Faculty Bibliography

A clear perception of the psychologic factors affecting both the physician and the patient can greatly influence the course of therapy in diabetes. Genuine, realistic assessment and acceptance of the limitations inherent in physician-patient interactions will lead to considerably more satisfying personal and professional relationships

A 61-year-old male, while recovering from a Whipple's procedure for pancreatic carcinoma, was treated for 13 days with an insulin infusion pump for diabetes exacerbated by enteral hyperalimentation. Treatment with continuous subcutaneous insulin infusion resulted in improved blood glucose control. Associated with this improvement was a reduction in plasma cholesterol, triglyceride and free fatty acid levels. Plasma epinephrine, norepinephrine, glucagon and cortisol concentrations were also lowered although growth hormone levels remained unchanged. It is concluded that enhanced metabolic control during hyperalimentation results in a decrease in counter-regulatory hormone levels and an improvement in the catabolic state in this patient. These preliminary observations provide evidence for maintaining euglycemia in diabetic patients while receiving nutritional support.

This cross-sectional study evaluated high-density lipoprotein subclasses measured by a precipitation technique before and after treatment in men and women with types I and II diabetes. Total high-density lipoprotein cholesterol was lower in subjects of both sexes with untreated type I and type II diabetes, the change occurring primarily in subclass 2. Insulin therapy raised total and subclass 2 high-density lipoprotein levels in men and women with type I and type II diabetes, the predominant rise occurring in subclass 2. The improvement was unrelated to metabolic control. Normalization of total and subclass 2 high-density lipoprotein was not achieved in women with type II disease who had higher body weights and triglyceride levels. Treatment with oral hypoglycemic agents did not lower total high-density lipoprotein or subclass 2 levels. It is concluded that therapies affecting high-density lipoprotein produce the preponderant change in subclass 2, insulin therapy increases total and subclass 2 high-density lipoprotein but may not restore levels to normal in the presence of elevated body weight and lipid levels, there is no relation between control of diabetes and changes in total and subclass 2 high-density lipoprotein levels, and treatment with oral hypoglycemic agents does not adversely affect high-density lipoprotein levels

The effects of glipizide on HDL subclass levels were prospectively evaluated in 7 women and 2 men with non-insulin dependent (Type 2) diabetes. Total HDL, HDL2 and HDL3 levels were unchanged during the treatment period. Baseline HDL levels were lower when compared to a control population which may have been due to the elevated body weight present in most subjects. Mean blood glucose and HbA1 levels were unchanged for the entire group although significant improvement was noted in 5 individuals. Triglyceride and cholesterol levels were not affected by treatment with glipizide. In conclusion, glipizide does not have an adverse affect on HDL lipoprotein levels when patients are followed prospectively