbedingungen und Dosierung des Disaccharids ansteigenden Verluste im Harn für die limitierte Fähigkeit des menschlichen Organismus Maltose zu verwerten. Solange weitere Untersuchungen während langdauernder Zufuhr am Menschen fehlen, kann eine alleinige Verwendung von Maltose als Kohlenhydrat in der parenteralen Ernährung nicht empfohlen werden.
    Notes: Summary Maltose (10% solution) was infused continuously over 2 h (0,25 g/kg BW/h) in maturity onset diabetics (n=9) and in non-diabetic patients (n=9) serving as controls. During and after infusion changes of parameters measured (blood glucose, IRI, FFA, lactate, pyruvate, uric acid, acid-base status, ketone bodies) were minimal. A significant rise in blood-glucose was observed only in non-diabetics. Serum maltose concentrations increased continuously up to 150 mg/100 ml during infusion and were nearly identical in both groups. Post infusion serum maltose decreased slowly during 7 h and urinary maltose excretion was found for 18 h. During the first 3 h controls excreted 4% of infused maltose (1.3% as maltose and 2.7% as glucose). In diabetics excretion of carbohydrates was higher and more variable: 14 (1.1–35.9) %. The slight metabolic changes, especially in diabetics and the possibility of supplying more calories are favorable effects of parenteral maltose. However slow elimination and increasing urinary losses depending on dosage and conditions of i.v. maltose application account for the limited utilization of the disaccharide in men. Unless further investigations will have been done maltose cannot be recommended as a sole substitute for carbohydrate in parenteral nutrition.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1440
    Keywords: Type 2 diabetes ; Secondary failure of sulfonylureas ; Combined therapy insulin/glibenclamide ; Hyperinsulinemia ; C-peptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In type 2 diabetes with “secondary failure of sulfonylurea therapy” good metabolic control can seldom be achieved by insulin therapy even with high insulin doses. Hyperinsulinemia however is a possible risk factor of cardiovascular disease in type 2 diabetes. Maintaining the effects of sulfonylurea action insulin should be added in as small amounts as possible to avoid hyperinsulinemia and to ameliorate hyperglycemia. 16 type 2 diabetics with “secondary failure” were treated either with insulin alone (group A;n=8) or with 3.5 mg b.i.d glibenclamide plus small amounts of intermediate insulin (group B;n=8) in a randomised order. After the inpatient period outpatient control was performed monthly up to six months, later on four times a year up to two years. Both groups were comparable with regard to age, duration of diabetes, body weight and metabolic control. The daily insulin dose was 14±2 IU $$(\bar x \pm SEM)$$ after one month and 19±2 IU after two years in group B. In contrast 30±3 IU and 43±5 IU respectively were needed in group A (p〈0.001). All patients B were treated with one daily injection, all patients A needed two injections. Resulting in nearly identical metabolic control in group A basal insulin levels exceeded those in group B after two years significantly (28.6±3.7 vs. 18.6±1.6 mcU/ml;p〈0.01). Endogenous C-peptide response was suppressed in group A compared to group B after inpatient period and after one month (0.12±0.01 vs. 0.49±0.15 and 0.09±0.04 vs. 0.13±0.08 pmol/ml;p〈0.05). The combined therapy of insulin and sulfonylureas demonstrates the benefit of a prolonged sulfonylurea administration in the treatment of type 2 diabetes with “secondary failure”. As compared to common insulin therapy a small amount of exogenous insulin by one daily injection additionally to glibenclamide shows similar improvement in metabolic control. Hyperinsulinemia as a risk factor of macroangiopathy is markedly reduced in patients treated with combined therapy compared to those with insulin alone.
    Type of Medium: Electronic Resource
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