Effect of moderate dosage of chlorpropamide in pregnancy on fetal outcome

The outcome of 19 pregnancies is reviewed in women receiving daily doses of at least 200 mg chlorpropamide for varying degrees of glucose intolerance. 4 required insulin in late pregnancy. In 13 mothers who had chlorpropamide during the first 13 weeks of pregnancy no fetal abnormality occurred. There were 2 intrauterine deaths, 1 neonatal death, 6 babies with birthweights greater than the 90th centile, and 2 with birthweights below the 10th centile. The total dosage taken during pregnancy varied from 5 to 105 g and the duration of administration varied from 3 to 39 weeks. Though the severity of diabetes loosely correlated with the daily chlorpropamide dosage, no constant relation existed between high daily dosage of chlorpropamide and obstetric or neonatal complications. It is concluded that it is more likely to be the poor control of the maternal diabetes in pregnancy than a pharmacological effect of the chlorpropamide on the fetal pancreas which is responsible for the poor results reported. 6 infants had intravenous glucose tolerance tests done within 3 hours of birth and the rate of glucose disposal and insulin response was found to be greater than in infants of untreated mothers with less severe diabetes.

Homeostasis of body weight in a diabetes clinic population

Body weights, blood glucose concentration, and therapeutic and clinical data were summarized by computer for each patient visit to our diabetes clinic between 1965 and 1970. Homeostasis of body weight was examined by plotting regression of body weight on time for patients making five or more visits to the clinic during the study period. A similar analysis was made of blood glucose values. Data from 131 patients treated with oral agents or by dietary regulation alone and forty-one patients treated with insulin were analyzed. Precision of regulation was assessed by calculating the coefficient of variation of body weight while the trend of body weight was assessed by calculating the slope of the linear regression equation relating body weight and time.

In both treatment groups the individual slopes for body weight clustered closely around zero and the mean slopes did not differ significantly from zero. The coefficient of variation of body weight was also small, averaging 4.6 and 3.7 per cent of body weight in the oral agent and insulin treatment groups respectively. In contrast, blood glucose fluctuated widely in the two groups. Mean slopes for glucose versus time did not differ significantly from zero, however.

The remarkable stability of body weight in this diabetic population despite widely varying modes of therapy, glucose concentrations, and degrees of body adiposity suggests that signals controlling long-term feeding behavior are either not related to these variables or, more likely, are multiple and sufficiently redundant to permit adaptation to perturbations of several metabolic variables.

Letter: Gestational diabetes

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Diabetes mellitus associated with epidemic of infectious hepatitis in Nigeria

This report concerns nine cases of diabetes mellitus associated with infectious hepatitis, an epidemic of which swept through eastern Nigeria between 1970 and 1972. All the patients showed the classical symptoms and signs of diabetes. They quickly responded to treatment, and after a few months the diabetes completely disappeared. Corticosteroid-glucose tolerance tests in four patients 12 to 30 months after the remission of their diabetes were normal. Contact with the remaining five patients had been lost a few months after clinical remission of their diabetes. The infectious hepatitis virus may have damaged pancreatic islet cells to cause an acute remittant form of diabetes mellitus.

Remission of diabetes mellitus during pregnancy

Two cases are reported in which a remission of diabetes was sustained throughout pregnancy. This seemed to be due in part to improved beta-cell function consequent on restoration of normoglycaemia before pregnancy, and in part to an increase in insulin sensitivity during pregnancy, which in the first case disappeared very rapidly after delivery.

Familial ADH-responsive diabetes insipidus: response to thiazides and chlorpropamide

Twenty cases of familial ADH-responsive diabetes insipidus were identified within five generations, and eight patients were studied by one of two established dehydration protocols. In each case there was partial to total failure of response to the initial administration of ADH which was slowly corrected by continued administration. This initial failure can lead to misinterpretation of the dehydration test unless the medullary solute washout effect is taken into account in chronically polyuric patients.Treatment consisted of thiazides and/or chlorpropamide. All cases responded well.The response to chlorpropamide suggests that the failure of ADH production is not complete in these patients, and that the major defect is a failure of ADH release in response to normal stimuli. Chlorpropamide may act by either facilitating ADH release or by synergistically interacting with available ADH at the tubular level.