Deterioration of glucose tolerance in non-diabetic non-IGT elderly population: potential role of Beta cell dysfunction and insulin insensitivity

Aim: As the human community develops, the group of aged individuals constitutes a larger percent of the total population. This particular group of people is characterized by increased incidence of macrovascular complications that are similar to those described in the metabolic syndrome or type 2 diabetes. Moreover, it is well known that the incidence as well as the prevalence of type 2 diabetes and impaired glucose tolerance is more common in old age people. The mechanism of age-related glucose intolerance is not yet completely clear. Subjects and A clinicobiochemical study was carried out comprising 20 apparently healthy non-diabetic nonobese old individuals [mean age 65 +/- 4.8 years] and 20 type 2 diabetic patients compared to 10 healthy young subjects. The senile group had no family history of diabetes. Cases with renal, hepatic, gastrointestinal, or endocrine abnormalities were excluded from the study. Intravenous glucose tolerance test [ivGTT] was done with sampling at 0, 5, 10, 15, 30, 45, and 60 min after glucose load and the following estimations were undertaken: glucose decay constant [kG], glucose and insulin areas under the curve, insulnogenic index, first phase insulin response, insulin resistance index and fractional insulin clearance. The senile and diabetic groups, when compared to the controls, had a ronsignificantly different fasting plasma glucose, but it was higher in diabetic patients. Fasting serum insulin was significantly higher in the studied groups than in the healthy control group. The senile group showed a significant reduction in glucose tolerance [KG 1.36 +/- 0.3%/min], decreased insulin sensitivity index [5.19 +/- 1.4 10-4 min-1 /[micro U/ml] and a marked reduction of first phase insulin response [2.45 +/- 0.78 micro U/ml per mg/dl], when compared with the control group. However, the degree of glucose intolerance and insulin insensitivity of the senile group was still significantly lower than that of type 2 diabetic patients. This study revealed that the insulin resistance seems to be a characteristic feature of the normal aging process and senility could be considered as an inevitable risk factor for glucose intolerance and metabolic syndrome with its accompanying health hazards. Conclusions: Insulin secretion, insulin clearance and interaction between insulin and target tissues are defective in elderly subjects. These functions are intermediate between healthy controls and NIDDM patients and may predispose the elderly population to the risk of impaired glucose tolerance or diabetes mellitus with its attendant macrovascular and microvascular complications

Testosterone and luteinizing hormones in impotent and infertile diabetic patients

This study comprised 29 diabetic patients, divided into 3 groups; 12 non complicated, 5 infertile and 12 impotent diabetic patients, in addition to 5 healthy normal males of matched age. All cases were subjected to thorough clinical examination, fasting and post prandial blood sugar, semen analysis for infertile group and radio immunoassay of serum testosterone and luteinizing hormones. It was found that, neuropathy and peripheral ischaemia were more common in the impotent diabetic group. Serum testosterone was significantly subnormal in the impotent group, but the luteinizing hormone was significantly subnormal in infertile one. The emperical use of androgen and luteinizing hormone in diabetics with sexual problems is not advisable as it could further depress the hypothalamopituitary gonadal axis

Pathogenesis of ascites in hepatosplenic shistosomiasis

Twenty two cases with hepatosplenic bilharzial affection in different stages, and 10 normal subjects were studied clinically, biochemically and by radio immunoassay methods. It was found that, Hypoalbuminaemia was very marked in terminal ascitic cases, but in premature ascites it w.as insignificant when compared to non ascitic hepatosplenic schistosmiasis. Hyperaldosteronism was significant in cases of ascites, premature or terminal, not related to plasmarenin activity, and even present in bilharzial cases without ascites. Thus, the use of aldosterone antagonists in the treatment of premature and terminal ascites is encouraged even its use in non ascitic cases may be considered to delay or prevent the development of ascites

Anaemia in diabetes mellitus

Eighty five patients with diabetes mellitus and 25 normal controls were studied clinically together with evaluation of their red cell values, bone marrow picture, serum iron and liver function tests. Normochromic normocytic anaemia was found to be a characterstic feature of diabetics having chronic complications or infections. Macrocytic normochromic anaemia was present in diabetics having ketoacidosis. Possible underlying mechanisms for the present anaemia was discussed. In non complicated diabetics anaemia was not present and serum iron was within normal limits. Conclusion was reached that the presence of anaemia in a diabetic patient is a sign of diabetic complications

Blood viscosity in diabetes mellitus

Eight five diabetics and 25 normal controls of matched age and sex were studied. Estimation of the whole blood viscosity by using the U-shaped viscometer tube was made. Significantly higher blood viscosity was a constant feature for diabetics. Correlation of viscosity to diabetic complications and type of diabetes was carried out. Hyperlipidemia, hyperfibrinogenaemia, increased alpha[2] and beta globulins showed a linear relation to the blood viscosity. Conclusions were reached that the estimation of blood viscosity in diabetics is a rapid, simple and reliable prognostic test for diabetics especially in complicated cases

Thyroid and male infertility

The functional state of the thyroid gland was evaluated clinically and by PBI for 104 infertile males and 25 normal controls. An euthyroid state was found to be fundamental for spermatogenesis. Hypothroidism was detected in 3 cases and a case record of azoospermic thyrotoxicosis is described with normalization of semen picture after medical control of the hyperthyroid state. Liothyronine therapy [20 ug/day] was very effective among infertile males with hypothyroidism and useless in euthyroidism. Study of the functional state of thyroid gland is essential before T 3 therapy