[Giovanni Martinotti and experimental pancreatectomy, a century ago]. / Giovanni Martinotti e la pancreasectomia sperimentale, un secolo fa.

On July 13th, 1888, Giovanni Martinotti (1857-1928) announced in Torino the feasibility of a total pancreatectomy in the dog. The essential details for a successful outcome of the operation, as described by Martinotti, were employed by Oscar Minkowski (1859-1931) in Strassburg for the demonstration of diabetes after total removal of pancreas in the dog, on May 22nd, 1889. Martinotti's work deserves a reevaluation in the history of diabetology.

[Diabetic foot: practical management of an old recurrent problem]. / Piede diabetico: gestione pratica di un vetusto problema ricorrente.

A simplified approach to the management of major lesions of the diabetic foot is presented. Two nosological types, the angiopathic foot and the neuropathic foot, are proposed, on the basis of diagnostic, therapeutic, prognostic and preventive criteria. A ten years personal experience is discussed.

[Education of the diabetic patient: 10-year experience at the Karen Bruni Center]. / L'educazione del diabetico: dieci anni di esperienza al centro KB.

On the basis of a ten year experience, new behavioural and philosophical approaches to the education of insulin-dependent diabetic patients are proposed by the Karen Bruni Diabetes Center of Turin. Conceptual and methodological revisions of conventional programs should be tried out. Practical difficulties are still restricting an integrated educational treatment of the diabetic persons.

[Principles, means and evaluation of a programme for diabetes education (author's transl)]. / Principi, mezzi e verifica di un programma di informazione per i diabetici.

A programme of patient information and education, as a primary tool of diabetes treatment, has been developed during the past 5 years, aiming to an effective self-management of diabetes. The programme is patient-oriented, with an essential psychological approach, based on a realistic language and following the concepts of a simple "diabetes philosophy". The diabetes is considered as an human condition, not necessarily a disease. Two phases are proposed. The first, termed "basic information", essentially consists of: 1) an individual checklist of 20 main-items to be gradually completed, with sharing of responsibilities between professionals and diabetics, according to the Etzwiler's contract concept; 2) a set of six original slide-tapes (Bell a. Howell and Reflex projectors) and video-tape films (Fairchild), with personal comments; 3) the red booklet "Condizione diabete" published in 1978 by the Karen Bruni Diabetes Centre. The second phase of the programme, termed "advanced information", is intended for a continuous up-to-dating of diabetological knowledge. The means used are: 1) periodical information meetings with discussion on various existential problems of diabetics; 2) a quarterly magazine "Centro KB", in which new techniques and investigations (such as C peptide and insulin antibody determination) are explained or local events are commented. The effectiveness of the programme has been evaluated through a questionnaire given to 305 subjects attending both the diabetes ward (in-patients and out-patients) and the diabetes clinic (out-patients only). The questionnaire asks 20 specific questions, of the multiple choice type, about day-to-day care complications, natural history of the diabetes, and so on. The percentage of total correct responses, as well as of correct responses to 3 key questions (hypoglycaemia, hyperglycaemia, complicating infections) has been analyzed on a computer PDP 11/23 (FORTRAN) in relation to demographic and diabetological variables. The educational level appears to be positively correlated with attendance to the ward (initial hospitalization) in comparison to the out-patients clinic, young age and insulin-dependence, and schooling. No relationship was found between level of information and metabolic control, as assessed by HbA1C. Following conclusions are drawn: 1) the complete programme of patient education is particularly valuable for young insulin dependent (ID) diabetics, who really need and properly use the information; 2) to the adult-old, non insulin-dependent diabetics (NID) a limited information programme seems to be more suitable; 3) a separation between ID and NID diabetics has to be considered when planning a future information programme; 4) permanent hard personal engagement by the diabetologist, and continuous review and criticism of information means and techniques, are requested if the tasks of a really patient-oriented teaching have to be attained.

[Blood lactate semiautomatic estimation during acidotic diabetic coma (author's transl)]. / Determinazione semiautomatica della lattatemia in corso di scompenso acidosico del diabete.

Blood lactate levels were determined by Lactate Analyzer 640 Kontron during the course of 7 cases of hyperglycemic hyperosmolar diabetic coma, with severe acidosis and more or less marked ketosis. In 5 cases lactate values were found in normal range; slight increases around 2 mmol/l were rapidly corrected following standard coma treatment. One of these cases presented with extreme acidosis and relatively mild hyperglycemia, with differential problems in regard to lactic acidosis. In 2 cases, the former with alcoholic cirrhosis, the latter with myocardial infarction, blood lactate was markedly increased; in the second case, full clinical recovery was accompanied by normalization of lactate levels. A previous biguanide treatment could be ruled out as a cause of lactic acidosis. Thus the association of lactic acidosis and diabetic ketoacidosis seems to be unusual in the absence of concurrent serious conditions. The semiautomatic determination of blood lactate, because of its remarkable prognostic importance, should be included among the routine procedures for the emergency treatment of diabetic coma.

[Determination of plasmatic C-peptide and its clinical uses]. / Determinazione del C-peptide plasmatico e sue applicazioni cliniche.

Physiopathological basis and methodological implications of the radioimmunological estimation of plasma C-peptide, as a test of beta cell secretory activity, are reviewed. Personal results are reported concerning C-peptide assay, both in basal and stimulative conditions, in insulindependent long-and short-term diabetes. In 1 case of organic, and 2 cases of functional hyperinsulinism, the test gave useful clinical information. The method of L. Heding-Novo Research Institute, Bagsvaerd, Denmark-, with previous elimination of proinsulin and insulinantibody in patients with high values of IgG insulin binding, proved to be suitable to endocrinological routine.

[Pathogenesis of diabetic microangiopathy. Fluoroangioretinal observations during monocomponent insulin therapy]. / Sulla patogenesi della microangiopatia diabetica. Osservazioni fluoroangioretinografiche in corso di trattamento con insulina monocomponente.

Current theories on the pathogenesis of diabetic microangiopathy and their effective therapeutical implications are reviewed. The possible role of insulin antibody production in insulin-treated diabetics concerning development and progression of retinopathy is particularly discussed. Thus the opportunity of a monocomponent (MC) insulin treatment in all newly diagnosed insulin-dependent diabetics is considered. The authors have carried out fluorescein angiography in two groups of subjects with JOD comparable for age, sex, diabetes duration (5-7 years), insulin requirement, metabolic control, absence of diabetic heredity as well as of clinical (ophtalmoscopic) signs of microangiopathy (retinopathy). The first group had been treated from the beginning with MC porcine insulin (Monotard) only; the second one with conventional Lente only. Early fluoroangiographic signs of retinopathy ("pre-retinopathy") as increased capillary filling, ischaemic areas, alterations in capillary permeability, microangioaneurysms, "primary exudation" had to be detected. In 2 out of 10 cases in the first group one isolated sign was found; one or more signs were found in the second group. In the first group the insulin antibody titer (IB) was under or nearly above the detection limit; in the second group insulin antibody titer was significantly positive. These preliminary findings suggest a larger prospective study.

[Evaluation of diabetic glycemic control in hospital and extra-hospital regimen (author's transl)]. / Valutazione del controllo del diabete insulino-dipendente in regime intra- ed extra-ospedaliero per mezzo di nuovi indici numerici del profilo glicemico giornaliero

It is suggested an evaluation of the degree of diabetic control in insulin-dependent "difficult" patient, during the period following the discharge from hospital. In 13 cases, the quality of glycemic regulation was compared in intra- and extra-hospital therapeutic regimen by means of 3 new indices of the diurnal blood sugar profile: the Mbs, delta, and Mdelta values. Mbs value describescribes the mean level of the blood sugar curve; delta indicates the amplitidue of the glycemic variability field; Mdelta reports both maximal and minimal extremes of the curve. A combination of the first two parameters proved adequate for a clinical assessment of diabetic control. In the majority of the cases, blood glucose patterns were found similar or even improve in extra-hospital conditions. The insulin dosage ordered during hospital staying was confirmed in all, but one, patients. Psychological approach is probably essential for such good results. The procedure seems to be suitable in order to establish a more correct starting point for an effective treatment of the diabetic out-patient.

[Modified graphic solutions for determination of the K coefficient in the rapid intravenous hyperglycemia test]. / Soluzioni grafiche modificate per la determinazione del coefficiente K nella prova di iperglicemia rapida endovenosa

Standard and modified graphical solutions for K rate determination of intravenous glucose tolerance test are presented and discussed. Some practical notices are collected. The procedures proved useful for the diagnosis of subclinical diabetes according to the WHO.