Yngve Larsson

Blood lipids in diabetic and non-diabetic schoolchildren.

The fasting blood levels of cholesterol, phospholipids, glycerides and free fatty acids (79 cases only) were determined in a group of 7–20‐ year‐old school children, consisting of 137 diabetics and 121 matched non‐diabetic controls.

Home Blood Glucose Monitoring in Diabetic Children and Adolescents.: A 3-year Feasibility Study

ABSTRACT. In order to elucidate the question whether blood glucose monitoring should replace glucosuria testing in childhood diabetes 160 diabetic children and adolescents were invited to participate in a feasibility study on home blood glucose testing. Seventeen girls and 15 boys with an age of 4–21 years and duration of diabetes for 0.3‐18.7 years accepted, thus a selection of motivated patients. They performed 20–22 diurnal blood glucose profiles, each consisting of 7 blood samples, during a 3 month period. Thereafter, all patients were encouraged to continue blood glucose self‐control and the actual performance of the 32 patients was evaluated 3 years later. Daily glucosuria tests were also made and HbA1 was analysed. Patients’attitudes were evaluated through 2 questionnaires. The study shows that blood glucose monitoring is feasible in the actual age groups. Most patients were positive towards blood tests, particularly because it gave an immediate answer to an actual problem, but its introduction did not change the metabolic control. However, pain restricted its daily use and only 6.4% of the patients preferred blood testing to urinalysis for long term use. Furthermore, the correlation between home glucosuria and HbA1 was as good as between home blood glucose and HbA1. It is concluded, that blood glucose self‐monitoring is a valuable tool in the management of childhood diabetes, but that it should be regarded as a complement to and not a substitute for daily home urinalysis.

Effect of glucagon on the plasma level of free fatty acids.

The effect of intravenously administrated glucagon on the plasma level of free fatty acids (FFA) and on blood sugar was studied in 24 girls, 11–19 years old, of which 10 had diabetes, 8 had obesity and 6 were controls. Fasting levels of FFA were significantly higher in the diabetes and obesity groups than in the control group. After glucagon there was a decrease of FFA which was more evident in the control and obesity groups than in the diabetes group. The blood sugar response was moderate and identical among the obese and the controls, but more marked and more prolonged among the diabetics. The mechanism behind the effect of glucagon on plasma FFA is discussed.

The Organization and Functions of a Clinic for Juvenile Diabetes

In view of the poor long‐term results of juvenile diabetes mellitus, a more intensive metabolic control is considered the therapeutic alternative which should be given serious long‐term trial. The consequences of this opinion as regards the organization of the diabetes clinic are described. The need of the subspecialities represented in the pediatric university clinic is emphasized. The role of the dietitian and principles of dietary treatment are outlined. Teaching of the patients is regarded as one of the main therapeutic tools, and methods used are described. Patients with juvenile diabetes should remain under pediatric supervision until they have reached full maturity.

43. Tolbutamide in Juvenile Diabetes

1. Sulphonylurea therapy with tolbutamide was tested in 33 fresh cases of juvenile diabetes, 15 boys and 18 girls, from 1 to 16 years old. 2. Tolbutamide alone in the initial phase of diabetes, without concomitant insulin (2 cases) produced no discernible effect on the levels of sugar in blood or urine. 3. When tolbutamide administration was begun in a postinitial phase, when the patient had received insulin for some months (11 cases) a clear normalizing effect appeared in 2 cases, but ceased after treatment had been given for 1 and 4 months, respectively. 4. When tolbutamide was given in an early initial phase, concurrently with insulin, and the diet was moderately restricted (20 cases), a definite effect was seen in 18 cases. This effect, which is still present in 15 cases, took the form of greatly reduced insulin requirements: for long periods the patients required no exogenous insulin and yet showed normal blood sugar levels and absence of glycosuria. 5. In a case of prediabetes a diabetic glucose tolerance normalized in association with tolbutamide therapy. 6. The negative attitude which earlier writers have displayed to sulphonylurea compounds in juvenile diabetes is unwarranted. Under the conditions outlined here, such drugs can produce a remission in the postinitial phase of diabetes. Even if its effect proves to be transitory, early treatment in this form may favourably influence the continued course of the disease. 7. These findings support the theory of a direct pancreotropic, beta-cell stimulating effect of tolbutamide. In the successful cases i t may be assumed that remnants of islet tissue were stimulated to increased insulin secretion after they had been protected by exogenous insulin against deleterious hyperglycaemia.

Acute complications in juvenile diabetes mellitus.

1. During the 10‐year‐period 1942–1952, 218 diabetic patients were hospitalized on altogether 500 occasions at the Medical Department of Crown Princess Lovisas Childrens Hospital in Stockholm. Ninety‐six (44.0 per cent) were admitted on one occasion only and the remainder on more than one occasion. Fresh, previously untreated diabetes was present on 142 occasions (28.4 per cent). The rest of the series consisted of patients suffering from previously diagnosed and treated diabetes. Diabetic coma occurred 24 times in the former group and 34 times in the latter. The total coma incidence in the whole series amounted to 11.6 per cent. The mortality was 4.1 per cent (9 patients), of which 3.7 per cent was from diabetic coma.

Dermatitis Herpetiformis in Children A report of three cases

Three cases of dermatitis herpetiformis in children are described. The first case, a new‐born child, is remarkable as the disease is very rare in the neonatal period. All the cases were typical with a symmetrical multiform eruption, a chronic course without affection of the general condition and with a marked longstanding eosinophilia of the blood.

Chemo-prophylaxis against Nosocomial Infections

1 Earlier experiments with chemo‐prophylaxis indicate the definite value of this method as a protection against infections of various kinds 2 Experiments have been carried out with chemo‐prophylaxis against nosocomial infections at a childrens hospital. 291 children of all ages were given a continuous small dose of sulfathiazole during the whole stay at the hospital. 309 children represented a control material which was not treated. The frequency of infection was considerably less in the treated group, and the difference is statistically significant 3 When nosocomial infections occurred in the treated group in spite of the prophylaxis, they were found to be more moderate than the infections in the control group 4 No toxic reactions of any importance were observed 5 The risk factors at chemo‐prophylaxis with compounds belonging to the sulfanilamide group are discussed. Finally, the practical applicability of the method is touched upon.

To Niilo Hallman at his reception of the Rosén von Rosenstein medal, May 1979

Niilo Hallman, It is a great pleasure and honour for me to welcome you here today in Uppsala as a most distinguished guest of the Swedish Pediatric Association and as a receiver of the Rosen von Rosenstein awards. It is easy to introduce Niilo Hallman to this audience because in the Scandinavian pediatric setting he is since many years a leading and wellknown person, both in his capacity as an outstanding research worker with a comprehensive scientific activity and as a leading member and adviser of many of our scientific societies, editorial boards and other organizations in the fields of pediatrics and child health. A rapid and active university career led Niilo Hallman to the chair of Pediatrics at the university of Helsinki already in 1957, including the post as chairman of the Children’s Hospital in Helsinki, a place which he has remained faithful until this day. Niilo Hallman’s contributions to our knowledge are many and important. The list of his scientific publications is long and impressive. Stimulated by the academic atmosphere of Harvard University where he spent a few years early in his career, his interest was awaked for the renal problems of children and especially the complex of the nephrotic syndrome. Within this field he has described a new, severe but fascinating disease, the nephrotic syndrome of the newborn, particularly common in the Finnish population-the “morbus Hallman”. It is further necessary to mention Niilo Hallman’s numerous studies on infantile gastroenteritis, still one of the main causes of the high infant mortality in poor countries and a disease that was a great killer also in the Scandinavian countries only a few decades ago. Niilo Hallman’s studies in the electrolyte shift and mineral metabolism in severe diarrhoea and on the treatment of this disease have greatly increased our knowledge in this field and contributed to the considerably improved prognosis for dehydrated children. Among the many other fields which Niilo Hallman has covered in his research work I would also like to mention his studies on the blood sugar of newborn children, which have helped to clarify a previously obscure area. Niilo Hallman’s outstanding capacity has led him to a number of important activities in child health, pediatric research and medical science both in his own country and in international organisations. Let me remind you of his leading role in the General Mannerheim League for Child Welfare, and in our sister organization, the Finnish Pediatric Association as well as his long-standing contributions within the Board of the International Pediatric Association, the European Society for Pediatric Research and the European Society for Pediatric Nephrology .

Physical exercise and juvenile diabetes - summary and conclusions.

Abstract. Larsson, Y. (Department of Pediatrics, University Hospital, Linköping, Sweden). Physical exercise and juvenile diabetes.—Summary and conclusions. Acta Paediatr Scand, Suppl. 283: 120, 1980.—The various metabolic effects of physical exercise in ketotic diabetics, non‐ketotic diabetics and non‐diabetics are summarized. A favorable metabolic effect is only observed during optimal insulin administration, while in ketotic diabetics exercise may aggravate the metabolic situation. The use of exercise as a tool in the routine treatment of young diabetics is described. Activity‐produced hypoglycemia should be prevented through an adequate food intake and through patient education. Regular exercise may postpone the appearance of diabetic microangiopathy.