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The occurrence of severe and mild hypoglycaemic attacks and their symptoms and signs were studied in 92 insulin-dependent diabetic children, 7-18 years old. A questionnaire was distributed to all families and they were interviewed by an experienced nurse. Severe attacks, for which the help of an adult was needed, were reported by 44% of the children during a 12-month period. Thirty-seven per cent of the attacks occurred in the mornings, most often attributed to extra physical exercise, but equally often without any obvious cause. They were more common in children with strict blood glucose control measured as HbA1c. Fast-acting carbohydrates, given by parents, relieved the attack in most children, but 15% needed a glucagon injection and 12% intravenous glucose. In all, 16% were admitted to hospital. Mild events occurred in 97% of the children, at least once per week in 53% of the children, and were not related to blood glucose control. They were often attributed to extra physical exercise and occurred mainly between breakfast and lunch. Initial symptoms were tremor and hunger; during the whole event tremor and sweating were most common. Parents noted pallor as the most common sign. The frequency of severe or mild attacks could not be correlated to the age of the child, duration of diabetes, daily dose or number of insulin injections.
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PMID:Symptomatic hypoglycaemia in childhood diabetes: a population-based questionnaire study. 252 88

32 subjects with long-term insulin-dependent diabetes mellitus (IDDM) were entered into a double-blind, randomised crossover trial with human and porcine insulin. They were treated during both periods with regular insulin and with protamine (NPH) insulin. 18 subjects started with human and 14 with porcine insulin; the two insulin periods each lasted twelve weeks; the insulin doses were much the same in the two periods (mean 23 [SD 9] U daily NPH; 14 [7] U daily regular insulin), as were blood glucose profiles and HbA1c values. There were 171 episodes of hypoglycaemia during human and 150 episodes during porcine insulin. Patients completed questionnaires after each hypoglycaemic episodes and at the end of the trial. Hunger and sweating without concomitant neuroglycopenic symptoms were significantly more frequent as initial warning symptoms during porcine than during human insulin (41% vs 20%), whereas neuroglycopenic symptoms were more frequent during human insulin. At the end of the trial 18 of 32 subjects reported diminished awareness of hypoglycaemia during human insulin compared with 6 of 32 during porcine insulin. Hypoglycaemia developed faster during human than during porcine insulin administration. The transfer of IDDM subjects from porcine to human insulin seems to alter warning symptoms of low blood glucose concentration, with consequent impairment of its early recognition.
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PMID:Warning symptoms of hypoglycaemia during treatment with human and porcine insulin in diabetes mellitus. 256 12

Thirty-seven insulin-dependent diabetic patients were tested for symptoms of hypoglycemia, cardiac autonomic neuropathy (i.e., heart rate variation during deep breathing, Valsalva maneuver, immediate heart rate response to standing), and isoproterenol sensitivity (defined as the dose of isoproterenol required to increase heart rate by 25 beats/min: I25). Tests of cardiac autonomic neuropathy showed no relation to hypoglycemic symptoms. On the contrary, a clear relationship could be established between isoproterenol sensitivity and adrenergic symptoms of hypoglycemia. Diabetic patients with decreased response to isoproterenol had fewer adrenergic symptoms, perceived hypoglycemia at a lower blood glucose level, and had more hypoglycemic accidents. Symptoms most related to isoproterenol sensitivity were tremor, sweaty palms, and hunger. With the isoproterenol-sensitivity test a distinction could be made between the groups at high (I25 greater than 3 micrograms) and low (I25 less than 3 micrograms) risk for hypoglycemic accidents. We suggest that the isoproterenol-sensitivity test could be used to identify diabetic patients at increased risk for hypoglycemia.
Diabetes Care
PMID:Hypoglycemic symptoms and decreased beta-adrenergic sensitivity in insulin-dependent diabetic patients. 282 74

An hyperglycaemic metabolic state disappeared and spontaneous hypoglycaemia occurred in a 58-year-old woman with non-insulin-dependent obese type II diabetes. Abnormal absence of the hunger response with provoked hypoglycaemia, increased serum insulin concentrations and reduced blood glucose/insulin ratio led to the diagnosis of pathological hyperinsulinism, which was found to be due to an insulinoma of the tail of the pancreas. After its excision the patient's carbohydrate metabolism returned to a mild type II diabetic state and there were no further hypoglycaemic attacks.
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PMID:[Hypoglycemia caused by insulinoma in diabetes mellitus]. 284 54

Food intake regulation is influenced by serum amino acid (AA) ratios. The objectives of this study were to determine whether non-obese subjects with diabetes have normal serum AA ratios, and to see if AA ratios relate to perceived hunger. We therefore measured fasting serum AA in nine normal subjects on two occasions and 19 patients with diabetes on four occasions over a two month period. At the time of the blood samples, the subjects with diabetes were asked to rate how hungry they felt on a scale of -3 (very hungry) to +3 (very full). There were no significant differences between the mean AA ratios of normal and diabetic subjects. There was a positive correlation between reported hunger score and the ratio of serum tryptophan (TRP) to the sum of the concentrations of the other large neutral AA (LNAA) (r = 0.286, n = 78, p less than 0.05). The relationships between hunger and other AA ratios were not significant. Variations of the TRP/LNAA ratio within each subject did not relate to differences in hunger from day-to-day. However, there was a positive correlation between the mean TRP/LNAA ratio and mean hunger score of the different subjects (r = 0.495, n = 19, p less than 0.05). The relationships between TRP/LNAA ratio and body weight or hunger score were not significant. It is concluded that the serum AA ratios are normal in patients with diabetes. The data is consistent with the hypothesis that a low serum TRP/LNAA ratio causes increased feelings of hunger in different individuals.
Diabetes Res 1988 Nov
PMID:Relationship between fasting serum tryptophan/large neutral amino acid ratio and reported hunger in subjects with diabetes. 324 45

The affinity and number of receptors were determined using Scatchard's, Meytes' and Rose's graphic analyses in the hepatic and fat plasmatic membranes of rats in various duration of hunger (2 and 7 days) and alloxan diabetes (3 and 7 days after alloxan administration) to test a hypothesis that increased affinity of insulin receptors was the first phase of their activation preceding an increase in the number of insulin binding sites. Irrespective of hunger duration an increase in the number and affinity of receptors was detected in the hepatic membranes and an increase in their affinity in the fat membranes. In diabetes of various duration the number of receptors in the membranes of both tissues increased. With an increase in the period of exposure the degree of expression of receptor changes decreased in the fat but not in the hepatic membranes.
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PMID:[Binding properties of insulin receptors in adipose tissue and hepatic plasma membranes in rats during fasting and in alloxan diabetes]. 352 18

In a summer camp for 47 diabetic children in Kinki district, Japan, in 1984, the relationship between hypoglycemic symptoms and blood glucose levels by self-monitoring was analyzed. During the 7-day camp, self-monitoring of blood glucose (SMBG) was carried out 599 times in total, 12.7 times per camper. SMBG due to hypoglycemic complaints amounted to 371. 154 measurements out of 371 indicated blood glucose levels under 80 mg/dl, but 78 monitorings were found to be over 200 mg/dl. Fatigue or weakness were the most frequent hypoglycemic symptoms, as was hunger sensation, each reaching approximately 40% in frequency. In most complaints of tremor, the blood glucose level was critically low. Prompt measurement of blood glucose is indeed necessary to properly treat diabetic children with 'hypoglycemic' symptoms.
Diabetes Res Clin Pract 1985 Dec
PMID:Relationship between hypoglycemic symptoms and blood glucose levels due to self-monitoring in summer camp for diabetic children in Japan. 383 7

Diabetes mellitus is a metabolic disorder which has affected several millions of population all over the world. It is characterized by an excess of sugar in the blood and urine, hunger, thirst and gradual loss of weight. Insulin is a hormone which regulates the carbohydrate and triacylglyceride metabolism through its action at several sites and facilitates the entry of glucose accumulation in the blood. Insulin also stimulates the synthesis of glucokinase and moderates the degree of gluconeogenesis. In the diabetic patient, there is an aberration in the functioning of insulin. Prior to the 1950s, control of diabetes was based entirely on insulin therapy. Unfortunately, some patients developed complications and thus need for some other therapy was realized. Presently control of NIDDM relies on compounds from two classes--sulphonylureas and biguanides. Although these drugs are widely accepted as being efficacious in treating some diabetics, they are ineffective in many others. Consequently, testing of many chemicals and plant extracts has continued. The object of the present paper is to bring up-to-date information on the hypoglycemic activity of plants, above all the plants occurring in our country, and those who se hypoglycemic activity has been scientifically documented in a more detailed way. Recent theories on the mechanism of action of these plants are also discussed.
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PMID:[Plants with hypoglycemic effects]. 811 60

An analysis conducted by WHO in 1991 and 1992 indicated that death rates from diseases related to diet and life-style (heart conditions, cancer, and diabetes) have increased significantly in many countries during the past 30 years, largely owing to changes in diet and life-style. 40 high-income countries have diet-related disorders, and as many as 80 middle-income nations may have both undernutrition and overnutrition problems. Undernutrition is widespread in some 50 low-income countries and is associated with a high incidence of stunting and micronutrient deficiencies (especially iron, iodine, and vitamin A). Diet-related deficiencies affect 2000 million people. WHO scientists reviewed data from 26 developed and 16 developing countries from the period 1960-89: 20 countries showed increases ranging up to 160% in death rates from diet-related and life-style-related causes. The biggest decreases were in Australia, Canada, Japan, and the USA where education advised people to limit intakes of fat, saturated fat, and salt as well as to increase exercise and reduce smoking. Data on food availability for 1988-90 showed that an estimated 786 million people in developing countries were chronically undernourished. Hunger and malnutrition affect many of the 123 million people living in 11 countries where the food situation is critical. Some 192 million children 5 years of age suffer from protein-energy malnutrition characterized by retardation of physical growth and lowered resistance to infections. 55 million of these underweight children are in south Asian countries. In these countries, about half of all deaths occur before 5 years of age, and the majority of these deaths are caused by diarrheal disease. It is estimated that up to 70% of diarrhea cases are food-borne in origin. There are 1500 million episodes of diarrhea annually in children 5 years of age, killing 3 million of them.
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PMID:International Conference on nutrition. 818 79

Recombinant human insulin-like growth factor-1 (rhIGF-1) is currently used experimentally to treat patients with insulin-resistant diabetes mellitus, impaired growth, protein malnutrition, and osteoporosis. We report here the case of a marked transient alteration in consciousness in a healthy 22-year-old man who was given an IV infusion of a relatively low dose of rhIGF-1 for 1 hour. This individual developed the sudden onset of dizziness, nausea, coldness, air hunger, and pallor. He became unresponsive to simple questions and experienced diaphoresis, a feeling of warmth, and paresthesias. Although there was a mild fall in heart rate and blood pressure, these hemodynamic effects did not appear sufficient to cause the altered mentation. There were no changes in serum glucose, phosphorus, or potassium that could seem to account for these events. This individual recovered completely several minutes after stopping the rhIGF-1 infusion.
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PMID:Altered mental function during intravenous infusion of recombinant human insulin-like growth factor 1. 855 53


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