Effect of short-term insulin treatment on the reversal of diabetes after transplantation of syngeneic cultured or uncultured fetal mouse pancreas.
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Biomedical subjects
Publications and source records attributed to F I Martin.
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Serum levels of the growth factor non-suppressible insulin-like activity (NSILA-S) have been measured in eleven pregnant women with diabetes mellitus during pregnancy and immediately (2 days) after birth. A significant increase in mean levels was observed with increasing gestation, reaching a peak at the time of delivery and subsequently returning to non-pregnant levels within 2 days. The NSILA-S levels in diabetic pregnancies were not different from those in non-diabetic pregnancies and there were no significant correlations between NSILA-S and birth weight, maternal diabetic control, age or duration of diabetes or the treatment required. The physiological role of high NSILA-S levels during pregnancy still requires elucidation.
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Glucose intolerance was found in 22% of the residents of Koki in Port Moresby, 5% of residents in the coastal village of Kalo and in 3% of 120 young civil servants. The respective prevalences of frank diabetes mellitus were 15.6%, 1% and 0%. Cholesterol and triglyceride levels were similar and low in all groups, despite both obesity and glucose intolerance in the urban-Koki residents who also had a significantly higher blood pressure. There is a need to identify those areas of Papua New Guinea where, in a similar fashion to other countries in the South Pacific, diabetes mellitus is increasing. Simple measures of dietary restriction and increased exercise may be effective in preventing diabetes from becoming a major health problem particularly in identified high prevalence areas.
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High-fibre diets, particularly with the addition of guar gum, have been reported to improve control of blood glucose concentration in diabetics. These studies are reviewed, and the results of a study of 22 obese, poorly controlled, poorly compliant diabetic outpatients are presented. In a random, single-blind controlled trial, either guar, or bran, or placebo were added to the previous diet. Over a three-month period, there were no changes in weight, fasting blood glucose levels, or random blood glucose levels. Problems of tolerance were experienced with guar gum. Therefore, supplementation of the diet of such patients with guar gum or bran does not produce long-term improvements in diabetic control in a clinical context. The use of naturally occurring high-fibre foods may slightly improve diabetic control in motivated patients, but further long-term trials are required to establish whether dietary fibre will have any significant role in the practical management of diabetes.
Oral glucose tolerance tests (75 g) in 185 urban residents of Port Moresby and 105 ethnically similar rural villagers showed that 15.8% of urban residents had diabetes mellitus (two hour plasma glucose > 11.0 mmol/l and a total of 22% were glucose intolerant (plasma glucose > 9.0 mmol/l), compared with 1.0% and 5.5% in rural people. - Urban men and women were significantly fatter than rural people, but within each population glucose tolerance was not significantly related to weight or to age, although the numbers of old people studied were small. Compared to Australians the Papua New Guinea subjects had a higher fasting plasma insulin (16.5 vs 10.7 microU/ml, p = < 0.05); independent of weight fasting plasma insulin was significantly higher in the rural than urban people studied. After the glucose load, plasma insulin and glucose levels were positively correlated in rural people. In contrast, for the urban group the relation best fitted a quadratic function, with decline in plasma insulin at high levels of glucose. - The prevalence of diabetes in urbanised Melanesians in Papua New Guinea appears similar to other South Pacific countries.
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A 35-year-old man with Cushing's syndrome due to ectopic ACTH production is described. The six-week history and severe proximal myopathy were highly suggestive of a malignant tumour, but a solitary phaeochromocytoma of the left adrenal gland was the source of ACTH production. The surgical outcome was successful and three months post-operatively the hypothalamic-pituitary-adrenal axis was normal. At 12 months follow-up he remains well with complete regression of the features of Cushing's syndrome.
Fasting plasma cholesterol, triglycerides and uric acid were measured in 109 Melanesian residents of Port Moresby and 71 residents of a Papuan coastal village. Cholesterol and triglyceride levels were low, mean cholesterol 3 . 74 and 3 . 70 mM/l and triglycerides 0 . 64 and 0 . 59 mM/l respectively in urban and rural residents, with no relation to age or sex. Uric acid was higher in urban men (0 . 37 mM/l) than either urban women (0 . 26 mM/l) or rural men and women (0 . 25 and 0 . 24 mM/l). The levels of plasma cholesterol found in this study are similar to previous reports on rural populations in Papua New Guinea. The apparent failure of plasma lipids to increase significantly in urbanised residents of port Moresby who had a significantly higher prevalence of both diabetes mellitus and obesity is unexplained.
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A population study on pancreatic islet cell antibodies (pica) among 3766 people from the town of Busselton, Western Australia showed that such antibodies were infrequent, the 'classical' insulin-dependent diabetes associated islet cell antibody being present in less than 0.01%. Pancreatic islet cell antibodies in this population were not associated with insulin-dependent diabetes mellitus, and ten known insulin-dependent diabetics did not have these antibodies. These results for an unselected population are in sharp contrast with those derived from studies on highly selected hospital patients.
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Nine of ten non-obese non-ketotic diabetics attending Port Moresby General Hospital had detectable C-peptide in plasma. All had received insulin for at least two months at the time of study. It is concluded that many non-obese non-ketotic young diabetics in Papua New Guinea retain pancreatic insulin secretion and so resemble the maturity onset diabetics of "Western" countries.
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Nineteen insulin dependent diabetics with onset at 30 years of age or less and duration of diabetes of greater than 25 years were divided into two groups on the basis of the presence or absence of clinically evident vascular disease. The patients without vascular disease were characterised by a later mean age of onset, lower fasting growth hormone concentration, and a lower frequency of the unusual HLA pattern B8 without A1 compared to the diabetics with vascular complications. The level of blood glucose control assessed over the last 15 years, insulin antibody titres, plasma glucagon levels and plasma cholesterol did not differ between the two groups. Residual beta cell activity was found in only one of the 19 patients. Although this study does not exclude an effect of the degree of blood glucose control or persistence of beta cell function in the early stages of diabetes on the subsequent development of vascular disease, it suggests that genetic factors, age of onset and plasma growth hormone levels may be more important.
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