Biomedical subjects
Publications and source records attributed to J M Limal.
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BACKGROUND: Conventional insulin therapy for diabetes mellitus is sometimes inadequate for controlling metabolic disturbances in young children; the risk of hypoglycemia is particularly high at this age. METHODS: Ten newly-diagnosed insulin-dependent diabetic children aged 1 to 7 years were treated by continuous subcutaneous insulin infusion using a portable pump. The mean duration of treatment was 17 months (4 to 42 months). RESULTS: The mean individual capillary blood glucose calculated over periods of 6 months ranged from 84 +/- 23 to 206 +/- 97 mg/dl. The glycosylated hemoglobin values were 6.5 to 8.9% during the same period. There was no hypoglycemic coma; 7 children experienced a total of 16 episodes of ketonuria. The average daily dose of insulin used by these 10 patients was 0.72 +/- 0.24 units/kg. CONCLUSION: Continuous subcutaneous insulin infusion is a feasible therapy and it was well tolerated even in the youngest children. External insulin infusion devices appear to be an alternative to conventional insulin therapy and a way of overcoming the therapeutic difficulties encountered with these young patients.
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The acute insulin response to i.v. glucose (AIRG) was evaluated in 344 first-degree relatives of patients with Type 1 diabetes. In 318 relatives aged 3 to 48 years without islet cell antibody and insulin autoantibody, correlations (p < 0.0006) were found between age and fasting insulinaemia, fasting glycaemia, or AIRG, with a peak during puberty. Assuming that these relatives without islet cells and insulin auto-antibodies have a low risk of developing Type 1 diabetes, we provided a "standard age-related chart" for AIRG with a "low" AIRG defined as a value below the 1st percentile for each pubertal stage. Using these cut-off points, predictive characteristics of a low AIRG for progression towards diabetes within 6 years were analysed. Four relatives developed diabetes and one displayed impaired oral glucose tolerance. Four out of these 5 subjects had islet cell and insulin auto-antibodies, but the other one was negative for these markers. Three of these 5 subjects had low AIRG at entry (30, 24 and 1 months before diabetes, respectively). The two others displayed a steady progressive decline (p < 0.02) of age-related during the follow-up before impaired oral glucose tolerance and diabetes appeared (rate of decline: 15 microU/ml/year). Thus, independently of the presence of islet cell antibodies, the predictive value of a low age-related AIRG during the follow-up is greater than the single low AIRG at entry.(ABSTRACT TRUNCATED AT 250 WORDS)