Effect of intravenous infusion of D-mannoheptulose on blood glucose and insulin levels in man.
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Adult↗
Biomedical subjects
A Lev-Ran
Publications and source records attributed to A Lev-Ran.
Transplantation of a pancreatic insulinoma into an insulin-resistant patient with juvenile diabetes.
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Adenoma, Islet Cell↗
Human obesity: an evolutionary approach to understanding our bulging waistline.
The unique worldwide spread of the human species and the remarkably long post-reproductive survival show that our genome permits excellent adaptation to vastly different environments. Moreover, the main scourges of later age, namely malignant growths and atherosclerosis, appear in humans later than in shorter-living animals. In recent years, excess weight and obesity have become mass phenomena with a pronounced upward trend in all developed countries. However, despite the detrimental effects of being overweight, these populations live longer than ever, which in part may be explained by the availability of better medical treatment. The prevalence and predicted further spread of obesity can be understood in the light of evolution. In all animal species energy metabolism is asymmetric with energy accumulation ('thrifty genotype') being the necessary condition of survival during hard times. For humans, which are no different to other animals in this respect, this genetic programming was necessary for survival because during the course of history, including the recorded history in the more developed Middle East, Europe or China, there was never a long period of uninterrupted food abundance, whereas famines were regular and frequent. Therefore fat accumulation, when food was available, meant survival at times of shortage, while the possible detrimental effects of overindulgence in food and being overweight expressed in unrealistically old age were irrelevant. It is the central, mostly intra-abdominal fat (in both humans and animals) that is more medically important than the subcutaneous truncal fat, and the accumulation of both types of fat is conditioned by high food consumption; therefore it is a historic novelty for human populations. In contrast, lower-body fat in human females is unique in the animal kingdom: it is much less metabolically active, it is of much lower pathologic significance than central fat, and it is programmed to be mobilized mostly during pregnancy and lactation. In view of all this, norms of desired weight should be based on hard mortality and morbidity statistics and not on theoretical, esthetic or fashion considerations. By this criterion, the upper limit of desirable weight is likely to be body mass index (BMI) 27 or 28, but specified for different populations (sex, race, ethnic origin); moreover, with aging, the detrimental effects of obesity diminish and finally disappear. Risks of other pathologies related to obesity (e.g. diabetes, hypertension and coronary disease) are also population-specific. However, total fatness, measured by BMI, is insufficiently sensitive as a risk factor, and fat distribution (upper-body versus low-body type, as reflected by waist circumference and waist:hip ratio) plays at least as prominent a role. Therefore the detailed norms, not yet available, should take into account both general obesity and fat distribution and be specific for different populations. Since long-term weight loss in adults is rarely achievable, public health measures should be aggressively directed at the prevention of obesity from childhood.
Adipose Tissue↗
Serum insulin, insulin antibodies and insulin requirement in the first period of insulin treatment in non-insulin resistant diabetics.
Twelve insulin-sensitive diabetics were studied for 200 days after the initiation of mixed beef-pork NPH insulin. Normalization of the fasting blood glucose was not accompanied by any elevation in the pre-treatment fasting immunoreactive insulin level. Insulin antibodies appeared in 2 patients on the second week of insulin treatment, in 6 others within 87 days. In 4 patients no antibodies were found 200 days after the start of insulin. The appearance of antibodies was accompanied in two patients by a decrease in insulin requirement, in others there was no change. When antibodies were present, the total maximum insulin binding capacity was 4 to 12 U/l, but the total insulin constituted only 3 to 36% of the binding capacity. Insulin wastage caused by the destruction of the immune complexes was calculated to be 0.35 to 5.6 U/die only, and this explains the negligible effect of insulin antibodies on insulin requirement in non-resistant patients.
Adolescent↗
Double-blind study of glycerol vs glucose in parenteral nutrition of postsurgical insulin-treated diabetic patients.
Twenty-five insulin-treated diabetic patients were randomly assigned postoperatively to 5 days of intravenous infusions of ProcalAmine (3% amino acids, 3% glycerol, and electrolytes) or FreAmineIII + dextrose and electrolytes. The solutions were given isocalorically and isonitrogenously. Insulin was adjusted to keep glycemia at the level of 150-200 mg/dl. The ProcalAmine group by the 5th day had plasma glucose of 158 +/- 25 mg/dl and required 1.20 +/- 0.10 U/hr insulin. The FreAmine + dextrose group had plasma glucose of 169 +/- 53 mg/dl and required 2.28 +/- 0.13 U/hr. At all time points postsurgically, the ProcalAmine group required less insulin.
Adult↗
Different body-fat distributions in IDDM and NIDDM.
Stepwise logistic regression was used for the analysis of the following anthropometric parameters in 146 adult patients with diabetes: waist/hips ratio, waist/thighs ratio, ratio of the arms-to-thighs circumferences, and ratio of the subscapular-to-triceps skinfolds. After adjustment for age and body mass index, only the waist/thighs ratio was found to have an independent discriminating value between insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients. The correlation of type of diabetes with the waist/thighs ratio was especially strong in women, exceeding even the role of age and body mass index. Other anthropometric parameters were related to type of diabetes through their correlation with waist/thighs ratio and had no independent discriminating value. The study shows that IDDM and NIDDM belong to different anthropometric types, which probably reflects their different pathogenesis.
Adipose Tissue↗
Nadirs of oral glucose tolerance tests are independent of age and sex.
We analyzed nadirs of 75-g oral glucose tolerance tests in 400 subjects who remained completely asymptomatic during the test. The median nadir was 63 mg/dl, the 10th percentile 48 mg/dl, and the 2.5th percentile 41 mg/dl. Seventy-five percent of the nadirs occurred at 3-4 h. There were no differences in the absolute level of nadirs between men and women, nor between the subjects 17-30 and 61-74 yr of age.
Adult↗
Heart rate variability in diabetes: relationship to age and duration of the disease.
Heart rate variability (HRV) during deep breathing was studied with a neonatal heart monitor in 143 control subjects and 218 patients with diabetes (102 with IDDM and 116 with NIDDM). In the control group HRV decreased after age 20 by 4-5 beats per decade (from 29.7 +/- 5.8 beats at age 20-29 to 11.8 +/- 5.4 beats at age 60+). In all age groups HRV in IDDM was lower than in the controls, and both age and duration of diabetes played a role in the decrease of HRV (from 21.5 +/- 5.3 beats at age 20-29 to 6.3 +/- 5.4 at age 60+). In NIDDM aging seemed to play a less important role, and the influence of the duration of the disease was not statistically significant. In both groups of patients the frequency of HRV below the 2.5th percentile was 82% in those with symptoms and/or signs of autonomic neuropathy, 64% in patients with peripheral neuropathy only, and 36% in those who had no obvious signs or symptoms of neuropathy. Interindividual variability was pronounced, and age and duration of the disease together accounted for only 36% of the observed differences between IDDM and the controls. Determination of HRV with a standard neonatal heart monitor presents an easy, simple, and nonstressful test of cardiac autonomic neuropathy. The norms of the test are age related.
Adult↗