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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the present study a randomized cross-over design was used to determine the clinical usefulness of adding 16 g of beet fiber to the ordinary diet of non-insulin dependent diabetic (NIDDM) out-patients. In addition, fiber effects on the gastrointestinal hormone responses to a standardized test meal were evaluated. The study included five patients treated with diet alone and eight patients treated with diet and sulphonylurea (SU). Beet fiber supplementation resulted in a 10% reduction (P less than 0.01) of serum cholesterol in SU-treated patients. No differences were found for fasting blood glucose, glycated hemoglobin, serum triglycerides or body weight. In the diet-treated patients, fasting plasma somatostatin was elevated during the fiber period. However, postprandial responses of insulin, C-peptide, glucagon, gastric inhibitory peptide and somatostatin were not influenced by an increased fiber intake in any group. All patients experienced mild gastrointestinal discomfort during the fiber period. In view of the limited metabolic benefit of beet fiber treatment we conclude that there is little use for this type of dietary fiber in the routine treatment of patients with NIDDM.
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PMID:Metabolic effects and clinical value of beet fiber treatment in NIDDM patients. 185 Jun 91

A 70-year-old man is referred to a urologist for recommendations on the management of metastatic prostate cancer. His cancer was diagnosed 5 years ago, and he underwent radical prostatectomy at that time. The tumour was confined to the prostate gland (Gleason score 7), and during surgery the lymph nodes were assessed as being clear of cancer. Before the surgery, the patient's prostate-specific antigen (PSA) level had been 8 ng/mL. After the prostatectomy, PSA was at first undetectable, but recently the PSA level rose to 2 ng/mL and then, at the most recent test, to 16 ng/mL. A bone scan was ordered to investigate back discomfort, which has been persistent but easily controlled with acetaminophen. Unfortunately, the bone scan shows several sites of metastatic disease. The man's medical history includes type 2 diabetes, which has developed during the past 3 years and which is controlled by diet, as well as asymptomatic hypertension, which is managed by means of a thiazide diuretic. The patient asks what treatments are available, what impact they are likely to have on his disease and what risks are associated with the therapies.
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PMID:Prostate cancer: 9. Treatment of advanced disease. 995 46

Compounds of the trace element vanadium have been shown to mimic insulin in in vitro and in vivo systems. These compounds have been found to exert anti-diabetic effects in rodent models of type 1 and type 2 diabetes mellitus as well as in a limited number of studies in human diabetic subjects. Thus, vanadium compounds have emerged as agents for potential use in diabetes therapy. However, treatment of diabetic animals with inorganic vanadium salts has also been associated with some toxic side-effects such as gastrointestinal discomfort and decreased body weight gain. In addition, vanadium salts have been reported to exert toxic effects on the liver and kidney. More recently, it was shown that organic vanadium compounds were much safer than inorganic vanadium salts and did not cause any gastrointestinal discomfort, hepatic or renal toxicity. This review briefly summarizes the anti-diabetic and toxic effects of vanadium compounds.
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PMID:Anti-diabetic and toxic effects of vanadium compounds. 1083 8

Adequate control of blood sugar has been repeatedly shown to translate into reductions in diabetic complications. Although insulin therapy in patients with type 2 diabetes can achieve and maintain near-normal glycemic goals associated with reductions in microvascular and macrovascular end points, it is often reserved for the later stages of management of these patients because of real or perceived concerns; these include fear and anxiety about worsening diabetes, failure of self-management, loss of quality of life, the pain of self-injection, and the possibility of multiple daily injections. Risks of hypoglycemia, weight gain, and cardiovascular disease may be concerns of physicians, but these risks are either manageable or, in the case of cardiovascular disease, unfounded. Taken together, the barriers to insulin therapy frequently compel physicians to consider it a treatment of last resort. Some of the more common barriers have been addressed through device options such as insulin pens and jet injectors, which may improve convenience but do not alleviate pain and discomfort. Transdermal delivery options using iontophoresis or ultrasound are in early stages of development, but methods based on transmucosal delivery-including buccal, nasal, and pulmonary routes-are further advanced. In particular, recent evidence shows that pulmonary forms of insulin are as safe and effective as rapid-acting injected insulin, and are well accepted by patients even over long-term periods of use. These innovative delivery systems may help overcome the barriers to insulin use.
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PMID:Evaluation of alternative strategies for optimizing glycemia: progress to date. 1243 59

The cytokine interleukin (IL)-6 has recently been linked with type 2 diabetes mellitus and has been suggested to affect glucose metabolism. To determine whether acute IL-6 administration affects whole-body glucose kinetics or muscle glucose uptake, 18 healthy young men were assigned to one of three groups receiving a high dose of recombinant human IL-6 (HiIL-6; n = 6), a low dose of IL-6 (LoIL-6; n = 6) or saline (Con; n = 6) infused into one femoral artery for 3 h. The stable isotope [6,6-2H2] glucose was infused into a forearm vein throughout the 3 h infusion period and for a further 3 h after the cessation of infusion (recovery) to determine endogenous glucose production and whole-body glucose disposal. Infusion with HiIL-6 and LoIL-6 resulted in a marked (P < 0.05) increase in systemic IL-6 concentration throughout the 3 h of infusion (mean arterial plasma [IL-6]s of 319 and 143 pg ml-1 for HiIL-6 and LoIL-6, respectively), followed by a rapid decline (P < 0.05) during the recovery period. Subjects experienced clinical symptoms such as shivering and discomfort during HiIL-6 administration, but were asymptomatic during LoIL-6 administration. In addition, only HiIL-6 elevated (P < 0.05) plasma adrenaline (epinephrine). IL-6 infusion, irrespective of dose, did not result in any changes to endogenous glucose production, whole-body glucose disposal or leg- glucose uptake. These data demonstrate that acute IL-6 administration does not impair whole-body glucose disposal, net leg-glucose uptake, or increase endogenous glucose production at rest in healthy young humans.
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PMID:Acute interleukin-6 administration does not impair muscle glucose uptake or whole-body glucose disposal in healthy humans. 1264 21

We report a singular clinical condition observed following a short duration treatment with sulphasalazine (SSZ) in a 64-year-old woman affected by psoriatic arthritis. Two weeks after starting treatment, a high degree, subcontinuous fever occurred, together with systemic discomfort, fatigue, headache, and ultimately a moderate wakefulness impairment. Upon admission to the hospital, a malar rash became evident. Modest notes of hepatotoxicity were also evident. All of the symptoms suddenly resolved after SSZ withdrawal. The markers of hepatitis become negative just 2 months later. It is interesting to note that after dismissal, in order to counteract the severe arthritic conditions and the presence of a type 2 diabetes, a combined therapy with methotrexate and cyclosporin had to be used, with no renal or hepatic side effects and remarkable therapeutic effects. No markers of autoimmunity were found in this patient. The chronology and the clinical events here described may confirm the hypothesis of a idiosyncratic reaction to SSZ, closely resembling a rare, sometimes irreversible, condition known as "the 3 week sulphasalazine syndrome".
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PMID:Abrupt occurrence of high fever and rash in a patient treated with sulphasalazine for psoriatic arthritis. 1497 71

Resistant starch (RS) includes the sum of starch and degradation products of starch that resist small intestinal digestion and enter the colon. This study was planned to examine the effect of resistant starch on hypolipidemic actions, blood glucose, insulin levels and humoral immune responses in healthy overweight subjects. Healthy overweight subjects (over 120% of their ideal body weights) were fed either 24 g/d of resistant corn starch (RS) or regular corn starch (CS) for 21 d with their regular meals. Although this double-blind feeding regiment resulted in no significant changes in their weights or other physical parameters for the relatively acute period of intakes, there were significant lowering effects of serum total cholesterol (p < 0.05) and serum LDL-cholesterol (p < 0.05) in subjects supplemented RS. Compared with the control starch group, the RS supplementation also reduced the mean fasting serum glucose concentrations (p < 0.05). Resistant starch supplement resulted in the increase in serum immunoglobulin G (IgG) concentrations. Serum insulin and complement 3 (C3) were unaffected. Tested resistant starch supplementation was reported to be palatable with minimal bowel discomfort. These results suggest that RS supplementation improves the blood lipid profile and controls the blood glucose levels in healthy overweight subjects without bowel discomfort. Therefore, RS has a potential to be used as one of the promising food ingredients for reducing risk factors involved in the development of atherosclerosis and type 2 diabetes in overweight individuals. However, in order to prove RS as a novel therapeutic agent of cardiovascular diseases and diabetes, controlled trials with larger sample sizes and longer duration are warranted.
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PMID:Resistant starch supplementation influences blood lipid concentrations and glucose control in overweight subjects. 1524 12

Psychological stress has been implicated as a cause of several psychosomatic disorders, but also as a factor that can unfavourably influence many diseases including diabetes mellitus. Measure of psychological stress in diabetes was performed by Psychological Stress Measure (PSM), a validated instrument, designed using 49 items drawn from descriptors generated by focus groups on stress. Clinical and psychological framework was assessed in a cohort of 100 type 2 diabetic patients (30 m, 70 f), aged 66.99 +/- 13.68 years considering disease grade, complications and level of instruction. Three other questionnaires were administered concurrently to all patients: Sickness Impact Profile (SIP), Functional Living Index (FLI) and SF-36 QOL. ANOVA statistical testing and Spearman correlation matrix were used also vs socio-cultural and clinical profile. Gender, obesity, diet compliance, smoking do not affect PSM response. Hypertensive patients and those with family history of diabetes show lower PSM scores, according to a sort of moderator effect on stress of concurrent and/or previous experience with chronic disease. Neuromuscular ailments are more prevalent in women; men vs women experience severe limitations of their working capacities and relational possibilities, with severe discomfort. In the whole, higher scores of PSM (greater stress p < 0.01) and lower scores of FLI (fair well-being perception; p < 0.01) are reciprocally related inside any school instruction level. Despite the great reciprocal association of the PSM vs FLI and SIP, no significant correlation is found between PSM vs SF-36 QOL. Socio-cultural elements interfere, and particularly instruction level quantified as school grades achieved, with the manner of living their disease. Interventions on psychological distress of type 2 diabetes mellitus patients is warranted, specially in the groups with lower levels of instruction which may need an attentive strategy for achieving a satisfactory coping with this disease.
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PMID:Psychological stress measure in type 2 diabetes. 1670 51

Some patients with type 2 diabetes mellitus (T2DM) have severe insulin resistance. Their insulin requirements are significantly greater. These patients need to take 2-3 injections at the same time to take the correct insulin dose or to redial the insulin pen. When daily insulin requirements are in excess of 300 units/day, the volume of the injected insulin becomes an issue. Large-volume injection can cause discomfort and lead to poor concordance with treatment. Using high-strength insulin e.g. U-500 insulin can reduce the volume of the injected insulin. Despite publications of small case reports or case series, no universal guidelines exist on the use of U-500 insulin. We discuss common sense approaches when considering the use of U-500 insulin in clinical practice.
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PMID:U-500 insulin: why, when and how to use in clinical practice. 1710 74

Healed partial thickness wounds including burns and donor sites cause hypertrophic scar formation and patient discomfort. For many patients with hypertrophic scars, pruritus is the most distressing symptom, which leads to wound excoriation and chronic wound formation. In spite of the clinical significance of abnormal innervation in scars, the nervous system has been largely ignored in the pathophysiology of hypertrophic scars. Evidence that neuropeptides contribute to inflammatory responses to injury include inflammatory cell chemotaxis, cytokine and growth factor production. The neuropeptide substance P, which is released from nerve endings after injury, induces inflammation and mediates angiogenesis, keratinocyte proliferation, and fibrogenesis. Substance P activity is tightly regulated by neutral endopeptidase (NEP), a membrane bound metallopeptidase that degrades substance P at the cell membrane. Altered substance P levels may contribute to impaired cutaneous healing responses associated with diabetes mellitus or hypertrophic scar formation. Topical application of exogenous substance P or an NEP inhibitor enhances wound closure kinetics in diabetic murine wounds suggesting that diabetic wounds have insufficient substance P levels to promote a neuroinflammatory response necessary for normal wound repair. Conversely, increased nerve numbers and neuropeptide levels with reduced NEP levels in human and porcine hypertrophic scar samples suggest that excessive neuropeptide activity induces exuberant inflammation in hypertrophic scars. Given these observations about the role of neuropeptides in cutaneous repair, neuronal modulation of repair processes at two extremes of abnormal wound healing, chronic non-healing ulcers in type II diabetes mellitus and hypertrophic scars in deep partial thickness wounds, may provide therapeutic targets.
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PMID:Making sense of hypertrophic scar: a role for nerves. 1772 64


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