Hemoglobin A_I (Hb A_I) levels were measured in 103 diabetic patients. It was found that the Hb As levels were significantly correlated with the FBS levels before 4 and 6 weeks.
When the FBS levels before 4 weeks'were matched, no significant relations were observed beteween Hb As levels and administration of insulin or hypoglycemic agents, age, sex, duration of diabetes mellitus, diabetic complications (retinopathy, nephropathy, neuropathy), obesity, blood pressure, smoking, serum HDL-cholesterol levels or lecithin-cholesterol acyltransferase activity.
It is concluded that Hb As levels may represent a good index of FBS before 4-6 weeks in diabetics.

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The pancreatic somatostatin content in streptozotocin-induced diabetic rats was examined with or without insulin administration. Streptozotocin, 65 mg/kg, was injected into Sprague-Dawley rats via the tail vein. The control rats were given 0.1 M citrate buffer, pH 4.5. Half of the diabetic rats received saline injection and the other half were injected daily with 4 units of Lente Insulin (Novo) subcutaneously for 4 weeks. On the day after the last injection, the rats were sacrificed by decapitation. Trunk blood was collected and the blood glucose was determined with an autoanalyzer. The pancreas was quickly removed, and somatostatin and insulin were extracted with chilled 2N acetic acid. The material was centrifuged and the supernatant was lyophilized and assayed by radioimmunoassay. The somatostatin content of the pancreas and of isolated islets was increased in the diabetic rats, and the increased somatostatin content returned to the control level after insulin administration. The insulin content of the pancreas was decreased in the diabetic rats, and insulin administration did not alter the content. Blood glucose decreased in the diabetic rats treated with insulin. Body weight increased in the insulin treated rats, but did not increase in the non-treated diabetic rats. It is suggested that the effect of the insulin administration on the pancreatic somatostatin content might derive from improvement of the diabetic state and/or of the hyperglucagonemia and/or of the hypoinsulinemia.

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The number and causes of severe hypoglycemic cases among diabetic patients during the past one year due to oral hypoglycemic drugs and insulin in Nagoya City were investigated by sending questionnaires to 521 physician's offices and 115 hospitals. 39.3% of the questionnaires were answered. 5868 cases of diabetic patients were included in the present study. The frequency of severe hypoglycemia was 0.31% among patients treated with oral hypoglycemic drugs and 1.27% among those treated with insulin. The percentage of severe hypoglycemia due to oral hypoglycemic drugs was lower than that reported by Yuchi in 1975 (1.36%). However, the patients managed by insulin were more or less equal to the percentage reported by Yuchi in 1975 (1.53%). The major cause of the severe hypoglycemia due to oral hypoglycemic drugs was inappropriate drug therapy by doctors. The major cause of the severe hypoglycemia due to insulin in the present study was insufficient intake of diet. Lack of proper education of patients about hypoglycemia and carelessness regarding hypoglycemia by both doctors and patients were also resposible for severe hypoglycemia due to insulin. The finding that seven out of eight cases of severe hypoglycemia due to oral hypoglycemic drugs were patients aged over 70 years emphasized the special attention needed in the therapy of oral hypoglycemic drugs in elderly patients. The body weights of patients with severe hypoglycemia due to insulin were light, indicating that lean patients were more liable to suffer from insulin hypoglycemia. A questionnaire concerning the injection modality of insulin in diabetic patients revealed that self-administration of insulin by patients was far more frequent than administration by doctors and nurses. However, severe hypoglycemia due to insulin occurred equally in self-injected Patients and in those injected by doctors or nurses. This clearly shows that the frequency of severe hypoglycemia due to insulin was smaller in patients undergoing selfinjection than that those receiving injections from doctors and nurses.

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The response of plasma glucagon to insulin-induced hypoglycemia in diabetics whose fasting blood sugars (FBS) were normalized by conventional therapy was investigated. The diabetic subjects were classified as follows. Group Da consisted of 10 patients whose FBS levels were up to 100 mg/dl, while group Db consisted of 9 patients whose FBS levels were more than 100 mg/dl but less than 140 mg/dl The control group (N) consisted of 12 non-obese, healthy subjects.
The blood ugar, plasma glucagon (IRG), growth hormone (HGH), and adenosine 3, 51-monophosphate (cAMP) were measured before and after intravenous injection of MC ctrapid insulin at a dose of 0.05 U/kg in group N and 0.05 U/kg or 0.1 U/kg in groups Da and Db. The FBS levels in groups N, Da and Db were 85±2 M±SE, 88±3 and 114±3 mg/dl, respectively. The minimal blood sugar levels after insulin injection in groups N, Da and Db were 37±2, 39±3 and 43±mg/dl, respectively. No significant differences in the responses of plasma HGH and cAMP were observed among the three groups. The plasma IRG levels before insulin injection in groups N, Da and Db were 108±27, 117±22 and 117±26 pg/ml, respectively. The maximal AIRG evels in groups N, Da and Db were 107±22, 69±15 and 22±14 pg/ml, respectively. Although the maximal AIRG levels in groups N and Da were not significantly different, the maximal AIRG level in group Db was significantly lower than that in group N. The incremental areas of plasma IRG for 120 min in groups N, Da nd Db were 4128±823, 2967±523 and -591±1254 pg. min/ml, respectively. There was no significant difference between the incremental reas of plasma IRG in groups N and Da, but the incremental area of plasma IRG in group Db was significantly lower than in group N.
In conclusion, it is suggested that the responsiveness of pancreatic A-cell function can be normalized in diabetics, if the diabetes mellitus can be well controlled, and that abnormality of pancreatic A-cell function in diabetes mellitus may result, secondarily, from shortage of insulin action.

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It is commonly accepted that the main aim of treatment in pregnant diabetics is the normalization of abnormal metabolism. Hemoglobin Ai (HbA_I) was therefore measured together with blood glucose in 28 pregnant diabetics in order to assess its use as an index of the control of diabetes in pregnancy.
Except for one of the women, all the subjects had been treated with insulin for diabetes before pregnancy. The average age of the pregnant diabeticse was 28.5 years and the average duration of diabetes was 6.7 years. The control groups consisted of 20 healthy non-pregnant women, 123 healthy pregnant women, 14 pregnant chemical diabetics and 90 non-pregnant diabetic women.
The average age amongs the control groups was 27.5 to 30.1 years. HbA_I was measured with an Isolab “Quick-Sep” Kit during each trimester of pregnancy and again in the postpartum period.
The HbA_I levels were 7.0±0.6%(M±S.D.) in the healthy women and 10.7±2.8 in the non-pregnant diabetics. The level in the healthy pregnant women (determined “normal” by GTT) was not significantly different from that of the non-pregnant healthy women, nor was there a change in level throughout pregnancy. In “borderline” pregnant women, the HbA_I level was significantly higher than that of “normal” women in the third trimester only.
Pregnant chemical diabetics showed no significant differences of level from those of the “borderline” group. The HbA_I level in pregnant diabetics was 11.1±2.5% during the first trimester, decreased significantly during the second and third trimesters, and tended to rise again slightly in the postpartum period. The decrease in HbA_I level during the second and third trimesters was believed to be a reflection of strict control during those periods and the increase in the postpartum period that of both relaxation of control and hyperglycemia.
Thirteen of the 28 pregnant diabetics have successfully delivered to date, and there appears to be a strong correlation between the levels of HbA_I and blood glucose in the third trimester and birth weight of the children. Neonates of diabetics mothers with HbA_I levels of below 9%, fasting blood glucose of below 100 mg/dl and postprandial blood glucose of below 130 mg/dl were considered close to normal. It is suggested therefore that HbA_I, fasting and postprandial blood glucose should be considered together as an index in the treatment of pregnant diabetics.

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The actions of porcine insulin antiserum on the interactions of insulin with human liver membranes were investigated. When ¹²⁵I-insulin was preincubated with anti-insulin serum, the insulin binding was decreased in relation to the concentration of antiserum. The ¹²⁵I-insulin binding to liver membranes in the presence of serum from insulin-treated patients, had an inverse relationship with the ¹²⁵I-insulin binding to patient serum (r=0.93, p<0.05).
Scatchard plot analysis of the ¹²⁵I-insulin binding data revealed no change in affinity in the binding data in the presence of antiinsulin serum, but there was a decrease in total binding capacity (high affinity plus low affinity). Anti-insulin serum accelerated the dissociation of insulin from liver membranes as compared to the control (p<0.05), and 98.5% of the dissociated insulin was found to rebind to anti-insulin serum. Similarly, ¹²⁵I-insulin dissociated from anti-insulin serum rebound to liver membranes.
The above results suggest that in vivo insulin bound to insulin antibodies does not bind to insulin receptor, and that insulin antibodies accelerate the dissociation of insulin from the receptor.

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This report concerns 12 cases of diabetes mellitus complicated by Dupuytren's contracture. The patients, 10 males and 2 females, ranged in age from 39 to 76 years. The duration of diabetes mellitus was from 8 to 23 ears.
Thickening and nodulation of the palmar fascia and flexor deformity were observedin all cases. Three patients had plantar thickness. The relationship between the clinical features of diabetes mellitus and Dupuytren's contracture is discussed. The diabetic control, in 10 cases who were treated with insulin, was poor.
Diabetic etinopathy was observed in 9 cases, and neurological abnormlities as judged from the ankle jerk and/or vibratory ensation in the lower limbs were also noted in all cases. In the case of patients under 60 years old, their ndition was complicated by cirrhosisof the liver and/or they were heavy drinkers or manual laborers. These factors seem to be contributory to the progression of Dupuytren's contracture. Patients who were treated by either partial asciotomy or massage with cream containing anti-inflammatory agents were slightly improved.
Thus, Dupuytren's contracture may be related to diabetic neuropathy and angiopathy, resulting from on uncontrolled diabetic state.

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Two cases of Turner's syndrome associated with diabetes. mellitus and anti-thyroid antibodies are reported. The first was a 36-yr-old woman who was admitted to our hospital due to short stature and amenorrhea. Her growth and development had been retarded from birth and diabetes mellitus was found at the age of 32. On admission she was 131 cm tall and weighed34 kg. Her chest was shield-shaped with immature breasts. Short metacarpus, black freles andsex-infantism were noticed. Her IQ titer was 70 and anti-thyroid antibodies were detected highly with normal thyroidal function. Her karyotype was 45 XO/46 XXqi. Her HLA type was A₂, A₁₀, B₇, and BW₂₂.
The second case was a 20-yr-old woman who was admitted to our hospital due to short stature and amenorrhea. She was born maturely with a birth weight of 2300 g and her growth had been retarded. Her grand-mother was a diabetic. On admission she was 140 cm tall and weighed 43 kg. She had goiter, a shield-shaped chest, short metacarpus, black freles and sex-infantism. Laboratory data revealed positive anti-thyroid antibodies with normal thyroidal function. Her karyotype was 45 X0. Her HLA type was A₂, B₁₂.
By endocrinological tests, both cases showed diabetic patterns of 100 g-OGTT and high LH & FSH responses to LH-RH tests. However, their TRH tests and Insulin-tolerance tests were normal.
A high incidence of diabetes mellitus and thyroid autoimmunity in Turner's syndrome has been reported in several papers. Based on our cases, the possible significance of an association of diabetes mellitus and autoimmunity with sex chromosomal abnormality is discussed.

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The plasma levels of four monocarboxylic short-chain fatty acids (SCFA) were determined gas-chromatographically in 10 normal subjects, 27 nontreated diabetics and 15 nontreated hyperthyroidism according to a modification of the methods of Mahadevan et al. The concentrations of acetate and propionate were markedly increased in diabetics. In particular, there was a close correlation between the acetate concentrations and levels of fasting blood sugar. These phenomena are explained on the basis of impaired functions of acetyl-CoA carboxylase (EC 6. 4. 1. 2.) and acetyl-CoA synthetase (EC 6. 2. 1. 1.). It appears likely that such impairments cause under-utilization of active forms of these organic acids and eleveated plasma concentrations of the free acids. The concentrations of isobutyrate and isovalerate were not significantly different among the various experimental groups.
Since the origins and physiological significance of these SCFA have not yet been thoroughly elucidated, they require further study in relation to branched-chain amino acids, pyruvate, citrate, lactate and medium-chain fatty acids.

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We have reported that glucomannan can be of great benefit in the treatment of diabetics by reducing serum cholesterol levels, decreasing postprandial glycemia, reducing 24-hour urinary glucose and decreasing the dosage of insulin. However, previous studies have suggested that the effects of glucomannan might be greater when it is used in a gelled form. We therefore compared the effects of glucomannan supplements in 50 g OGTT and a test meal in normal subjects.
The mean blood glucose and insulin levels with standard OGTT supplemented with 3.9g glucomannan in three different ways (non-gelled, gelled or mixed into glucose solution) were less than those of the standard OGTT. However, there were no significant differences among these groups.
On addition of 3.9 g glucomannan to the test meal, glucomannan caused a marked decrease in the mean blood glucose and insulin level compared to the OGTT groups. When 3.9 g glucomannan was incorporated into the food (butter and corn soup), the mean blood glucose and insulin levels were more significantly reduced than those in the case of taking 3.9g glucomannan 15 min before the test meal.
It is suggested therefore that glucomannan should be intimately mixed with the food for the management of diabetics as well as guar gum and pectin.

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