Experience with NovoPen, an injection device using cartridged insulin, for diabetic patients.

An insulin injection device, NovoPen, incorporating cartridged U100 Human Actrapid insulin was used in a group of 31 insulin-dependent diabetic patients aged 31.4 +/- 11.2 years (mean +/- S.D.; range 16.5-57.0) to assess its acceptance and suitability in a regimen involving an injection before each of their three main meals plus an evening injection of Human Monotard insulin from a conventional syringe. Twenty-seven patients completed 48 weeks of NovoPen therapy and preferred to continue with the multiple injection regimen in the long term. The device was well accepted and may make multiple injection regimens more feasible.

Diabetic control with gliquidone--a short acting sulphonylurea.

Gliquidone (Glurenorm) and glibenclamide were compared in a cross-over study of 20 non insulin dependent diabetics. Both drugs achieved similar levels of control, as measured by self home monitoring, glycosylated haemoglobin and N-acetyl-beta-D-glucosamidase levels. However, with glibenclamide hyperglycaemic control was only achieved at the expense of more hypoglycaemic episodes. The study examined the tailoring of drug dosage to the patients needs and found that in the majority of patients it was necessary to give both glibenclamide and gliquidone thrice daily. It confirmed the acceptability of self glucose monitoring in a home population.

Ciclazindol: an oral agent with weight reducing properties and hypoglycaemic activity.

In a single blind crossover study, ciclazindol, 10-(m-chlorophenyl)-2, 3, 4, 10-tetrahydropyrimide (1, 2 alpha) indol-10-ol hydrochloride (Fig. 1), has been found to have hypoglycaemic action, and to produce reduction in appetite and weight. The mode of action appears to be different from either biguanides or sulphonylureas. Side-effects were few and mild. Metformin 500 mg b.d. had comparable hypoglycaemic effect but did not suppress appetite. Ciclazindol may be useful as a mild oral hypoglycaemic agent for obese patients, and would be suitable for once daily administration.

N-Acetyl-beta-D-glucosaminidase levels and the onset of diabetic microangiopathy.

N-Acetyl-beta-D-glucosaminidase (NAG) levels in serum and urine from diabetics have been measured over a three-year period to assess their potential as indicators of the onset of retinopathy and nephropathy. The presence of retinopathy and nephropathy was confirmed by fluorescein angiography performed at the end of the study and by proteinuria, respectively. Three groups of diabetics were investigated, those on insulin, on oral hypoglycaemics, or on diet only. There was no apparent correlation between total NAG activity in serum with the development of retinopathy, nor were serum isoenzyme variations useful in this context. However, urine total NAG activity demonstrated a striking difference between diabetics of all groups and normals. In particular the B isoenzyme doubled in diabetics. The potential use of this finding in relation to prediction of the onset of microangiopathy is discussed.

Insulinopenia in impaired glucose tolerance preservation of insulin response to I.V. arginine and tolbutamide.

Immunoreactive insulin (IRI) response to successive i.v. injections of glucose (0.3 g/kg), arginine (5 g) and tolbutamide (20 mg/kg) was measured in 11 non-obese patients with mild glucose intolerance and 11 control subjects. In 3 of the patients the IRI response to i.v. arginine and subsequent i.v. glucose was also measured. The mean peak IRI level following glucose was grossly diminished in the patients compared to controls but peak IRI levels following arginine and tolbutamide were similar in the two groups. Administering arginine prior to glucose in the 3 patients tested resulted in a lowering of the IRI response to arginine but no increase in the IRI response to glucose. The decreased IRI response to i.v. glucose associated with an adequate response to i.v. arginine and tolbutamide in these patients suggests a failure of the B-cell sensor mechanism for glucose and may provide a physiological explanation for the recognized value of restricting carbohydrate relative to protein in the treatment of this condition. Any defect in the sensor mechanism for arginine appears quantitatively much less severe than that to glucose.

N-Acetyl-beta-D-glucosaminidase levels and diabetic microangiopathy.

N-Acetyl-beta-D-glucosaminidase (NAG) activity has been measured in the serum and urine of primary and secondary diabetics and in primary diabetics with microangiopathy. NAG activity has also been measured in the tears of diabetics with ocular complications and diabetics with no ocular changes. Results have shown significantly higher levels of urinary NAG in diabetics with proteinuria (p less than 0.001) and proteinuria and retinopathy (p less than 0.001). There was no correlation between urinary NAG activity and serum creatinine (r = 0.28) or urinary NAG and the degree of proteinuria (r = 0.24). Increased urinary NAG levels were also observed in secondary diabetes associated with haemochromatosis and acromegaly. Significantly higher serum NAG levels were found in newly diagnosed diabetics (p less than 0.01) and significantly lower levels in chemical diabetics (p less than 0.01). Compared to non-diabetic controls tear NAG levels were significantly higher in the diabetic controls (p less than 0.01), in diabetics with retinopathy (p less than 0.01), and in diabetics with cataract formation (p less than 0.05). An assessment of this enzyme is made in relation to the development of diabetic microangiopathy.