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Query: UMLS:C0011849 (diabetes)
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We report a Malay girl suffering from generalised lipodystrophy, with clinical features of absence of body adipose tissue, hepatomegaly, hyperpigmentation and muscular hypertrophy. She also had hyperlipaemia, hypercholesterolemia and non-ketotic insulin-resistant diabetes mellitus. The possibility of malnutrition-related diabetes mellitus was excluded because of (a) no personal or family history of malnutrition (b) no pancreatic calcification (c) total loss of subcutaneous fat and (d) her requirement for insulin was more than 21.2 units/kg body weight which would be too high even for malnutrition-related diabetes mellitus. Attempts were made to control her diabetes initially with subcutaneous boluses insulin, then continuous intravenous insulin infusion (CIVII) and finally orally with fenfluramine and chlorpropamide.
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PMID:Generalised lipodystrophy. 239 9

Seven undernourished and seven obese, insulin-requiring type 2 diabetic subjects, who were matched for age, sex, and duration of diabetes, were subjected to oral glucose tolerance tests. Although fasting glucose and free insulin levels were similar in both groups, glucose tolerance was markedly worse in the undernourished subjects, with a mean incremental glucose area (+/- SE) of 22.8 +/- 2.3 mmol/l.h vs. 12.4 +/- 1.3 in the obese diabetic subjects (P less than 0.001). The incremental insulin response (area under the curve) to oral glucose in the undernourished group (39.3 +/- 7.9 mU/l.h) was 50% lower than the response in both the obese group (89.2 +/- 19.9, P less than 0.001) and a group of non-diabetic, normal weight-for-height subjects (77.1 +/- 5.7, P less than 0.01). Peak insulin levels were similarly reduced to approximately half the levels seen in the obese and control groups (P less than 0.01). Undernutrition is known to impair both glucose tolerance and insulin secretory reserve by reducing the beta cell number, size, and granulation. It is concluded that chronic undernutrition accentuates beta cell dysfunction in undernourished diabetics, leading to increased glucose intolerance.
Diabetes Res Clin Pract 1990 Jan
PMID:Chronic undernutrition may accentuate the beta cell dysfunction of type 2 diabetes. 240 81

For an adequate interpretation of the significance of somatomedin levels in clinical conditions, a number of factors should be considered which may have an influence on the result. First of all, the heterogeneity of the somatomedins, both in their complexed form and after dissociation, should be considered. These forms have an unequal degree of cross-reactivity in different assay systems, while only the function of SM-C/IGF-I and, to a minor degree, of IGF-II have been established. Both are mitogenic and IGF-II has more insulin-like effects than does SM-C/IGF-I. Only the latter has been shown to increase length in dwarf mice. Somatomedins are produced in many tissues. This has led to the concept of autocrine or paracrine functions. The levels of SM-C/IGF-I increase with age, and there is a large increase during puberty, particularly when measured in the radioimmunoassay. In addition its level is influenced by growth hormone, to a minor degree by thyroid hormones, prolactin and perhaps by HCS and insulin. Finally, the nutritional and metabolic state of the patient is important: low values have been found in malnutrition, poorly regulated diabetes mellitus and insufficiency of the liver. Measuring somatomedins may be helpful for diagnosis and evaluation of the therapy of certain disorders, but the complexity of the regulation of their blood levels needs caution in the interpretation of results.
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PMID:[Somatomedins. Structure, physiology and clinical data]. 243 21

Acute protein-calorie malnutrition impairs both glucose tolerance and insulin secretion, and long-term pancreatic damage leading to malnutrition diabetes has been postulated. The present study has investigated this association in rats weaned onto 5% protein (LP) or 18% protein (normal, N) diet from age 3 weeks to 6 weeks. From 6 weeks both LP and N rats were fed N diet for the remainder of the experiment. LP rats did not grow while on the LP diet and remained significantly lighter for several weeks. Nose to tail tip length was identical for the two groups in both sexes at both 24 and 48 weeks, and mean body weight was not significantly less in LP than N after 18 weeks in either sex. Protein/DNA ratios in LP (an index of cell size) remained lower than N in heart, skeletal muscle, and lung at 24 and 48 weeks, but not in gut, liver, or kidney tissues. Thus, skeletal growth was apparently not impaired by the early malnutrition, but muscle tissue did not catch up. The similarity in final body weight implies greater adipose stores in older LP rats. At 12 weeks there was no difference in glucose tolerance tests (GTT) either between males and females within a dietary group or between N and LP, despite impaired insulin secretion in LP. Both fasting glucose levels and GTT deteriorated markedly between 12 and 48 weeks in all rats, but especially in LP males. Serum insulin levels following glucose injection were lower at 48 weeks than 12 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term follow-up after early protein-calorie malnutrition in young rats: sex difference in glucose tolerance and serum insulin levels. 250 76

Plasma lipid profiles--total cholesterol (TC), LDL-cholesterol, HDL-cholesterol, triglycerides and phospholipids--were studied in relation to two parameters of diabetic control (fasting blood sugar (FBS) for short-term control and glycosylated haemoglobin (HBA1C) for long-term control) in 46 diabetic patients (22 insulin-dependent (IDDM) and 24 non-insulin dependent (NIDDM] and 22 non-diabetic control subjects. We confirmed the positive correlation between FBS and HBA1C. All diabetic patients had significantly higher triglyceride levels (P less than 0.05) than controls, which were not influenced by degree of glycaemic control. NIDDM patients tended to have higher than normal TC levels (P less than 0.05). In IDDM, TC level was positively correlated with HBA1C (r = 0.37, P less than 0.05), and negative correlations were established between FBS and HDL-cholesterol (r = -0.46, P less than 0.02) and the HDL-cholesterol:TC ratio (r = -0.49, P less than 0.01), suggesting an increased atherogenic risk with poorer diabetic control. It is concluded that lipoprotein abnormalities exist in Nigerian diabetics, though not as consistently as in Caucasians. The differences may be due to, among other factors, differences in genetic make-up, diet (typical African diet being rich in plant fibre and poor in cholesterogenic nutrients) and aetiology of the diabetic state (tropical diabetes being highly heterogeneous and now thought to be linked to malnutrition).
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PMID:Plasma lipid profiles in relation to diabetic control in Nigerians. 255 Nov 65

Thirty Ethiopian malnutrition-related diabetes mellitus (MRDM) patients were HLA typed and their HLA antigen frequencies were compared to those of 31 previously typed insulin-dependent diabetes mellitus (IDDM) patients and to 84 controls from the same ethnic background. In comparison to controls, a striking association between MRDM and HLA-DR3 (X2 = 15.15, p = 0.0001) was observed, whereas the frequency of HLA-DR4 was non-significantly increased (RR = 1.72). The frequency of DR2, DQw1, and DQw6 was decreased among MRDM. In comparison to IDDM that is associated with both DR3 and DR4 in this population, MRDM showed no significant differences in HLA class II antigens frequencies. Therefore, the genetic basis of susceptibility to MRDM and IDMM in Ethiopia is at least partially identical.
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PMID:HLA-DR and -DQ antigens in malnutrition-related diabetes mellitus in Ethiopians: a clue to its etiology? 262 60

Diabetes mellitus is a state of absolute or relative insulin deficiency leading to hyperglycemia and profound changes in the body lipids and proteins. The World Health Organisation (WHO) classification of diabetes distinguishes between: insulin dependent diabetes mellitus (IDDM), non-insulin dependent diabetes mellitus (NIDDM) and malnutrition related diabetes mellitus (MRDM). In childhood the overwhelming majority is due to an autoimmune betacell disease leading to IDDM.
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PMID:Definition and classification of diabetes. 263 89

Diet therapy is an important factor in overall care of most GI patients. Historically, diets have been used unscientifically in many of these patients without positive results. Nutritional care and diet therapy are critical for two reasons. First, malnutrition is an expected sequelae to most, if not all, GI diseases or disorders. Failure to eat, digest, or assimilate nutrients can provoke malnutrition in just a few weeks, although careful assessment of anthropometric, clinical, biochemical, and nutritional history by a trained professional can protect against this. Diet therapy through the elimination of offending foods such as wheat gluten or lactose, or inclusion of specialized products such as medium chain triglycerides or elemental formulas, can sustain nutritional status. Dietary components such as insoluble fiber appear to have physiologic effects, while soluble fibers may have metabolic effects important to diabetes and cardiovascular disease. There is a high potential for malnutrition in Crohn's disease during active and remittent phases. Elemental enteral formulas or TPN are used during the active phase to ensure optimal nutritional status and bowel rest. Hyperalimentation using the GI tract during remittent stage maintains this. Avoiding offending foods by Crohn's patients is an acceptable practice as long as entire categories of foods are not deleted. Avoiding all foods containing gluten from wheat, rye, barley, and oats, however, is a crucial prerequisite to recovery from celiac disease. Gluten is commonly used as a stabilizer, emulsifier, and extender in the food industry and is not always shown on food labels. Careful consultation with a registered dietitian can identify hidden sources of gluten in the diet.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Dietary therapy in gastrointestinal disease. 264 90

Gastrointestinal disorders associated with diabetes mellitus have a prevalence rate of 30 to 75%. The most prominent disorders are gastroparesis, diarrhea, and constipation. Severity of symptoms range from mild to severe with the most affected patients being at risk for the development of protein calorie malnutrition. An historical review of the major studies which defined the diagnosis, pathophysiology, and prevalence of these disorders is presented. Guidelines for accurate nutritional assessment, which is essential to the decision to initiate nutritional therapy in this difficult to assess population, are also included. Current methods devised for treatment of diabetic gastroparesis and related disorders are presented. Emphasis is placed on recent developments in nutritional support techniques which make it possible to meet the energy requirements of all such patients. Practical outlines for glucose control in patients receiving TPN or enteral feeding and guidelines for transitioning from parenteral feeding to an oral diet are also presented.
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PMID:Overview of gastrointestinal disorders due to diabetes mellitus: emphasis on nutritional support. 264 46

The etiology of malnutrition-related diabetes mellitus (MRDM), mostly seen in the developing countries, is still unknown, though an excessive consumption of cassava and a low intake of protein are considered to be its causative factors. Previous immunological studies, though rarely performed, have so far, to our knowledge, shown no case of MRDM with iselt cell antibodies (ICA). We found a 16-year-old MRDM boy with ICA and report on this in the present communication.
Diabetes Res Clin Pract 1989 Jan 03
PMID:The presence of islet cell antibodies in malnutrition-related diabetes mellitus. 264 42


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