A E Lambert

Hyperglycaemic effect of nifedipine.

histotoxic symptoms may be due to these, but the exact mechanism of action of thiocyanates is not known.4 Thiocyanate intoxication with blood concentrations above 200 mg/l may be rapidly corrected by haemodialysis, which reportedly removes several grams of the drug.5 We tried peritoneal dialysis but in the absence of clearance studies, which we could not do, we cannot comment on the procedure for intoxication with this compound.

Gastric Acid and Pancreatic Polypeptide Responses to Sham Feeding Are Impaired in Diabetic Subjects with Autonomic Neuropathy

To assess the relationship between cardiac and extracardiac dysfunction in diabetic autonomic neuropathy, the gastric acid output and the pancreatic polypeptide (hPP) secretion in response to sham feeding were evaluated in diabetic patients with (group 1) and without (group 2) cardiac autonomic neuropathy (CAN), and in normal subjects (group 3). All patients assigned to the group with CAN exhibited an impaired beat-to-beat heart rate variation during deep breathing. The basal gastric acid output was comparable in the three groups (1.3 ± 0.5, 2.8 ± 1.5, and 3.9 ± 1.5 mmol/h, respectively). In contrast, the gastric acid output stimulated by sham feeding was significantly lower in patients with CAN (5.3 ±1.3 mmol/h) thanin diabetic subjects without CAN (14.0 ± 3.5 mmol/h; P < 0.01) and in controls (10.9 ± 3.1; P < 0.05). The maximal gastric acid secretion capacity, determined after pentagastrin injection, was similar in all patients. Mean basal hPP concentrations were comparable in the three groups (185 ± 53 pg/ml, 131 ± 29 pg/ml, and 116 ± 19 pg/ml). In the controls and diabetic subjects without CAN, a significant mean 60% increase of the hPP levels above basal values was observed during sham feeding. In contrast, no significant hPP response occurred in the group with CAN. These data suggest that diabetic CAN is associated with dysfunctions of the vagal pathways controlling the gastric acid output and the hPP secretion. Moreover, the results demonstrate a strong association between cardiac autonomic neuropathy and gastric vagal neuropathy (P < 0.001).

Treatment of systemic hypertension in insulin-treated diabetes mellitus with rilmenidine.

The effects of a new alpha 2 agonist (S 3341 or rilmenidine) on blood pressure (BP), glycemic control, lipid metabolism and renal function were investigated during a 16-week open study in 29 insulin-treated diabetic patients with mild to moderate hypertension. There were 17 men and 12 women aged 50.9 +/- 2.2 years (mean +/- standard error of the mean). Duration of diabetes and insulin therapy was 218 +/- 24 and 143 +/- 30 months. After 2 weeks of placebo, systolic and diastolic BP was 165 +/- 3 and 97 +/- 0.5 mm Hg, respectively (supine). Rilmenidine (S 3341) given alone at daily doses of 1 or 2 mg according to the clinical response led to a prompt and sustained decrease of systolic and diastolic BP (159 +/- 4 and 88 +/- 1 mm Hg after 2 weeks; 149 +/- 3 and 85 +/- 1 mm Hg after 12 weeks; p less than 0.01). Seventeen patients (59%) had normal BP (systolic BP less than 160; diastolic BP less than 90 mm Hg, supine) after 12 weeks of S 3341. Diuretics were associated with S 3341 for the nonresponders at week 12; this led to normalization of BP in 90% of the patients at the end of the study. Glycemic control was assessed by home glucose monitoring (5 determinations/1 day per week), 24-hour glucosuria and postprandial plasma glucose at the outpatient clinic (n = 7) as well as by the measurement of the glycosylated hemoglobin. None of these parameters was significantly affected by S 3341.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of Plasma Glucose and Plasma Free Insulin During CSII and Intensified Conventional Insulin Therapy

The plasma glucose and plasma free insulin profiles of six totally insulin-dependent diabetic patients were compared during periods of 4 days in hospital under a conventional insulin therapy (ICIT) comprising 4 daily injections of regular insulin and under continuous subcutaneous insulin infusion (CSII). Two profiles of prandial insulin administration with CSII were compared: a rectangular (R) and an exponential wave (E) in which 50% of the dose was given rapidly followed by an exponential decrease. In both cases, the basal infusion rate was increased by 30–50% between 5 a.m. and 8 a.m. Mean circadian blood glucose was equally good with ICIT: R and E: 7.0 ± 0.9, 7.3 ± 1.0, and 7.1 ± 1.0 mmol/L, respectively. In five patients, fasting plasma glucose was higher with ICIT than with R and E (12.7 ± 1.8 versus 6.9 ± 1.0 and 6.8 ± 0.8 mmol/L, respectively; t test: P < 0.05; Wilcoxon: P = 0.06). Mean plasma free insulin level was significantly higher (t test: P < 0.005; Wilcoxon: P < 0.05) with ICIT (0.46 ± 0.04 nmol/L) than with R (0.37 ± 0.04 nmol/L) or E (0.36 ± 0.05 nmol/L), although the daily doses were similar. In conclusion, CSII leads to a better glycemic control than ICIT, since it appears to prevent the morning rise of blood glucose.

Effect of Acarbose on blood glucose profile of totally insulin-dependent diabetic patients.

SummaryThe effects of an a-glucosidase inhibitor, Acarbose (Bay g 5421) upon the circadian plasma glucose profile were studied in 7 diabetic patients in i hospital. All subjects were totally insulin-dependent as demonstrated by their low preand postprandial plasma C-peptide levels. The patients received Acarbose (5 days) or a placebo (4 days) in a randomized order.The mean plasma glucose levels, the M value and the MAGE index recorded during both periods were compared. Acarbose was given at doses of 200, 100 and 100 mg before breakfast, lunch and dinner, respectively. The doses of regular insulin (4/day) were daily adapted throughout the study in an attempt to reach the best possible glycemic control. Even though the insulin doses did not significantly differ during both periods, a significant dei crease of the mean plasma glucose levels was observed when the patients received Acarbose (8.2 ± 0.4 vs 10.1 ± mmol/1; P < 0.05). Moreover, the drug induced a significant decrease of postprandial plasma glucose ...

Treatment of hypertension in diabetic patients.

Hypertension, common in diabetic patients, worsens not only the risk of cardiovascular complications, but also that of microangiopathic complications (nephropathy, retinopathy) of diabetes mellitus. It is thus important to ensure the perfect control of even mild hypertension in diabetic patients. However, treatment sometimes becomes difficult given that certain categories of antihypertensive drugs interfere with blood glucose control and/or lipid metabolism, interfere with the symptomatology of hypoglycemia, or promote orthostatic hypotension, a complication of autonomic neuropathy. A study was undertaken to determine the effects of rilmenidine, administered for 16 weeks, in 29 diabetic patients treated with insulin and experiencing mild-to-moderate hypertension (supine diastolic blood pressure, 96.7 +/- 0.5 mmHg). Administered as single-drug therapy, rilmenidine rapidly normalized blood pressure (systolic blood pressure, less than 160 mmHg; diastolic blood pressure, no more than 90 mmHg--supine) in 17 patients; this persisted throughout the trial period. Addition of a diuretic after 12 weeks in the remaining 12 patients led to normalization of blood pressure in nine additional patients. Blood glucose control (evaluated at home by weekly blood glucose measurements and by glycosylated hemoglobin levels) was unaffected by treatment. Plasma levels of cholesterol (total, high-density lipoprotein and low-density lipoprotein), triglycerides and proteinuria (or microalbuminuria) showed no change during the course of the trial. In conclusion, rilmenidine offers an effective and safe treatment for mild-to-moderate hypertension in diabetic patients treated with insulin and does not interfere with their blood glucose control.

Deficience Isolee En Acth Et Hypothyroids Primitive: Une Entite Clinique A Part Entiere Discussion Etiopathogenique D’Une Observation

SummaryThe simultaneous unusual occurrence of isolated adrenocorticotrophin (ACTH) deficiency and primary hypothyroidism was clearly demonstrated in a female patient complaining of tiredness. An empty sella was also evidenced by computed tomography and magnetic nuclear resonance. We suggest that an autoimmune process could be involved in the pathogenesis of the syndrome.

Syndrome de Werner avec complications inhabituelles

This case of Werner syndrome proved highly interesting because of severe insulinoresistant diabetes, various complications, myelofibrosis progressing as an acute myeloid leukemia. Recent concepts about the syndrome are commented upon.

Résistance à l'insuline et acanthosis nigricans.

SummaryWe report the case of a young female patient who presented, at the age of 13, a severe glucose intolerance with very high plasma insulin levels. She was immediately treated with insulin, a treatment which could be stopped 9 months later while the glucose tolerance remained slightly abnormal inspite of a persistent hyperinsulinism. Virilism and acanthosis nigricans developped soon after puberty. The level of erythrocyte insulin receptors was markedly diminished whereas anti-receptor antibodies were not detected. Thus, the patient presented a syndrome of type A (originally described by Kahn) associating glucose intolerance (or diabetes), viri lism and acanthosis nigricans. This congenital syndrome, occurring in young females, is characterized by a severe insulin resistance due to a decreased number (or impaired function) of insulin receptors. Our patient was treated with an association of cestrogen-antiandrogen which resulted in a rapid decrease of hirsutism without apparent modification of glucose t...

Comparaison de l'insuline humaine semi-synthétique et de l'insuline porcine chez des patients diabétiques avec ou sans anticorps anti-insuline circulants.

SummaryThe effects of semi-synthetic human insulin (IHSS) and monocomponent porcine insulin (IPMC) were compared in a double blind study carried out in 9 totally insulin dependent diabetic patients in hospital. Short-acting preparations of these insulins were administered subcutaneously 4 times per day at an identical dose in each subject. Plasma glucose and plasma free insulin were measured 28 times on the 3rd day of each insulin treatment. At none of the 28 time points were the mean plasma glucose and free insulin levels significantly different. In the 5 patients without or with only a low titer of anti-insulin antibodies (AIA —), the mean circadian glycemia was markedly higher (under IHSS or IPMC) and the glycemic fluctuations were more pronounced (with IPMC) than in the 4 other subjects with a higher titer of anti-insulin antibodies (AIA +). This observation could be explained by a reduced half-life of circulating insulin in patients AIA —, leading to low levels of plasma free insulin, and, thus, to g...