ABSTRACT
A case of factitious remission of type I diabetes in an adolescent girl is reported. The clue to diagnosis came from an inconsistency between clinic blood glucose levels and the corresponding values of glycosylated haemoglobin. Investigations of 24 h hormone and metabolite profiles demonstrated discrepancies between insulin dose, endogenous insulin production and free insulin levels which provided confirmatory evidence of surreptitious self-administration of insulin by the patient.
Subject(s)
Diabetes Mellitus, Type 1/diagnosis , Glycated Hemoglobin/analysis , Adolescent , Blood Glucose/analysis , Diabetes Mellitus, Type 1/blood , Female , Humans , Insulin/blood , Ketone Bodies/bloodSubject(s)
Bile Acids and Salts/analysis , Gastrectomy , Gastric Juice/analysis , Pylorus/surgery , Vagotomy , Adult , Gastric Juice/microbiology , Humans , Male , Middle Aged , Time FactorsABSTRACT
Fasting glycosylated haemoglobin was analysed in 535 consecutive patients having an oral 75 g glucose tolerance test for diagnostic purposes. A reference range for fasting glycosylated haemoglobin was established from patients with a non-diabetic glucose tolerance test as defined by the World Health Organisation Expert Committee on Diabetes Mellitus. The predictive value of a glycosylated haemoglobin of over 10.0% (mean normal +/- 3 SD) for detecting a diabetic glucose tolerance test was 89% but sensitivity was only 43%. A raised glycosylated haemoglobin is useful for confirming the diagnosis of diabetes mellitus in patients with long-standing hyperglycaemia but glycosylated haemoglobin is within the reference range in many patients with newly developed diabetes or other minor abnormalities of glucose tolerance. The glucose tolerance test must remain the test of choice in these patients.
Subject(s)
Diabetes Mellitus/diagnosis , Glucose Tolerance Test , Glycated Hemoglobin/analysis , Adolescent , Adult , Aged , Blood Glucose/analysis , Diabetes Mellitus/blood , Evaluation Studies as Topic , Fasting , Humans , Middle Aged , Reference Values , World Health OrganizationABSTRACT
The composition of serum seromucoid, the protein fraction of serum not precipitated by 0.6 M perchloric acid, has been shown to vary with the technique of preparation. Immunochemical examination revealed that 91.5% of the protein present in the seromucoid fraction of serum was alpha 1 acid glycoprotein, the remainder consisting of alpha 1 antitrypsin, alpha 1 antichymotrypsin, beta 2 glycoprotein, haemopexin, albumin, and pre-albumin. Serum alpha 1 acid glycoprotein concentration determined by radial immunodiffusion correlated well with serum seromucoid concentration although the former was usually 0.4 g/l lower. The determination of serum alpha 1 acid glycoprotein by an immunological method is more precise than the seromucoid method and is not subject to interference from other proteins.
Subject(s)
Orosomucoid/analysis , Adolescent , Adult , Albumins/analysis , Chymotrypsin/analysis , Chymotrypsin/antagonists & inhibitors , Female , Hemopexin/analysis , Humans , Immunodiffusion , Immunoelectrophoresis , Inflammation/blood , Intestinal Diseases/blood , Male , Middle Aged , Prealbumin/analysis , Trypsin Inhibitors/analysis , alpha 1-Antichymotrypsin , alpha 1-Antitrypsin/analysisSubject(s)
Cholesterol/blood , Diabetes Mellitus, Type 1/blood , Dietary Fats , Zea mays , Adipose Tissue/metabolism , Adolescent , Adult , Child , Child, Preschool , Chromatography, Thin Layer , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/therapy , Diet, Diabetic , Esters/blood , Fasting , Fatty Acids/blood , Fatty Acids/metabolism , Humans , Hypercholesterolemia/blood , Infant , Insulin/therapeutic use , Linoleic Acids/metabolism , Male , Oils , Oleic Acids/metabolism , Statistics as TopicABSTRACT
The results of the first 10 years of a prospective study of the effect of corn-oil and standard diets given to diabetic children since diagnosis suggest that the corn-oil diets currently available in Britain are not acceptable to most diabetic children and adolescents. Attempts to administer such diets may result in hyperpre-beta-lipoproteinaemia. In most diabetic children normal serum lipid levels can be maintained with adequate diabetic control and a standard diabetic diet.
Subject(s)
Diet Therapy , Fats, Unsaturated , Hyperlipidemias/prevention & control , Hyperlipidemias/therapy , Adolescent , Child , Child, Preschool , Cholesterol/blood , Diet Therapy/adverse effects , Humans , Lipoproteins/blood , Oils , Zea maysABSTRACT
A method is described to determine the fatty acid composition of small samples of subcutaneous adipose tissue, and of fasting plasma free fatty acids (FFA) and triglycerides. These analyses were carried out on samples from five normal children, six diabetic children consuming a standard diabetic diet, 17 diabetic children prescribed a diet rich in corn oil since diagnosis 4-7 years ago, and 2 brothers with familial hypercholesterolemia on a corn oil diet for 3 yr. The results obtained showed that: (1) The composition of adipose tissue triglycerides in the diabetic children on a standard diet was similar to that in the normal children. (2) The 17 diabetic children were consuming different quantities of corn oil. (3) There was a highly significant correlation between the percentage of linoleic acid present in adipose tissue and in the fasting plasma FFA fraction. It is therefore concluded that future assessments of the adherence of these diabetic children to their corn oil diet will be possible by examination of the fasting plasma FFA fraction, obviating the need for repeated adipose tissue biopsies. (4) The sum of the concentration of saturated and monounsaturated fatty acids of the same chain length in adipose tissue was similar to that in the fasting plasma FFA fraction, even though the proportions of individual acids were different in the two fractions.
