[The blood insulin/blood sugar ratio. Its diagnostic and therapeutic value in hypoglycemic children].
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Blood Glucose↗
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Clearance rate of intravenously administered lipid in postoperative patients.
Elimination rate (K) of intravenously given triglyceride was studied in seventeen patients who underwent elective abdominal operations, and levels of adrenaline, noradrenaline, insulin and blood sugar were simultaneously measured, as stress-indices. All these indices, except for the insulin/blood sugar ratio, increased post-operatively. The postoperative K value increased significantly in comparison with the preoperative value. There was no significant correlation between K value and any of the stress-indices. These results suggest that the initial catabolism of the lipid emulsion triglyceride is enhanced by surgical stress.
Adult↗
Cardiovascular risk factors clustering features of insulin resistance syndrome (Syndrome X) in a biracial (Black-White) population of children, adolescents, and young adults: the Bogalusa Heart Study.
Recently, independent factors representing different features of insulin resistance syndrome (Syndrome X) have been identified by factor analysis in middle-aged and elderly adult populations. In this study, factor analysis was applied to the clustering characteristics of Syndrome X in a biracial (Black-White) community-based population of 4,522 children (ages 5-11 years), adolescents (ages 12-17 years), and young adults (ages 18-38 years) from the Bogalusa Heart Study who were screened during 1988-1996. Ponderal index (weight (kg)/height (m)3), levels of insulin, glucose, triglycerides, and high density lipoprotein cholesterol, and systolic and diastolic blood pressure were used as measures of components of Syndrome X. No evidence was found to support a one-factor hypothesis for this syndrome, but factor analysis yielded two uncorrelated factors (factor 1: insulin/lipids/glucose/ponderal index; factor 2: insulin/blood pressure). These two factors explained 54.6% of the total variance in the entire sample. The factor loading patterns were very similar in all race and age groups, based on high values of coefficients of congruence (0.89-1.0). These results suggest that Syndrome X is characterized by the linking of a metabolic entity (hyperinsulinemia/insulin resistance, dyslipidemia, and obesity) to a hemodynamic factor (hypertension) through shared correlation with hyperinsulinemia/insulin resistance, and that the clustering features are independent of sex and age in both Black and White populations.
Adolescent↗
Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children.
Perioperative blood glucose and insulin levels were measured in children (1-9 years of age) randomly assigned to two groups according to anesthesia technique, general anesthesia (group GA) or general anesthesia combined with regional anesthesia (group RA). Children in the GA group (n = 10) received halothane and opioids, while children of the RA group received epidural anesthesia with bupivacaine (0.25%) and adrenaline combined with halothane anesthesia (n = 10). Children in both groups received 2.5% dextrose in 0.4 N saline administered by volumetric infusion pumps throughout the study period, the infusion rate being adapted to the child's age. Blood samples for glucose and insulin determinations were obtained: at induction, at the end of surgery, and 30, 60 and 120 min after surgery. In response to an identical glucose load, blood glucose levels increased significantly in both groups (P < 0.001), while no differences between groups were observed. Insulin levels did not change significantly postoperatively in the GA group (P = 0.058), while a significant increase was observed in the RA group (P < 0.001). Insulin/blood glucose ratio increased significantly only in the RA group (P < 0.05). The higher insulin secretion in response to glucose infusion in the RA group compared to the GA group may indicate an increased peripheral insulin resistance after regional anesthesia or, more likely, this secretion may be beneficial in contributing to improve postoperative nitrogen balance.
Anesthesia, Conduction↗
Plasma insulin response to various secretagogues in insulinoma.
Since the development of radioimmunoassay for insulin, the diagnosis of insulinoma has been made easily. However, it has been assumed that insulinoma is heterogenous in the histological structure as well as in clinical findings. Therefore, the present study was performed to investigate the insulin response to various stimuli and to evaluate the various insulin response tests in 19 patients with insulinoma. The fasting blood glucose was 19 to 90 mg/100 ml in insulinoma and 81 +/- 5 (mean +/- S.D.) mg/100 ml in normal controls. Plasma insulin (IRI) in insulinoma ranged from 10 to 255 microU/ml, while in the control it was 14 +/- 9 microU/ml. However, insulin/blood glucose ratio increased in insulinoma (0.2-11.2) compared with the normal control (0.18 +/- 0.11). In oral glucose tolerance tests, plasma IRI increased and reached peak levels of 48-244 microU/ml, remaining elevated in most cases. In the intravenous tolbutamide test, plasma IRI increased conspicuously to 82-1,330 microU/ml and hypoglycemic coma was provoked in 54%. Plasma IRI was elevated in the intravenous glucagon test and reached the peak levels of 85-400 microU/ml, which exceeded those of the control group. Plasma IRI increased to more than 100 microU/ml after arginine infusion and formed bizarre curves. There were no correlations between plasma IRI response to various stimuli and malignancy, type of B-granule or insulin content of insulinoma tumors. It is concluded that fasting plasma IRI, insulin/glucose ratio, tolbutamide test and glucagon test are highly valuable for the diagnosis of insulinoma.
Adenoma, Islet Cell↗
Gender-specific programming of insulin secretion and action.
Insulin secretion and glucose tolerance were studied in 20-week-old male and female offspring of rat dams maintained on an isocaloric 20% or 8% protein diet during pregnancy and lactation after transfer to the same diet at weaning. Protein-restricted male and female offspring were also weaned onto a 20% protein diet. In males, post-absorptive insulin concentrations were suppressed by protein restriction from conception to adulthood (by 41%; P<0.001); however, basal insulin levels were 2.6-fold higher (P<0.001) if protein restriction was limited to gestation and lactation. Post-absorptive insulinaemia in females was unaffected by early or sustained protein restriction, but was lower than for males in the control group and the group exposed to protein restriction during early life alone (by 40% (P<0.001) and 52% (P<0.001) respectively). Plasma insulin/blood glucose ratios were higher in males compared with females in both control and early protein-restricted groups (1.6-fold (P<0.05) and 2.3-fold (P<0.001) respectively). A positive linear relationship existed between mean ambient insulin and glucose concentrations in males (r=1.0) and females (r=0.9), but the gradient was 12.4-fold greater (P<0.01) in males. beta-Cell function was evaluated after intravenous glucose challenge. In males, the acute insulin response and the suprabasal 30-min area under the insulin curve were dramatically higher in rats exposed to protein restriction during gestation and lactation alone (2.6- and 2.8-fold respectively; P<0.001). In contrast, these parameters were lowered by extending the exposure to protein restriction to adulthood in males, and by either early or prolonged exposure to protein restriction in females. The insulin resistance index was increased (2.5-fold; P<0.001) in male, but not female, rats exposed to protein restriction during gestation and lactation alone, and was not increased by extending the period of protein restriction to adulthood in either sex. Thus the data have demonstrated gender-specific lowering of insulin sensitivity due to protein restriction during early life only. The insulinogenic index (insulin response in relation to prevailing glycaemia) was increased in male, but not female, rats exposed to protein restriction during gestation and lactation alone (3.0-fold; P<0.001). A modest decline in insulin secretion in the female groups exposed to protein restriction until either the end of lactation or adulthood was compensated by increased insulin sensitivity, as demonstrated by significant decreases in the insulin resistance index in both groups (by 48% and 52% respectively; P<0.05). Glucose disappearance rates did not differ between the male and female control or early protein-restricted groups but were higher in both male (31%; P<0.05) and female groups (46%; P<0.001) exposed to protein restriction from conception to adulthood. Marked gender differences in glucose-stimulated insulin secretion were not associated with gender differences with respect to glucose tolerance. Our data therefore demonstrated that exposure to protein restriction during early life alone leads to relative insulin resistance and hyperinsulinaemia in adulthood, but this relationship is gender specific, observed only in males, and glucose tolerance is maintained.
Analysis of Variance↗
Comparative effects of two doses of glibenclamide upon metabolic rhythms in maturity-onset diabetics.
Five maturity-onset diabetics have been studied during therapy with glibenclamide 2.5 mg and 5 mg by half-hourly blood sampling for twelve hours. All patients had lower mean blood glucose concentrations during therapy with 5 mg glibenclamide. There was no significant difference between serum insulin concentrations on the two doses, however, serum insulin/blood glucose ratio was higher during the larger dose of glibenclamide. Mean blood lactate, pyruvate and serum triglycerides were significantly lower, and blood glycerol, 3-hydroxybutyrate, and plasma non-esterified fatty acids were increased during therapy with 5 mg. In the individual patient the changes in blood glycerol and plasma non-esterified fatty acids were related to changes in circulating insulin concentration and did not appear to be a true extra-pancreatic effect of glibenclamide. The mechanism of any extra-pancreatic effect remains unclear.
Aged↗
Refractory hypoglycemia associated with a malpositioned umbilical artery catheter.
An infant with unexplained hypoglycemia who responded poorly to medical management had the tip of his umbilical artery catheter positioned near the major arteries supplying the pancreas. Catheter repositioning resulted in immediate normoglycemia. A "reactive" response to the direct infusion of glucose is postulated on the basis of the clinical response and a decrease in serum insulin/blood glucose ratio.
Blood Glucose↗
Cardioselective (metoprolol) and non-selective (propranolol) beta-blockade and glucose homeostasis.
The effects of two beta-adrenergic receptor blocking drugs, the non-selective propranolol and the cardioselective metoprolol, on the concentrations of blood glucose, serum insulin (IRI) and growth hormone (GH) were studied in 8 healthy male volunteers both at rest and on exercise. The tablets of 160 mg of propranolol and 200 mg of metoprolol were tested against a placebo. The heart rate and systolic blood pressure were significantly lower during treatment with the active substances than with placebo. There were no significant differences between the blood glucose and serum IRI levels after the compounds and the placebo. A decreased insulin/blood glucose ratio after exercise was seen during metoprolol. The serum GH levels were of about the same magnitude after the three different treatments but the peak values were seen 30 and 40 minutes earlier after propranolol and metoprolol than after the placebo. The concentrations of the drugs in plasma did not correlate significantly with the changes in serum levels of IRI and GH in the exercise test. In the present acute test situation propranolol and metoprolol did not significantly affect glucose homeostasis and there were no apparent differences between the drugs.
Adult↗
[Personal experience with the diagnosis of organic hyperinsulinism].
The diagnosis of organic hyperinsulinism was established in 47 patients based on the typical clinical symptomatology supported by laboratory evidence of hypoglycaemia and raised serum insulin concentrations. For the diagnosis of the disease the test of controlled fasting is suited best. During this test and after its termination the blood sugar level (in mmol/l), serum insulin (in mU/l) and their ratio (insulin/blood sugar) are assessed. In all patients the test had to be discontinued because clinical manifestations of hypoglycaemia developed which are typical for organic hyperinsulinism. Other methods, incl, examination by means of an isoglycemic clamp or insulin receptors are not specific and cannot be used for diagnosis. As to imaging (localisation) methods in the examined group the lowest yield was obtained by computed tomography (positive only in one patient), better results were obtained by sonography (21%) and angiography resp, (45%). When methods were combined an insulinoma was detected in 55% patients while on operation it was found in 82% patients. The authors' experience provides evidence that for the diagnosis of organic hyperinsulinism a decisive role is played by the clinical symptomatology supplemented by laboratory evidence of hypoglycaemia and possibly by a raised serum insulin concentration.
Adolescent↗
[On the determination of blood insulin at the epididymal fat appendix of the rat by means of labelled glucose. IV. The dynamics of insulin secretion in persons with normal metabolism and in aged diabetics after repeated administration of glucose, sulfonylureas and human growth hormone; a contribution to the pathogenesis of human diabetes in aged].
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Aged↗
[On the determination of insulin in the blood of epididymal fatty tissue of the rat with the aid of marked glucose. I. Method and margins of error].
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Adipose Tissue↗
[On the determination of insulin in the blood of epididymal fatty tissue of the rat with the aid of marked glucose. II. Experimental and clinical experiences].
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Adipose Tissue↗
[On the determination of insulin in the blood through the epididymal fat accumulation of the rat with aid of labelled glucose. III. The effect of sulfonylurea and biguanide (DBI) on canbohydrate metabolism of isolated fatty tissue and diaphragm of the rat].
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Animals↗
Effect of the glucagon on the plasma insulin-activity after hypophysectomy.
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Glucagon↗
[Measurement of serum insulin activity with epididymal fat tissue of rats in vitro].
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Adipose Tissue↗