The aim of this retrospective study was to evaluate the prevalence of microalbuminuria in type 1 and 2 diabetic patients with or without high blood pressure levels. 653 patients were involved in the study [type 1 : n = 413 (normotensive : n = 298 ; hypertensive : n = 115) ; type 2 : n = 240 (normotensive : n = 93 ; hypertensive : n = 147)]. In type 1 diabetic patients, the prevalence of microalbuminuria was of 21 per cent. Microalbuminuria was also found in 28 per cent of type 2 diabetic subjects (p < 0,10 vs type 1). The prevalence of microalbuminuria was significantly higher in hypertensive than in normotensive diabetic subjects (28 vs 20 per cent ; p < 0,05). Blood pressure in type 1 and 2 normotensive patients was significantly higher in subjects with than without microalbuminuria. We also observed higher HbA1 levels in microalbuminuric type 1 diabetic patients. Finally, we also assessed that the prevalence of diabetic chronic complications was higher in type 1 patients with than without microalbuminuria (p < 0,05). This relationship was not evidenced in type 2 diabetic patients. In conclusion, the prevalence of microalbuminuria in a population of type 1 and 2 diabetic patients is high. We confirm in this study the relationship between microalbuminuria, blood pressure, and HbA1.

The aim of the study was to evaluate the effect of a computer-assisted insulin delivery on the glycemic control of type I unstable diabetic patients. 6 subjects, who already received 2-4 daily insulin injections, were treated with a pocket-size microprocessor device for periods lasting 2-14 months. The total daily insulin doses remained unchanged during the experimental period. However, the percentage of regular insulin decreased significantly from 63 +/- 3% to 47 +/- 7% (p less than 0.05). HbA1 levels decreased from 10.1 +/- 0.6% to 9.4 +/- 0.4% after 2 months computer (p less than 0.05). However, in the 2 patients who used the device for 11-14 months, the overall glycemic control was comparable during the basal and experimental periods. Hypoglycemic episodes were not increased.

SummaryThe simultaneous unusual occurrence of isolated adrenocorticotrophin (ACTH) deficiency and primary hypothyroidism was clearly demonstrated in a female patient complaining of tiredness. An empty sella was also evidenced by computed tomography and magnetic nuclear resonance. We suggest that an autoimmune process could be involved in the pathogenesis of the syndrome.

The aim of this study is to compare the blood glucose profile and the glycemic control in Type 1 diabetic patients under two conventional semi-synthetic human insulin regimens (2 daily injections) combining regular (Actrapid) and intermediate acting insulins (Monotard or Protaphane). Actrapid-Monotard (scheme A) and Actrapid-Protaphane (scheme B) were administered during 3 months each, in a randomized order, to 18 outpatients. The glycemic control was evaluated by home glucose monitoring, as well as by the monthly measurements of HbA1. The total daily dose of insulin was comparable during each treatment period: 0.68 +/- 0.06 (scheme A) and 0.71 +/- 0.06 U/kg body wt. (scheme B) (mean +/- SEM). However, the total percentage of regular insulin was higher with Monotard than with Protaphane: 58 +/- 3 vs 48 +/- 5% in the morning (p less than 0.005) and 51 +/- 2 vs 46 +/- 3% in the evening (p less than 0.05). In C-peptide positive patients, the blood glucose values were comparable at all times with either insulin scheme. In contrast, in C-peptide negative patients, the blood glucose levels were higher in the afternoon with scheme B: 11.8 +/- 1 vs 8.6 +/- 1 mmol/l at 3 pm (p less than 0.02) and 12.2 +/- 1.3 vs 9.7 +/- 1.6 mmol/l at 6 pm (p less than 0.01). A slight but not significative increase of HbA1 was observed during the B period. In conclusion, an Actrapid-Protaphane scheme requires the use of a lower proportion of regular insulin than an Actrapid-Monotard treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of our study was to measure the gastric emptying rate for a solid meal in diabetic patients who had no gastrointestinal complaints with (group 1, n = 12) or without (group 2, n = 10) cardiac autonomic neuropathy and in normal controls comparable in age and sex (group 3, n = 10). Gastric emptying rate was assessed with a sequential scintiscanning method. The percentages of the initial isotope activity remaining in the stomach at different times (20, 40, 60, 80, 100, and 120 min) after the ingestion of a Tc-99m-labeled test meal and the emptying half-time were calculated. Cardiac autonomic neuropathy was determined by the beat-to-beat variations in heart rate during deep breathing. A significant reduction of the gastric emptying rate was observed in group 1. Indeed, at 80, 100, and 120 min the percentage of residual isotope activity was 73 ± 4, 60 ± 6, and 50 ± 6% (mean ± SE), respectively, in group 1 versus 61 ± 3 (P < .05), 45 ± 4 (P < .05), and 32 ± 4% (P < .02) in group 2. In group 3, residual isotope activity was 57 ± 4 (P < .05 vs. group 1), 41 ± 4 (P < .05), and 29 ± 4% (P < .02), respectively. Emptying half-time was also longer in group 1 (121 ± 9 min) than in group 2 (95 ± 6 min, P < .05) or group 3 (90 ± 4 min, P < .02). For a given diabetic patient, there was no correlation between abnormal low gastric emptying and cardiac autonomic neuropathy. In conclusion, this study shows that in a group of diabetic patients with cardiac autonomic neuropathy, mean gastric emptying rate for solid meals is significantly impaired when compared with patients without cardiac autonomic neuropathy or normal controls, even when gastrointestinal symptoms are absent.

Calcitonin and its carboxyl-terminal flanking peptide (PDN-21), also encoded by the calcitonin gene, were measured by RIA in unextracted serum of normal subjects and patients with primary hyperparathyroidism and surgically verified and suspected medullary thyroid carcinoma. Serum PDN-21 was detectable (greater than 0.005 ngeq/ml) in the large majority of normal subjects (92%), and the values increased significantly more in men than women (4.8- and 2.0-fold, respectively; P less than 0.01) in response to 1-min iv calcium injections. Calcitonin was detectable (greater than 0.025 ngeq/ml) in only 25% of normal subjects before iv calcium and became measurable after iv calcium in 88% of men and 41% of women. In patients with chronic hypercalcemia due to primary hyperparathyroidism, PDN-21 and calcitonin were within normal limits. In normal subjects, iv pentagastrin (0.5 microgram/kg BW) did not increase PDN-21, and calcitonin remained undetectable. In 41 medullary thyroid carcinoma patients, basal PDN-21 and calcitonin levels were increased similarly, and they were stimulated in response to iv calcium or iv pentagastrin. In 5 siblings of medullary thyroid carcinoma patients, PDN-21 and calcitonin were increased in response to iv pentagastrin, and we suspect C-cell hyperplasia or medullary thyroid carcinoma. In conclusion, a diagnostically useful RIA for the measurement of PDN-21 in unextracted serum which complements calcitonin measurements has been developed.

SummaryThe effects of an a-glucosidase inhibitor, Acarbose (Bay g 5421) upon the circadian plasma glucose profile were studied in 7 diabetic patients in i hospital. All subjects were totally insulin-dependent as demonstrated by their low preand postprandial plasma C-peptide levels. The patients received Acarbose (5 days) or a placebo (4 days) in a randomized order.The mean plasma glucose levels, the M value and the MAGE index recorded during both periods were compared. Acarbose was given at doses of 200, 100 and 100 mg before breakfast, lunch and dinner, respectively. The doses of regular insulin (4/day) were daily adapted throughout the study in an attempt to reach the best possible glycemic control. Even though the insulin doses did not significantly differ during both periods, a significant dei crease of the mean plasma glucose levels was observed when the patients received Acarbose (8.2 ± 0.4 vs 10.1 ± mmol/1; P < 0.05). Moreover, the drug induced a significant decrease of postprandial plasma glucose measured at 10.30 am and 8.30 pm; the M value was also lower during Acarbose than during placebo (36 ± 6 vs 45 ± 6; P < 0.02) while the MAGE index remained unaffected. Except for an increase in the number of hypoglycemic episodes, no side effects were recorded. Thus, Acarbose could represent an useful complementary drugt in the treatment of type 1 diabetes, essentially by lowering the postprandial rise of plasma glucose.

SummaryDiabetic autonomic neuropathy is a poorly defi ned neurologic entity with morbid and occasional lethal consequences. Cardiovascular effects of the diabetic autonomic neuropathy may include resting tachycardia, postural hypotension and painless myocardial infarction. The involvement of cardiovascular reflexes (beat-to-beat variation during breathing of Valsalva manoeuvre) assesses a cardiac parasympathetic dysfunction.The occurrence of a postural hypotension implies an orthosympathetic damage. We analysed the incidence of autonomic neuropathy in a group of totally insulindependent diabetic patients (mean circadian C peptide level: 0.04 + 0.003 pmol/ml, mean ± SEM) and in a group of diabetic patients, with a residual insulin secretion (mean circadian C peptide level: 0.80 ± 0.09 pmol/ml). 44 % of all the patients had up to 4 cardiovascular abnormal tests.Postural hypotension was observed in 11 % of the subjects. We found a significative correlation between the autonomic neuropathy and the duration of diabetes in subjects of group I (p < 0.01). No correlation between autonomic neuropathy and C peptide level or mean glycosylated hemoglobin was observed. The high incidence of autonomic neuropathy and the poor prognosis of this diabetic complication justifies its systematic research in all type I and type II diabetic patients.

The plasma glucose and plasma free insulin profiles of six totally insulin-dependent diabetic patients were compared during periods of 4 days in hospital under a conventional insulin therapy (ICIT) comprising 4 daily injections of regular insulin and under continuous subcutaneous insulin infusion (CSII). Two profiles of prandial insulin administration with CSII were compared: a rectangular (R) and an exponential wave (E) in which 50% of the dose was given rapidly followed by an exponential decrease. In both cases, the basal infusion rate was increased by 30-50% between 5 a.m. and 8 a.m. Mean circadian blood glucose was equally good with ICIT: R and E: 7.0 +/- 0.9, 7.3 +/- 1.0, and 7.1 +/- 1.0 mmol/L, respectively. In five patients, fasting plasma glucose was higher with ICIT than with R and E (12.7 +/- 1.8 versus 6.9 +/- 1.0 and 6.8 +/- 0.8 mmol/L, respectively; t test: P less than 0.05; Wilcoxon: P = 0.06). Mean plasma free insulin level was significantly higher (t test: P less than 0.005; Wilcoxon: P less than 0.05) with ICIT (0.46 +/- 0.04 nmol/L) than with R (0.37 +/- 0.04 nmol/L) or E (0.36 +/- 0.05 nmol/L), although the daily doses were similar. In conclusion, CSII leads to a better glycemic control than ICIT, since it appears to prevent the morning rise of blood glucose.

SummaryContinuous subcutaneous insulin infusion (CSII) was performed in 3 totally insulin dependent diabetic patients (postprandial C peptide: 0.03 ± 0.01 pmol/l) for periods lasting up to 9 months. During this period, each patient measured his capillary blood glucose 2 to 5 times per day with the Dextrosix(R)/Dextrometer(R) method. A good glycemic control was achieved at home, as assessed by a mean plasma glucose level of ± 140 mg/dl and a M value ranging from 9 to 24. The mean total glycosylated hemoglobin levels in the 3 patients were 9.3, 9.2 and 11.9% respectively. Hypoglycemic episodes were rarely observed; CSII did not affect the usual way of life of the patients. We did not observe any improvement of the conduction velocy of sciatic nerves, as assessed by electro-myography after a few months of CSII.We conclude that a good glycemic profile can be obtained at home in totally insulin dependent patients with CSII.

histotoxic symptoms may be due to these, but the exact mechanism of action of thiocyanates is not known.4Thiocyanate intoxication with blood concentrations above 200 mg/l may be rapidly corrected by haemodialysis, which reportedly removes several grams of the drug.5We tried peritoneal dialysis but in the absence of clearance studies, which we could not do, we cannot comment on the procedure for intoxication with this compound.Distal part of oesophagus and stomach showing necrotic mucosa.

The artificial endocrine pancreas is generally used to control blood glucose in brittle diabetic patients. In this study, it was applied to the diagnosis and surgical management of a pancreatic insulinoma. Several tests were performed without the risks inherent to severe hypoglycemia. It was also used during surgery, permitting an optimal blood glucose control.