H. Liebermeister

Weight regain after low calorie diet: long term pattern of blood sugar, serum lipids, ketone bodies and serum insulin levels.

Summary4 years after controlled clinical treatment with a 1000 calorie mixed diet, 24 patients were reinvestigated to assess (1) whether the improved metabolism, as observed during therapy, is merely the result of starvation and (2) to what extent this improvement continues beyond the time of dietary treatment. — The following tests were carried out: Oral G.T.T. (100 g), immunoreactive insulin, free fatty acids, free glycerol, triglycerides, cholesterol, acetoacetate and beta-hydroxybutyrate. — 12 patients had been able to maintain their weight or reduce further. They showed a slightly improved glucose tolerance and a more normal secretion kinetic for insulin release. However, 12 individuals who were found to have a 35% weight gain (Broca), returning almost to their initial weight, showed a decreased glucose tolerance compared with previous examination, while insulin levels were slightly elevated, with a typically delayed secretion. Both groups showed a weight-independent elevation of cholesterol and triglyceride levels and a marked decline of plasma FFA, free glycerol and ketone bodies. The parameters of lipid metabolism may possibly be influenced by the composition of the diet, while a change of weight after reduction primarily affects blood sugar levels and, to a lesser extent, insulin levels.

Behandlung von Altersdiabetikern während der Operation mit intravenösen Tolbutamidgaben

SummarySubstitution of insulin for a dietary regime with or without oral hypoglycaemic agents prior to operation is, despite its general use, often not satisfactory because of lack of time and leads frequently to hypoglycaemia and sometimes to excessive insulin-antibody production. We therefore administered 1.0 g of Tolbutamidei.v. together with at least 100 g of carbohydrates per day to 36 non-insulin dependent diabetic patients, and compared the results with those of 28 similiar cases switched to insulin preoperatively in the usual way (I), and those of 27 patients receiving insulin before, during and after the operation (II). Interventions in the group on Tolbutamide i.v. (III) were more severe and lasted longer than those in the control groups. Blood-sugar levels on the operation day rose to 209 ± 76 mg% in the Tolbutamide group, (Control group I 203 ± 57, II 186 ± 52). Hypoglycaemia was observed in the control groups only. The method proposed avoids unnecessary insulin treatment and its consequences, and can be recommended, with correct selection of patients, for further evaluation during minor and more extensive operations.