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Biomedical subjects

J L Selam

Publications and source records attributed to J L Selam.

At least 109 records · Page 6Linked to original sources
PubMed1982

Total implantation of a remotely controlled insulin minipump in a human insulin-dependent diabetic.

This study reports our first total implantation of an insulin minipump in a severely unstable 23-year-old female insulin-dependent diabetic. The implantable unit includes a stepping motor, a percutaneously refillable insulin reservoir (10 ml, U 100 special insulin), a battery with a life span of one year, and a method for prevention of overdosage. Variable continuous basal and superimposed 1-hour high rates are programmed and checked via an external remote controller. The pump was inserted in the lateral muscles of the abdomen and the insulin delivery catheter terminated in the peritoneal cavity. Excellent glycemic control was reached rapidly and has continued seven months after implantation (mean blood glucose is 123 +/- 62 mg/dl; glycosylated hemoglobin is 7.0 +/- 1.2%), with the unit providing the only source of insulin. The only negative aspects were a chronic lymphorrhea in the first two months, and a need for frequent and laborious insulin refills (every 20 days). Only slight local discomfort was experienced. Thus, although further miniaturization and autonomy are expected, these preliminary results show that with careful instruction and followup, implanted pumps could represent a reliable and safe alternative to conventional insulin therapy for selected diabetics.

Adult↗
PubMed1981

[Post-hyperglycaemic hypoglycaemia: effects of somatostatin (author's transl)].

Precise recordings of reactive (post-hyperglycaemic) hypoglycaemia were ensured by continuous blood glucose monitoring during oral glucose tolerance tests. The definition of hypoglycaemia was limited to the following criteria: absence of chemical diabetes; fall in blood sugar to less than 30% of the fasting level or to less than 2.50 mmol/l (0.45 g/l); development of clinical signs of hypoglycaemia. An infusion of somatostatin over 4 hours slowed down the initial rise in blood sugar during the first 90 minutes and the rise was prolonged throughout the infusion whatever its duration. The maximum glycaemia reached was 13.3 mmol/l (2.40 g/l) at the 250th minute. Interruption of the infusion led to a rapid fall in blood sugar to a level identical (2.1 and 2.5 mmol/l) with and without somatostatin respectively. Somatostatin infusions, while frankly diabetogenic in certain circumstances, do not prevent reactive hypoglycaemia but rather delay its onset.

Adult↗
PubMed1981

Effects of somatostatin added to insulin in a glucose-controlled insulin infusion system.

Five insulin treated diabetics were studied on three consecutive days. Overnight variable intravenous insulin infusions were used before each study to maintain normoglycaemia and to calculate the optimal basal insulin infusion rate (1.1 +/- 0.1 U/h) which ws then kept constant throughout the study day. A standard 400 kCal breakfast with 25 g xylose was given at 0800 h. When the blood glucose rose above 4.1 mmol/l, an external artificial pancreas was used to infuse either extra insulin (day INS) or somatostatin for either 3h (day som) or the entire 8h experimental period (day SOM). Peak post-prandial blood glucose values were similar on all three days. The blood glucose rebounded after the cessation of the somatostatin infusion on day som. Post-prandial blood xylose peaks were lowered by somatostatin on both days but rebounded after the cessation of the somatostatin infusion on day som. The area under the plasma and urinary xylose curves was lowered by somatostatin only on day SOM. Growth hormone and glucagon levels were not statistically different on all 3 days. Thus somatostatin, when added to an optimal insulin infusion, minimised the insulin requirements by slowing intestinal absorption, but led to rebound hyperglycaemia if not feed-back controlled.

Adult↗
PubMed1979

Circulating lymphocyte subpopulations in juvenile insulin-dependent diabetes. Correction of abnormalities by adequate blood glucose control.

Circulating lymphocytes from 39 juvenile insulin dependent diabetics of recent onset were studied by six membrane marker techniques and mitogen stimulation. Well controlled (n = 14) were grouped separately from poorly controlled (n = 25) patients. The total lymphocyte counts were not different from 50 control subjects. The percentage of T-cells detected by erythrocyte rosettes and B-cells detected by erythrocytes--antibody--complement rosettes was significantly decreased only in poorly-controlled diabetics (64.1 +/- 1.3 and 9.7 +/- 1.8, vs 71.0 +/- 1.0 and 15.3 +/- 0.6 in controls). Cells bearing receptors for the Fc fragment of IgG immunoglobulins were decreased in both groups. Mitogen stimulation was not different from controls but was significantly lower in poorly controlled than in well controlled diabetics. Optimal blood glucose control for 5 +/- 2 days using an external artificial pancreas led to a rapid normalisation of membrane marker values and mitogen responsiveness of lymphocytes from previously poorly controlled diabetics. Separate in vitro experiments showed that glucose had an inhibitory effect on mitogen stimulation at concentrations greater than or equal to 8.3 mmol/l and on T- and B-lymphocyte numbers at concentrations greater than or equal to 55.6 mmol/l. DL 3-hydroxybutyrate tested at 17.1 and 34.2 mmol/l only depressed mitogen responsiveness. Such results suggest a rapidly reversible T-cell defect closely linked to the existing metabolic disturbances.

Adolescent↗
PubMed1979

The external artificial pancreas: an instrument to induce remissions in severe recent juvenile diabetes. Comparison with a preprogrammed insulin infusion system.

Remission of juvenile insulin-dependent diabetes is a rare, temporary, and partial phenomenon which seems to be related to an improvement of the residual insulin secretion supported by prompt and rigorous insulin therapy. Thus, remissions allowing the replacement of insulin by oral drugs were attempted in 23 insulin dependent ketotic juvenile diabetics (age 10 +/- 2 years) of recent onset (apparent duration of diabetes 71 +/- 5 days) treated by an external artificial pancreas during 5 +/- 1 days and compared with 10 control diabetics treated by a less effective technique (preprogrammed insulin pump without feedback control) during 6 +/- 1 days. 18 (78%) remissions of long duration (1-26 months) occurred after artificial pancreas compared with 3 (30%) in the control group. Measurement of daily urinary C-peptide excretion confirmed the improvement of the residual insulin secretion in patients with insulin-induced remissions. Thus, the excellent blood glucose control given by an artificial pancreas seems necessary to lead to much more frequent remissions of diabetes than usually reported.

Acute Disease↗
PubMed1978

Sustained insulin-induced remissions of juvenile diabetes by means of an external artificial pancreas.

Remission of diabetes was attempted in 12 recent acute onset ketosis-prone juvenile diabetes after short term (5 +/- 1 days) but excellent blood glucose control by the external artificial beta-cell. The comparison group comrised patients undergoing traditional treatment (n = 28). Nine (75%) persistent (over 3-14 months of duration) although partial (oral drugs required) remissions were obtained in the former group as compared to 3 (11%) in the latter group (p less than 0.05). Cases which showed remissions after insulin infusion had a plasma insulin response to IV glucagon still present before insulin infusion, and a daily urinary C-peptide excretion significantly enhanced after (p less than 0.01). Urinary C-peptide/blood glucose remained improved during the remission period. Thus, early effective treatment by means of the artificial pancreas may break the vicious circle hyperglycaemia-insulin depletion-hyperglycaemia and lead to frequent and sustained remissions of juvenile diabetes.

Acute Disease↗
PubMed1977

[Clinical and diabetic research of the artificial extracorporeal pancreas].

With the external artificial pancreas used by the authors, blood glucose is continuously controlled by insulin delivered through an IV infusion and adjusted to two parameters: instantaneous blood glucose levels and increasing or decreasing patterns of blood glucose. The artificial pancreas can be used to treat acute diabetic disorders an to evaluate insulin needs. Furthermore, exogenous insulin homeostasis can be studied: the delay to reach an insulin effect is 18 mm +/- 2 and it remains within 28 mm +/- 2 after the infusion has been stopped; fractional insulin needs are evaluated. From these data, it appears that the efficiency of exogenous insulin exhibits a circadian rhythm.

Artificial Organs↗
PubMed1977

Evaluation of exogenous insulin homoeostasis by the artificial pancreas in insulin-dependent diabetes.

With the artificial pancreas used by the authors, insulin was delivered through a venous infusion and the rate of delivery was adjusted according to data provided by a continuous blood glucose monitor. After different trials we selected control algorithms integrating two parameters: instantaneous blood glucose concentration and increasing or decreasing patterns of blood glucose. A constant basal insulin infusion rate was added and improved the control of glycaemic excursions. Different parameters concerning exogenous insulin homoeostasis were determined. The delay to reach an insulin effect was 18+/-2 min and was shortened by a priming-dose at the beginning of the infusion. The insulin effect remained for 28+/-2 min after the infusion had been stopped, but differences were noted in the morning (21+/-2 min), in the afternoon (32+/-2 min) and during the night (25+/-3 min). Insulin needs were evaluated during meals. Related to the amount of carbohydrates, the doses fell from 0.53 units/hr/g of carbohydrate for breakfast to 0.15 for dinner. From these data, it appears that the efficiency of exogenous insulin exhibits a circadian rhythm.

Adolescent↗
PubMed1976

[Treatment of diabetic keto-acidosis through continuous insulin infusion].

Presented are results obtained with a continuous intravenous infusion of regular insulin in 13 cases of diabetic ketoacidosis. A bolus of 10 units of insulin followed by an average of 15 units delivered via an infusion pomp induce an immediate and regular decrease of blood glucose levels (1.63 +/- 0.15 g/h). A large quantity of glucose (25 g per hour) shortens duration of ketosis (7.0 +/- 1.2 h).

Adult↗
PubMed1976

HL-A antigens in insulin-dependent diabetes mellitus.

HLA antigen typing by lymphocytotoxicity was performed for 2 groups of unrelated caucasian subjects. The first group was composed of 100 subjects with insulin-dependent diabetes mellitus. The second group was composed of 270 healthy subjects without diabetes. Our study has shown that for the inhabitants of Languedoc the BW15 antigen is not the most frequently found (11% of the diabetics, 10% of the healthy subjects) contrary to findings reported by others. The B8 antigen was the most frequently found (20% of the diabetics, 16,3% of the healthy subjects), in agreement with the findings of the same authors. The frequency of BW15 and B8 found simultaneously was increased (observed 3%, expected 1.38%). The principal findings of our study were a significantly increased frequency of Da25 and B18 (23% and 25% for the diabetic subjects, 11.26% and 12.22% for the healthy subjects), and a significantly decreased frequency of A11 and B12 (6% and 18% for the healthy subjects). The association of Da25 and B18 was observed for HLA phenotypes, suggesting a higher incidence of the Da25-B18 haplotype. For the diabetics, the types BW15, BW40 and Da25-B18 have little hereditary character, and are rapidly insulin dependent individuals.

Adult↗