S. Nolan

Insulin Patterns in Equivocal Glucose Tolerance Tests (Chemical Diabetes)

Hyperinsulinemic patterns are a well recognized feature of equivocal glucose tolerances of the chemical diabetes type, i.e. those that are neither definitely nondiabetic nor clearly diabetic. A more complete characterization of such insulin responses is obtained when the data are expressed in terms of increments in insulin from the zero time point. Thus, two patterns of insulin increments after oral glucose become evident when the equivocal zone of glucose tolerance is divided into lower and upper segments. Tests in the lower segment show normal increments at the halfhour point of the test; at one hour these tests show excessive increments which persist throughout the five hours of observation. On the other hand, tests in the upper zone show delays in the serum insulin rise at the half-hour point, followed by normal increments at one hour and excessive increments thereafter. The pattern is the same whether or not obesity is present. It is suggested that tests in the equivocal zone of Glucose Tolerance Sum values be taken to be indicative of chemical diabetes. Tests with the Sum in the lower half of the equivocal zone could then represent chemical diabetes with mild intolerance stemming from insulin ineffectiveness, since insulin increments in this group are at or above the mean values recorded in nondiabetic controls. On the other hand, chemical diabetes with moderate glucose intolerance and Glucose Tolerance Sums in the upper half of the equivocal zone would be understood to result from a combination of an initial delay in the serum insulin rise followed by normal and then excessive increments in serum insulin with the latter two indicative of insulin ineffectiveness. However, insulin ineffectiveness may also be present at the time of the insulin delay. High glucose:insulin ratios in tests indicative of chemical diabetes are almost always attributable to higher glucose increments with insulin increments normal or excessive compared to normal glucose tolerances. Deficient insulin increments contribute to the high ratios only at the half-hour point in tests with Glucose Tolerance Sums in the upper zone of equivocal glucose tolerances.

Age‐Related Changes in Growth Hormone in Non‐Diabetic Women

ABSTRACT: In non‐obese women with unimpaired glucose tolerance (1,185 oral glucose tolerance tests) the serum level of growth hormone (GH) in the fifth and sixth age decades was below that in the third and fourth decades. Although obesity was associated with serum GH levels below those characteristic of non‐obese women, there was no evidence of a further age‐related decrease of the type observed in the non‐obese subjects. The lower serum GH level in women of the later age decades may well be related to the menopause with its decrease in the serum level of estrogen. Since there is no further age‐related decline in GH in obesity, it would appear that in obese premenopausal females, estrogen does not exert its usual GH‐enhancing effects.

Glucose Tolerance, Insulin, and Growth Hormone in Thyrotoxicosis and in Myxedema

In 32 consecutive patients with untreated thyrotoxicosis, oral glucose tolerance was normal in 60%, indicative of chemical diabetes in 29%, and diagnostic of overt diabetes in 11%. In 52 serial patients with myxedema, the corresponding figures were 50, 32, and 18 per cent.In subjects with glucose tolerance unimpaired, reactive hypoglycemia was absent in untreated thyrotoxicosis but occurred in 24% of the controls and in 43% of those with myxedema. Contrary to general belief, flat glucose tolerance curves were only slightly, if at all, more frequent in myxedema than in control subjects.In thyrotoxic or myxedema patients with normal glucose tolerance, the serum insulin responses were about the same as those of control subjects. Chemical diabetes in thyrotoxicosis or in myxedema was also accompanied by blood glucose and serum insulin responses indistinguishable from those recorded in control subjects with normal thyroid function and chemical diabetes. The same was true of overt or established diabetes in con...

Thyroid hormone‐like effects without thyrotoxicosis during one year's therapy with NA‐DT3 for hypercholesterolemia

A thyroid hormone analogue, sodium dextro‐triiodothyronine (NaDT3), at a dosage of 1 mg/day for 1 or 2 yr, decreased serum cholesterol levels about 30% in 26 hyperlipidemic adults. There were less sustained decreases in the serum phospholipids, and occasional lowering of the serum triglycerides, but no effects on body weight, blood pressure, or pulse rate. Changes recognized as variable concomitants of spontaneous or induced thyrotoxicosis, such as transient increases in fasting blood glucose, calcium, and globulin, persistent rises in alkaline phosphatase, and nonsustained decreases in hematocrit are consonant with the fact that Na‐DT3 exerts about one tenth of the thyroid hormone activity of LT3. These changes, however, appear to represent actions of iodinated amino acids apart from those effects that result in clinical thyrotoxicosis.

Phenformin Therapy of Chemical Diabetes

REPEATEDLY equivocal oral glucose tolerance test of the chemical diabetes type, i.e., neither definitely normal nor clearly diabetic by several current standards,1-5 may progress to persistent fasting and postprandial hyperglycemia which meets all criteria for overt diabetes mellitus. The data of the United States Public Health Service3 indicate that in time course of a decade, this occurs in about 50 per cent of the persons with a persistently equivocal tolerance for glucose. This sequence indicates that persistent chemical diabetes is an important arena for the prevention of overt diabetes. If this is so, then any measures which reduce or cancel such limited degrees of glucose intolerance could be prophylactic against the development of diabetes mellit.us and against its concomitants and corn plications.. The data herein presented tabulate tile results of a two-year trial of ami oral antidiabetic agent., phenetliyl l)iguamde or phenformin, in attempts to reduce time laboratory manifestations of chemical diabetes.

17(OH) corticosteroid and estrogen excretion with virilizing adrenal tumors.

In an adult with a virilizing adrenocortical adenoma and in six similar published instances, the high levels of urinary 17-ketosteroids usually present were associated with normal excretion of 17(OH)c

Ether derivatives of a progestin and estrogen in monthly dosage

The monthly ingestion of quingestanol acetate (2.5 mg) and quinestrol (2 mg) for 1 year by menopausal women was associated with increased numbers of superficial cells in Daginal smears and decreases in intermediate and parabasal cells. High serum FSH and LH levels were promptly returned to normal and remained normal. Serum triglyceride and T4 levels and plasma 11(OH) corticosteroids were consistently increased. Serum inorganic phosphorus and calcium levels decreased during the first month of treatment and remained decreased throughout the year. The calcium and phosphorus changes could reflect a protein‐anabolic effect with deposition of these ions in bone salts, but alternative explanations can be suggested. Serum solutes other than those already cited, serum enzymes, hematologic findings, electrocardiographic tracings, urinary steroids and creatinine, glucose tolerance and the associated serum insulin and growth hormone patterns, and a number of other routine laboratory procedures were not consistently affected by therapy with these dosages of quinestrol and quingestanol acetate. After 1 year of treatment urinary steroids and their responses to oral metyrapone were unchanged. Possible side etfects occurred in 3 of 18 patients: malaise, generalized pruritus, nausea, vomiting, and dizziness.

Growth Hormone Levels in Chemical Diabetes

ABSTRACT: Chemical diabetes is an incompletely defined form of glucose intolerance which is more common in the later decades of life. Long‐term observations indicate that in half of the patients with persistent chemical diabetes, overt diabetes mellitus develops in the course of one decade of aging. Other studies have established that chemical diabetes is characterized by hyperinsulinemia which may be preceded by an initial lag in the insulin responses to oral administration of glucose. As a group, persons with chemical diabetes manifest higher serum triglyceride levels, a greater frequency of electrocardiographic abnormalities, and increased proteinuria.