[Consequences of early in the month of ramadan diabetic type 2 initially mal control]

Consequences of fasting in Ramadan on the metabolic control of previously poorly. Controlled diabetics are obvious but little described. We followed 20% type 2 diabetic patients with no known complications. They were receiving oral antidiuretic treatment and were poorly controlled with a HhAlc of 9, 6 +/- 2, 1%. They insisted on fasting even when advised not to do it. Clinical parameters, glycaemic and lipoproteins levels were evaluated three times: 20-30 days before Ramadan, between 20 - 27 day in Ramadan and 20 days after the end of Ramadan. Fasting did not change their- weight nor there. Blood pressure. But it worsened the glycaemic control fasting glycemia increased by 2, l mmol/l [p < 0, 01] and fructosamine by 93 rmol/l [p < 0, 03]. However glycated hemoglobin remained unchanged. A 39% reduction in the HDL-cholesterol [p<0,003] was associated with a 24% increase in LDL cholesterol [p < 0, 02]. These parameters returned to their initial levels 20 days after the end of Ramadan. Ramadan, fasting may significantly worsen glycemic and lipoprotein control in initially poorly controlled type 2 diabetic patients

[Giganto-acromegaly: a report of a case]

The occurrence of acromegaly before the end of the growth period is very rare. We report a case of a patient who presented an acromegalo-gigantism. His height reached 2.45 m and his weight 145 kg. He had a typical facial dysmorphy and an insulin requiring diabetes mellitus. There was no sign of cardio-respiratory failure or of endocrine deficiencies. The echocardiography showed that the left ventricule was moderately dilated and hypertrophied but the systolic function was preserved. Hormonal investigation revealed high growth hormone [GH] levels without suppression after oral glucose load. Other pituitary secretions were normal. Initial tomodensitometry revealed an invasive macroadenoa. The patient had two trans-sphenoidal resections of the tumor completed by radiotherapy [45 Gy]. Afterwards, because of still unsuppressed GH levels, the patient was treated with Octreotide. This first published case of acromegalo-gigantism in Tunisia is particular not only by its rarity but also by its moderated effects on vital functions in spite of along spontaneous evolution

[Cortisol rhythm during Ramadan]

We studied the nyctohemeral cortisol secretion rhythm and the cortisol response to 1-24 corticotropin during Ramadan in 11 healthy, male volunteers aged 20-35 years. Their response to 250 mg 1-24 corticotropin was investigated 2 weeks before Ramadan by testing daily at 08:00 and 20:00 hours. After 16-22 days of fasting, their cortisol levels were measured at 08:00 hours and their response to 1-24 corticotropin at 20:00 hours. Before Ramadan, the baseline cortisol level was significantly higher at 08:00 hours than at 20:00 hours and the cortisol response to 1-24 corticotropin was also higher at 08:00 hours but this difference was not significant. During Ramadan, the cortisol level at 08:00 hours was lower than at the same time before Ramadan; the level at 20:00 hours was slightly higher than at the same time before Ramadan. There was no significant difference between the cortisol response to 1-24 corticotropin at 20:00 hours during Ramadan and the responses before Ramadan at 20:00 hours and 08:00 hours

[Metabolic effects of Ramadan fasting on type 2 diabetes]

We assessed the effects of Ramadan fasting on metabolic control, particularly change of HDL-cholesterol in 25 type 2 diabetic patients treated with diet or oral agents, with good metabolic control. Clinical and biochemical parameters and food intake were evaluated 3 weeks before Ramadan, in the fourth week of Ramadan and 3 weeks after Ramadan.There were no changes in body weight and blood pressure nor any metabolic complications. The mean plasma fasting glucose, serum fructosamin and haemoglobin A1c did not change. We found a negative relation between cholesterol intake during Ramadan and the change of HDL-cholesterol. When cholesterol intake was lower than 400 mg/day, plasma HDL-cholesterol increased by 13% at the end of Ramadan and by 23% 3 weeks after Ramadan

[Food intake, and anthropometrical and biological parameters in adult Tunisians during Ramadan]

We evaluated the effects of fasting during Ramadan on nutritional intake and plasma lipoproteins in 20 healthy adults of normal weight. A 5-day food questionnaire was completed for every participant. Clinical investigations, anthropometrical measurements and laboratory analysis were also undertaken. Body weight, blood pressure and blood glucose were not influenced by fasting but there were non-significant modifications in the plasma lipid fractions. The total cholesterol remained unchanged. Total daily energy intake was comparable before, during and after Ramadan despite the decrease in meal frequency during fasting. Thus fasting in Ramadan did not affect dietary intake, clinical, anthropometrical and most biological parameters