W.J.H. Butterfield

EFFECT OF DIET, SULPHONYLUREAS, AND PHENFORMIN ON PERIPHERAL GLUCOSE UPTAKE IN DIABETES AND OBESITY

Abstract Peripheral glucose metabolism has been studied during oral glucose-tolerance tests in obese non-diabetics, before and after weight reduction by diet or oral phenformin therapy, and in maturity-onset diabetics before and after phenformin therapy, sulphonylurea therapy, or combined phenformin and sulphonylurea therapy. The results confirm earlier work that peripheral glucose uptake is reduced in obesity and diabetes. In non-diabetic subjects, weight reduction but not phenformin therapy caused a striking increase in glucose uptake. In the diabetics, successful therapy with any of the drugs, as gauged by a substantial fall in the fasting blood-sugar, was associated with a significant increase in glucose uptake. These findings suggest that the block to peripheral glucose uptake in obesity is different from that in diabetes, and that both blocks are reversible.

The effect of mild exercise on glucose uptake in human forearam tissues in the fasting state and after oral glucose administration

Peripheral glucose uptake was found to be comparable in the right and left arms at rest in fasting non-diabetic and diabetic subjects. In the fasting state, glucose uptake and blood flow in the exercising arm was higher than in the resting arm. Following the oral administration of 50 Gm. glucose, glucose uptake rose both in the resting limb and, to an even greater extent, in the exercising limb in the non-diabetic subjects. In the diabetics, the findings were variable, and no effect of exercise could be detected in 2 insulin-dependent diabetics deprived of insulin The mechanism of action of the exercise effect and its dependence on circulating insulin is discussed.

The 25-g intravenous glucose tolerance test: A critical appraisal

Abstract Absolute and incremental K values (glucose disappearance rates) have been calculated with the aid of a computer from arterial and venous blood sugar levels obtained simultaneously during the 25-g intravenous glucose tolerance test and correlated with the fasting blood the peak blood sugar following the 25-g intravenous glucose load, the peak rise of blood sugar above the fasting level, the blood sugar 15 min. after the start of the 3 min glucose infusion, the blood sugar 60 min after the start of the infusion, the mean glucose uptake by the peripheral tissues over the whole test, 0–61 min, the mean peripheral glucose uptake from 13–61 min and the skinfold thickness. None of the K values regularly gave rectilinear slopes of decline of the blood sugar but absolute venous K values for the last phase of the test gave the highest correlation coefficients. The incremental K values did not discriminate between normal and diabetic subjects; heavy urinary glucose losses in diabetics probably account for the high glucose disappearance in these circumstances. Absolute K values did discriminate but this is due in large part to the height of the fasting blood sugar in diabetics. None of the K values correlated closely with the total peripheral glucose uptake but the absolute K values did with the fasting and 60 min blood sugar.

Effect of exercise on peripheral uptake of 131I-iodo insulin and glucose in nondiabetics☆

The effect of exercise on insulin and glucose uptake in peripheral tissues in nondiabetic subjects has been studied by comparing the results of intraarterial injections of 131I-iodo insulin into resting arms with those of a similar injection when the forearm muscles were exercising. In the resting state, statistically significant linear correlations between the insulin concentration achieved and the insulin uptake from the blood and between the insulin uptake and the subsequent increase in glucose uptake were confirmed. Exercise markedly increased insulin uptake in relation to insulin concentration but did not affect the relationship between glucose uptake and insulin uptake. The simplest explanation for the effect of exercise increasing glucose uptake by muscle is an increased insulin uptake through the larger capillary bed opened up in response to muscle contraction.

The Population Served by the Out-patient Department of a London Teaching Hospital: A Study of Guy??s

The London teaching hospitals have filled several important roles in British medicine. First, for some centuries they have provided care for the sick; secondly, in providing care they have played a considerable part in developing modern effective treatment; and thirdly, until recent times they were the only places in England and Wales where the aspirant physician or surgeon could gain his clinical experience. Thus, in a very real sense they are not only the kernel of the London, but of the English medical tradition also. Many of them, including Guys, were seriously damaged in the war, and have embarked on rebuilding programmes. Therefore, partly because information was required for future planning in Guys itself, and partly because we were invited to participate in a national study of out-patient services sponsored by the Nuffield Provincial Hospitals Trust, we have carried out a survey of the Guys Hospital Outpatient department. Our first analysis,1 which was of the returns of outpatient attendances made by hospitals to the Ministry of Health (SH3 reports), showed that while in England and Wales as a whole, as well as in the Metropolitan Regions, out-patient attendances have increased some 15 per cent over the period 1951-1961, new or old out-patient attendances in the London teaching hospitals have changed little if at all; Guys was no exception. We present here a report on the nature of the outpatient population itself, and because of the similarity in the trends of the SH3 returns we believe that our findings are probably applicable to the other large central teaching hospitals. Our present findings confirm and amplify those of a preliminary pilot study.2