Microalbuminuria following exercise, an early sign of diabetic nephropathy.

Microalbuminuria after physical exercise is characteristic for the preclinical stage of diabetic nephropathy, permitting an early diagnosis of this severe complication of diabetes mellitus. In 24 patients with type I diabetes, 11 women and 13 men free of clinical and biological signs of renal damage, the presence of microalbuminuria has been investigated by radial immunodiffusion in the urines collected between 3 and 7 hrs in the morning, as well as after a 20-min rest following a moderate exercise of 75 watts during 20 min at the ergometric bicycle. The patients were distributed into four groups, according to the age of disease, and microalbuminuria was expressed in micrograms/min. Compared with the mean values recorded in normal subjects by the same method (6.8 micrograms/min), the level of microalbuminuria has been significantly higher in the cases evaluating since more than two years, in keeping with the time elapsed after onset, and particularly following exercise. No relationship could be established between the quality of metabolic control of diabetes and the levels of microalbuminuria after exercise.

The dynamic of impaired glucose tolerance in women with fetal gigantism.

In a group of 51 women who had given birth to giant children, the glucose tolerance test (GTT) was performed at entry in the study and after intervals of 6 to 12 years. The results of the first determination, estimated according to the WHO's criteria (1980), have revealed an impaired glucose tolerance (IGT) in 7 cases (14%); the second determination showed IGT in 10 cases (20%) and diabetes mellitus in 2 (4%). Insulinemia assays, concomitant with the second performance of GTT, showed the highest values in the diabetic subjects, moderate values in those with IGT, and low values in those with normal glucose tolerance. The presence of obesity in some cases could not be considered as fully responsible for the glucose tolerance impairment in the women with fetal gigantism. The dynamics of glucose tolerance disorders showed variations in time, i.e. the initial pathologic changes were no more recorded on the second testing in the same subjects, while women with normal initial GTT showed high insulinemia or IGT on the second determination.

Blood glucose and plasma insulin responses to various carbohydrates in type 2 (non-insulin-dependent) diabetes.

The blood glucose and plasma insulin responses to some simple carbohydrates (glucose, fructose, lactose) and some complex ones (apples, potatoes, bread, rice, carrots and honey) were studied in 32 Type 2 (non-insulin-dependent) diabetic patients. Blood glucose and plasma insulin were measured at zero time and then at 15, 30, 60, 90 and 120 min after ingestion of 25 g glucose, fructose or lactose, or 30 g honey, 50 g white bread, 125 g white rice or potatoes, 150 g apples or 260 g carrots. Maximum blood glucose and plasma insulin responses were recorded 60 min after ingestion of each test meal. At this time the increases in blood glucose and in plasma insulin were significantly higher after the more refined carbohydrates (glucose, fructose and lactose) than after the more complex ones (apples, potatoes, rice, carrots and honey, -p less than 0.01). Counting the blood glucose increase after glucose as 100%, the corresponding increases in glycaemia for other carbohydrates were: fructose, 81.3%; lactose, 68.6%; apples, 46.9%; potatoes, 41.4%; bread, 36.3%; rice, 33.8%; honey, 32.4% and carrots, 16.1%.

Immunoglobulin A in diabetics.

Serum immunoglobulins G, A and M were investigated by radial immunodiffusion in a group of 217 diabetics (133 males, 84 females) of whom 152 were insulin dependent and 65 non-insulin dependent. Higher values of IgA as compared with IgG and IgM were observed whatever the criteria of clinical analysis used. The highest IgA values were found in diabetics aged over 65 at the onset of disease and in those with renal complications.

Study of some lymphocyte metabolic parameters in diabetes mellitus.

Cytochemical study of peripheral lymphocytes in 78 diabetic patients and 22 controls included the determination of glycogen (with calculation of the "glycogen score"), lipids and nucleolar RNA (with calculation of the so-called "lymphocyte nucleologram"). All three metabolic components showed marked differences between the diabetes and the controls. Further analysis in terms of sex, patient's age, duration of disease, basic treatment and main complications of diabetes, also showed certain variations of the above parameters but of lesser amplitude. Metabolic alterations of lymphocytes in diabetes mellitus reflect the pathogenic particularities of the disease, and might probably be used as a basis for further practical purposes.

The behaviour of some biologic parameters in obese patients after short-term exercise under restrictive diets.

Seven obese female patients with a mean age of 40 have received for 3-4 days a diet of 1000 cal followed by a diet of 300 cal/day. At the end of each period of diet, the patients performed an exercise of 75 watts for 15 min on the ergometric bicycle. Some biologic parameters determined before, as well as 15 min and 60 min after exercise did not show important differences in terms of the diet applied. Glycemia was constantly low, while glucagon, lactate and free fatty acids (FFA) values rose, particularly within the 15 min following exercise. After the same interval, insulinemia was unchanged or even increased. These results support the opinion that, even under restrictive diets, the reaction of obese patients to a short-term exercise is similar to that of normal weight subjects, their sources of energy being the same. The behaviour of insulinemia, which did not change or even increased, while in normal weight subjects it decreases on exercise, might be due to a lesser epinephrine activity in obese patients and/or a lesser FFA release from the adipose tissue.

Study of some serum protein fractions in various clinical forms of diabetes mellitus.

With a view to studying the eventual alterations of protein metabolism, some serum protein fractions such as: immunoglobulins (IgG, IgA, IgM), transferrin and ceruloplasmin were determined in 100 diabetics (52 males, 48 females) in comparison with a control group of 26 healthy subjects. Significant differences were found between IgA and transferrin values both in diabetics and in controls. IgA tended to increase with the length of disease, whereas IgG, IgM and transferrin showed a contrary trend. IgA and transferrin values were higher in the patients with juvenile and young adult diabetes, as compared to maturity onset and senile diabetes. Other immunoglobulin and transferrin changes were related to sex, age, type of treatment, degree of stability, presence of chronic complications. No significant anomalies were found for ceruloplasmin. The results confirm the presence of serum protein alterations in diabetes mellitus, whose significance may be correlated with the clinical particularities of the disease.

Effect of the antidiabetic treatment of hyperlipoproteinemia in newly detected diabetes mellitus.

A parallel study concerning the influence of antidiabetic treatment of the carbohydrate and lipid disturbances were carried out in 209 patients with newly discovered diabetes mellitus: 120 females and 89 males, ranging in age from 28 to 73 years. The treatment applied in terms of the clinical from of the disease was: insulin in 12 cases, tolbutamide in 25 cases, glurenorm (a sulphenyl urea derivative in 114 cases, biguanide in 45 cases, tolbutamide associated with biguanide in 13 cases. After 60 days of treatment, the incidence of HLP fell from 55.02% to 43.06% (in 90 of 209 cases), with a change in the distribution of the five HLP types. Parallel analysis of blood glucose, triglycerides (Tg) and cholesterol (Ch) revealed appraisable differences in the post-therapeutic evolution of the three biochemical parameters in terms of the treatment applied. A statistically significant, parallel and comparable decrease in glycemia, Tg and Ch was recorded after insulin and glurenorm; biguanides lowered only glycemia and Tg, and tolbutamide only glycemia. The fact that correction of carbohydrate disturbances is accompanied by a significant decrease only of Tg and not of Ch suggests that the pathophysiologic mechanisms by which these lipid fractions are modified in diabetes mellitus, differ and are probably independent on one another. The close relationship between the weight excess and plasma Tg (but not also plasma Ch) levels, likewise lends support to this assumption.

Plasma phosphorus and magnesium values during treatment of severe diabetic ketoacidosis.

Plasma phosphorus and magnesium were determined in 76 diabetics, admitted with severe ketoacidosis (pH less than or equal to 7.20, total CO2 less than or equal to 10 mEq/l) before and 24 hours after beginning the treatment, which did not include supplementary phosphorus or magnesium. Phosphorus presented initially high values (1.76 + 0.69 mEq/l) which fell substantially 24 hours after beginning the treatment (0.87 +/- 0.26 mEq/l); magnesium values, initially low (0.76 +/- 0.19 mEq/l), fell still further within 24 hours of treatment (0.64 - 0.16 mEq/l). For phosphorus (and to a lesser extent for magnesium) calculation of the regression line indicated a direct positive relationship with both hydrogen ion concentrations (r = 0.67) and blood glucose (r = 0.73), the differences being statistically significant. The more rapid the decrease in glycemia and correction of acidemia and the greater the amount of glucose administered in the course of treatment, the more marked was the fall of plasma phosphorus and magnesium values.

Metabolic "responders" and "non-responders" to muscular exercise in diabetes.

The metabolic effects of muscular exercise (bicycle ergometer, 75 watts, 15 min) were studied in 16 healthy controls and 49 diabetics distributed into three groups. The first two groups included insulin-dependent diabetics three hours after administration of insulin (group A, 24 cases) or 12--18 hours after the last insulin dose (group B, 18 cases). Group C included 7 non insulin-dependent diabetics. According to the glycemia response, the patients were listed as: high responders (greater than 20% below the initial values), low responders (10-20% fall) and non-responders (increase or less than 10% decrease). The data obtained show that, in most cases, in the presence of insulin, exercise has a hypoglycemic effect and, in its absence, a hyperglycemic one. To a lesser extent, the fall in glycemia may be attributed to an apparently insulin-independent mechanism. Exercise can only be indicated (in high-responders) or contraindicated (in non-responders) after a routine tolerance test.