Biomedical subjects

D E Seigler

Publications and source records attributed to D E Seigler.

10 recordsLinked to original sources

PubMed1994

Splanchnic and systemic absorption of intraperitoneal insulin using a new double-tracer method.

The absorption of a bolus of intraperitoneal insulin into the splanchnic and peripheral circulations was separately assessed in dogs using an infusion of two insulin tracers (A1-[3H]insulin and B1-[3H]insulin). One tracer was infused into the superior mesenteric artery and the second into the jugular vein. Serial samples were taken before and after an injection of insulin (1 U/kg ip). Sampling was from the portal vein and the inferior vena cava. By using the principle of equivalent entry of tracer and unlabeled material, we developed two simultaneous equations for the rate of splanchnic and peripheral insulin absorption at each time point. These were solved to yield the two rates. Mean concentrations in the portal vein were approximately 25% higher than in the inferior vena cava, reflecting the splanchnic absorption. This rate accounted for almost half (51 +/- 9%) of the insulin absorbed. The remainder of the absorption was peripheral. The total recovery of intraperitoneal insulin, absorbed by either route, was 88 +/- 11%. Portal absorption peaked earlier than peripheral. Absorption by both routes was 90% complete within approximately 2 h (131 +/- 16 min). In summary, therefore, intraperitoneal insulin is rapidly and almost completely absorbed, with absorption split between the splanchnic and peripheral routes of entry.

Absorption↗

PubMed1992

Morning versus bedtime isophane insulin in type 2 (non-insulin dependent) diabetes mellitus.

Morning versus bedtime administration of NPH insulin was compared in 12 subjects with Type 2 diabetes and overt fasting hyperglycaemia. Subjects were studied at baseline (diet alone) and after 2 months on each of the two insulin programmes in a random crossover design, in which dosage was increased until at least one daily preprandial blood glucose was consistently in the range of 3.9 to 6.0 mmol l-1. Mean (+/- SEM) daily total insulin dosage was equivalent for the morning (0.36 +/- 0.03 units kg-1) and for the bedtime (0.37 +/- 0.03 units kg-1) insulin administration schedules. Glycaemic control was improved on both insulin regimens, but was better on bedtime than morning insulin. Fasting plasma glucose (mmol l-1) was 12.0 +/- 0.7 (baseline), 8.6 +/- 0.7 (morning), and 4.6 +/- 0.3 (bedtime), respectively. Mean 24 h plasma glucose (mmol l-1) was 13.3 +/- 1.3, 9.0 +/- 0.7, and 7.8 +/- 0.7. Glycated haemoglobin (%) was 7.65 +/- 0.35, 6.23 +/- 0.26, and 5.81 +/- 0.32. The improvement of basal glycaemia is a consequence of increased basal metabolic clearance of glucose (baseline, 47.6 +/- 3.1 ml m-2 min-1; morning 63.5 +/- 5.4, bedtime 103.5 +/- 7.1). There was no change in hepatic glucose output. It is concluded that bedtime administration of intermediate acting insulin results in increased basal insulinaemia, leading to improved basal glycaemia and consequent improved overall metabolic control, compared to morning insulin administration. Therefore, bedtime may be the preferable timing of insulin therapy for patients with Type 2 diabetes and overt fasting hyperglycaemia.

Circadian Rhythm↗

PubMed1984

Medial plantar sensory response. Sensitive indicator of peripheral nerve dysfunction in patients with diabetes mellitus.

The effects of near-normal glucose control on nerve conduction results were studied in 10 patients with insulin-dependent diabetes mellitus who underwent a six-month program of intensification of therapy. The most striking electrophysiologic abnormality was the medial plantar sensory nerve conduction response. A sensory nerve action potential could not be elicited in seven of the 10 patients at the baseline evaluation. Over the six-month period of near-normal glucose control, there was a return of sensory nerve action potential in all 10 patients. Medial plantar sensory nerve conduction responses appear to be a sensitive and early electrophysiologic indicator of peripheral nerve dysfunction in patients with diabetes mellitus. Near-normalization of plasma glucose levels by intensification of diabetes management may be accompanied by correction of this early abnormality.

Adult↗

PubMed1982

Glycemic control in insulin-dependent diabetes mellitus. Comparison of outpatient intensified conventional therapy with continuous subcutaneous insulin infusion.

We compared glycemic control achieved on an outpatient basic with three insulin regimens in 10 patients with insulin-dependent diabetes mellitus. The regimens studied included: (1) intensified conventional therapy with twice-daily regular and lente insulin; (2) intensified conventional therapy with long-acting ultralente insulin plus multiple preprandial injections of regular insulin; (3) continuous subcutaneous insulin infusion. Each treatment period was two months long. At the beginning of the study and the close of each study period, patients were hospitalized for a 48-hour evaluation of glycemic control. Each new insulin regimen was begun after discharge, with the dosage adjusted using preplanned algorithms, patient self-monitoring of blood glucose and defined blood glucose targets. Glycemic control markedly improved on all three treatment regimens, to a comparable degree, as assessed by mean plasma glucose level, mean amplitude of glycemic excursions, M value (an index of glycemic lability), urinary glucose excretion and glycosylated hemoglobin level.

Adolescent↗

PubMedDate not supplied

Lack of a persistent reduction in serum lipid and apoprotein levels in insulin-dependent diabetic patients receiving intensified insulin treatment.

Type I insulin-dependent diabetic patients have an increased risk of atherosclerotic vascular disease that may be determined in part by their tendency to develop circulating lipid and lipoprotein abnormalities. The occurrence of such findings in asymptomatic ambulant Type I patients with mild or moderate hyperglycemia might suggest that conventional methods of insulin treatment are as inefficient at normalizing lipid abnormalities as they are in achieving euglycemia. It would then be important to ascertain whether intensive methods of insulin treatment effectively normalized lipid levels. Ten insulin-dependent young adult diabetic patients were studied on a conventional insulin treatment regimen and then at two-monthly intervals for a six-month period during which they were managed by three different intensified insulin treatment regimens. Plasma glucose levels improved substantially (p less than 0.001) after two months of intensified therapy (106 +/- 4 mg/dl) and did not change significantly thereafter for the remaining four months of intensified insulin treatment. Apart from a short-lived decrease in total-, LDL- and HDL-cholesterol after two months of intensified treatment (baseline total triglyceride 116 +/- 13 mg/dl, total cholesterol 174 +/- 16 mg/dl, HDL-cholesterol 46 +/- 3 mg/dl). There were no persistent changes in serum lipids, lipoprotein cholesterol or in levels of their major apoproteins A-I, A-II and B. These findings support the contention that, despite moderate hyperglycemia, conventional insulin treatment may be adequate to maintain normal lipid levels. In such circumstances achievement of euglycemia by intensified insulin therapy leads to little change in circulating lipid and lipoprotein values.

Adolescent↗

PubMedDate not supplied

Algorithms for adjustment of insulin dosage by patients who monitor blood glucose.

Patient self-monitoring of blood glucose is a useful adjuvant to diabetes therapy that facilitates improved glycemic control when used as part of an intensive diabetes management program that includes careful balancing of food intake, energy expenditure, and insulin dosage. This paper describes an approach by which patient-determined blood glucose measurements may be used to attain and maintain glycemic control. The patient is provided with a set of algorithms by which minor adjustments in a therapeutic routine may be made to achieve the desired control.

Blood Glucose↗

PubMedDate not supplied

Optimizing pumped insulin delivery.

The use of portable devices for the subcutaneous infusion of insulin may facilitate the attainment of improved glycemic control in selected patients with insulin-dependent diabetes mellitus. Successful use of a program of continuous subcutaneous insulin infusion requires patient cooperation and motivation, routine monitoring of glycemia, and attention to food intake and activity. This article describes an approach by which patients may optimize glycemic control utilizing a set of algorithms based on patient-determined blood glucose measurements. The algorithms permit programming the insulin infusion device to achieve the desired control.

Diabetes Mellitus, Type 1↗

PubMedDate not supplied

Lack of effect of improved glycemic control on C-peptide secretion in patients without residual B-cell function.

Ten patients with insulin-dependent diabetes mellitus underwent a program of intensification of therapy that resulted in marked improvement in glycemic control. C-peptide secretion in response to a test meal and to an intravenous glucagon challenge was used to assess pancreatic B-cell function in terms of residual endogenous insulin secretion. Patients, who had diabetes for a mean (+/- SEM) of 8.4 +/- 1.9 yr, had minimal or no C-peptide response at baseline evaluation. C-peptide responses remained unchanged when reassessed after 2, 4, and 6 mo of improved glycemic control.

Blood Glucose↗

PubMedDate not supplied

A comparison of insulin regimens in insulin-dependent diabetes mellitus.

Glycemic control in 10 ambulatory patients with insulin-dependent diabetes mellitus was compared on three intensive treatment regimens: (1) twice-daily regular and lente insulin; (2) multiple preprandial injections of regular insulin accompanied by long-acting ultralente insulin; and (3) continuous subcutaneous insulin infusion with a portable infusion pump. All regimens included (1) careful attention to diet, exercise, and insulin; (2) patient self-monitoring of blood glucose; and (3) the use of algorithms for the attainment of improved control. Treatment periods were 2 mo in duration. All parameters of glycemic control evaluated (including inpatient mean plasma glucose, mean amplitude of glycemic excursions, M-value, urinary glucose excretion; glycosylated hemoglobin; and outpatient blood glucose values) showed marked improvement from baseline, yet no difference when the intensive regimens were compared with each other. All elements of the treatment system appeared to be important in achieving improved glycemic control.

Adolescent↗

PubMedDate not supplied

Psychological effects of intensification of diabetic control.

We studied the psychological effects of a program of intensification of glycemic control, using three different insulin regimens: (1) twice-daily regular and lente insulin; (2) multiple preprandial doses of regular insulin coupled with long-acting ultralente insulin; and (3) continuous subcutaneous insulin infusion (CSII). Ten patients used each of the regimens for periods of 2 mo. Patients monitored blood glucose 4-7 times daily. Using the Hopkins Symptom Checklist, there were significant reductions in depression, interpersonal sensitivity, and anxiety during all three treatment programs. Self-concept scores were more positive following CSII therapy. Positive self-concept ratings were correlated with positive attitudes about diabetes, medical care, persons with diabetes, and current diabetes regimens. After all subjects had experienced CSII, self-concept was positively related to attitudes regarding the insulin pump. Patients reporting more positive attitudes toward their current diabetes regimens had lower glycosylated hemoglobin levels. Thus, there were no adverse psychological effects of blood glucose monitoring, intensification of therapy, or use of infusion pumps by the parameters measured.

Adult↗