Adolfo Puxeddu

Modification of glycosylated haemoglobin concentration during artificial endocrine pancreas treatment of diabetics

SummaryIn order to verify whether or not insulininduced blood glucose control can acutely lower glycosylated haemoglobin levels, HbAI (a+b+c) (HbAI) was measured in 11 diabetics before, during and after 3 days of treatment with an “artificial endocrine pancreas” (Biostator). Initially 5 patients were in fair glycaemic control (group A), while the other 6 showed poor control (group B). HbAI levels decreased significantly after 3 days in both groups A (from 9.6 ± 0.2% to 8.5 ± 0.3%, mean ± SEM, p < 0.05) and B (from 13.7 ± 0.2% to 12.6 ± 0.3%, p < 0.05). A further HbAI decrease was observed until day 60 following Biostator treatment, during which period glycaemic control inproved, as assessed by fasting and post-lunch plasma glucose values and daily glycosuria determined every 10 days.These results suggest that increased HbAI levels may be reversed early by strict blood glucose control during a 3 day period. It is concluded that HbAI levels not only reflect long-term glycaemic control, but also recent acute variations in mean blood glucose values.

Use of insulin glargine in patients with hyperglycaemia receiving artificial nutrition

The purpose of this study was to verify whether it is possible to use insulin glargine (Lantus) subcutaneously in patients receiving artificial nutrition (AN) and if the analogue is capable of obtaining and maintaining good glycaemic control without inducing hypoglycaemia. The sample considers 25 patients receiving AN, diagnosed diabetics and non-diabetics, who had previously been prescribed traditional insulin therapy. All were to be given subcutaneous insulin glargine at a dosage equal to the average of insulin/day administered in the preceding days spent receiving AN. Twenty-five consecutive patients, not stratified in any way, were judged eligible in the last six months of 2004 and first two months of 2005. Four out of these 25 could not be evaluated, either because they did not begin or complete the treatment with Lantus (3/4) or because the proper number of glycaemic tests were not carried out (1/4); 21/25 patients, 84% of the sample with a mean age of 68.7 years (range 46–91 years), finished the study and could be evaluated. The mean glycaemic values after treatment with glargine were already better on the second day, and on the seventh day the difference was statistically significant. No hypoglycaemia requiring medical intervention occurred. This study confirms the possibility of using insulin glargine in patients receiving AN with hyperglycaemia regardless of the type of nutrition and whether or not the patient is diabetic.

Fibromyalgia: nosography and therapeutic perspectives.

▪ Abstract:  Fibromyalgia (FM) is an important cause of morbidity and health expenditure. Severe widespread extra‐articular chronic pain, along with nonrestorative sleep, dominates the clinical syndrome. The pathogenesis of FM remains unclear. While dysfunction in serotoninergic neurotransmission is believed to play an important role, several neurologic and immuno‐endocrine mechanisms may also be relevant. A theory is advanced based on an inherited imbalance in neuro‐vegetative systems resulting from increased sympathetic tone because of a metabolic deficiency in the serotoninergic system that, when exposed to a precipitating event, leads to the development of the clinical manifestations of FM. The importance of both nonpharmacological treatments and multimodal medication management is stressed. ▪

Urinary excretion and plasma levels of norepinephrine and epinephrine during diabetic ketoacidosis.

Sympathetic activity was determined in 13 ketoacidotic diabetics by evaluation of plasma and urinary catecholamines, before and in the course of medical management. Patients were divided into two groups. Group A (severe ketoacidosis, n = 5) and Group B (moderate ketoacidosis, = 8), depending on plasma glucose, pH and plasma bicarbonate levels. The results showed an enhanced sympathetic activity in all patients before treatment, with significant decrease during therapy. In Group A plasma catecholamines were higher than in Group B, both before and in the course of therapy. A significant correlation was found between basal plasma catecholamines and initial plasma glucose, plasma bicarbonate, hours of therapy and insulin dosage required to obtain plasma glucose levels below 150 mg/100 ml .These results, suggesting a close correlation between glycometabolic control and adrenergic activity, emphasize the role of the sympathetic nervous system as a powerful contrainsular factor in the pathogenesis and metabolic derangement of diabetic ketoacidosis.

Preliminary observation on the clinical tolerance of interferon-beta in cancer patients.

Nine patients with metastatic solid tumors were given IFN-β by i.v. bolus injections. Six escalating doses (from 1 to 9 × 104 IU) followed by 6 additional injections at the dose of 9 × 106 IU were administered every other day (schedule A) in 3 of the 9 patients. IFN dose was also increased to a maximum of 46 × 106 IU, and 12 individual injections of 1, 2, 3.3, 5, 7, 9, 12, 16, 21, 27, 34 and 46 × 106 IU of IFN were given over a minimum of a 24-day period (schedule B) in 6 of the 9 patients. The single maximal tolerated dose ranged from 9 to 46 × 106 IU. The toxicity of IFN-β given as scheduled in this study was significant but acceptable.

Red cell 2,3-DPG levels in diabetic vasculopathy.

SummaryRBC 2,3-DPG resulted statistically increased versus normal subjects in 22 insulin-dependent diabetics affected by arterial vasculopathy and in 19 vasculopathic non-diabetic patients. RBC 2,3-DPG, on the other hand, did not differ from the normal mean in 16 insulin-dependent diabetics without vascular involvement. The increase of RBC 2,3-DPG represents principally a consequence of the vasculopathy.