Dietary intake in Swedish diabetic children

The energy and nutrient intakes by 14 children with type I diabetes and 13 healthy peers were investigated by the 24-h recall method and the results were compared with current recommendations for the general population and with the guidelines for the dietary management of diabetes mellitus. The diabetic children showed not only good compliance with the recommendations but also a better intake in practically all respects than their healthy counterparts. The total energy intake by the diabetic children was in good agreement with the recommendations, while that of the controls was slightly lower. The protein energy per cent in the diet of the diabetic children was 18%, compared with 14% in the controls. Forty percent of the energy in the diet of the diabetic children was derived from fats, 36% in the controls. With the exception of carbohydrates, ascorbic acid and iron, the diet of the diabetic children had a higher nutrient density than that of the control children and the reverse was true for carbohydrates only. However, because of the generally higher energy intake displayed by the diabetic children, even the intake of these nutrients was at least as good in the diabetic children as in the controls. Eighty-six percent of the diabetic children but only 46% of the control children stated that the day for which intake data were given was a representative day.

Vascular reactivity during the first year of diabetes in children

Functional vascular response to hypoxia was studied in 24 children followed up prospectively for one year after diagnosis of type 1 diabetes mellitus. Postocclusive reactive hyperaemia was detected non-invasively in the skin using a transcutaneous PO2 method at 37 degrees C. Repeated experiments under standardized conditions were performed before institution of insulin treatment and 3, 7, 21, 30, 180 and 360 days after diagnosis. Impaired vascular reactivity was noted at the first experiment as compared with control children and slight but significant improvement was then noted up to the experiment at 180 days (p less than 0.01). At 30 and 180 days no significant difference between diabetic and control children was found. A small decrease in mean postocclusive reactive hyperaemia was observed at the experiment performed after 360 days. Fast normalization of urine glucose excretion, blood glucose and haemoglobin A1 occurred during the first three weeks of treatment but these variables showed no significant correlation to vascular reactivity, either at diagnosis or later. Impaired vascular reactivity can thus be diagnosed even before the institution of insulin treatment and improves during the first months of treatment, reaching the range of controls. Other factors than indicators of carbohydrate control have to be studied in the search for explanations of the abnormal vascular function in newly diagnosed diabetic children.

Arachidonic acid-induced aggregation of platelets from human cord blood compared with platelets from adults

Using a double-sample technique, platelet aggregation induced by arachidonic acid (AA) was studied in cord blood samples from 29 newborns and 20 adults, all healthy and drug-free. Of the platelets from adults (10 males, 10 females), all aggregated after 1.0 mM AA. After 0.5 mM AA, all platelets aggregated except those from 4 males which did not respond at all. The great majority of cord blood samples aggregated similarly to samples from adults. Platelets from all 15 newborn females and 11 of 14 newborn males aggregated irreversibly after 1.0 mM AA, while those from 3 of the 14 male newborns showed a reversible aggregation. All 11 newborn samples aggregated irreversibly after 0.5 mM AA. These results prove that the cyclo-oxygenase pathway for platelet aggregation operates satisfactorily in newborn infants. The double-sample technique is of value for cord blood samples. Late cord blood samples showed more marked aggregation than samples taken earlier.

Reduced vascular reactivity in diabetic children and its relation to diabetic control

The vascular reactivity in response to ischaemia was studied by a non-invasive method of measuring transcutaneous oxygen tension used at 37 degrees C, in 28 children with type I diabetes mellitus. Postischaemic hyperaemia was significantly reduced in the diabetic children compared with 34 healthy children. The degree of reduction in vascular reactivity correlated to both short-term and long-term diabetic control. Among tested variables, urinary glucose excretion during the night preceding the test showed the highest coefficient of correlation to the peak of the postocclusive reactive hyperaemia (r = -0.59, p less than 0.01). This peak was only weakly correlated to triglycerides and glycosylated haemoglobins and showed no significant correlation to fasting plasma glucose or to the duration of the disease. It was weakly correlated to the total daily insulin dosage but not to the dosage of insulin/kg body weight. Multiple linear regression analysis revealed that urinary glucose excretion, plasma glucose, haemoglobin A1, serum triglyceride and serum cholesterol, duration of diabetes, and insulin dosage per kg body weight together explained 54% of the variation in vascular reactivity. The reduced vascular reactivity found in diabetic children could not be explained by the usual parameters of carbohydrate control alone. This new non-invasive method is able to reveal a reduction in vascular function in diabetic children and should therefore be of value in attempts to find the causes of vascular dysfunction in diabetics.

Increased high density lipoproteins in diabetic children

Serum lipoprotein lipid and apolipoprotein concentrations were determined in 27 diabetic children (5-18 years old) and 13 matched healthy controls. The serum cholesterol concentrations in the diabetics were slightly higher than in the controls (P less than 0.05) due to a significantly higher level of the high density lipoprotein cholesterol (P less than 0.01). Also the serum concentration of apolipoprotein A-I, the major protein constituent of the high density lipoprotein fraction, was higher in the diabetic children (P = 0.05). There were no significant differences between the groups with regard to the serum triglyceride concentrations or the apolipoprotein C-II and C-III concentrations. Neither the lipoprotein lipid nor the apolipoprotein levels were significantly correlated with variables related to the degree of regulation of the diabetic disease. No obvious explanation, based on the present data, can be given for the increased high density lipoprotein cholesterol concentrations in insulin-treated diabetics in comparison with the healthy children. It is possible, however, that the increased high density lipoprotein cholesterol concentration may be caused by an increased level of insulin in the circulation of insulin-treated diabetic children.

Induction of male puberty by long-term pulsatile subcutaneous LH-RH therapy

Prolonged low dose LH-RH treatment was given to induce puberty in a 17.8-year-old male with hypogonadotrophic hypogonadism. The patient had developed panhypopituitarism after transcranial surgery of a craniopharyngioma at the age of 16.8 years. One year after the operation he had no signs of pubertal development and was of short stature. A small portable automatically-timed infusion pump, connected to a subcutaneous (s.c.) catheter, was used for the 328-day-long treatment, which was given in periods of between 16 to 185 days. Twenty micrograms of LH-RH s.c. was given every 90 min. Growth hormone therapy, 8 IU intramuscularly (i.m.) twice weekly, was instituted at the same time. During the prolonged LH-RH treatment the gonadotrophin secretion normalized. The serum concentration of testosterone increased to the normal range of adult males. Rapid pubertal progression occurred with development of pubic hair to adult type and increase in size of the penis. Testicular volume increased from 2 to 12 ml. Nocturnal emissions occurred after 30 weeks of pulsatile LH-RH treatment and sperms were found in the ejaculate after 43 weeks. The height of the patient increased from 162 to 176 cm. Thus, chronic pulsatile low dose LH-RH treatment can induce normal pituitary - gonadal function with pubertal maturation and spermatogenesis in primary male hypogonadotrophic hypogonadism.

Elevated serum selenium in diabetic children

Twenty-seven diabetic children, 16 girls and 11 boys, 5-18 years of age, with a duration of the disease ranging from 2-15 years, comprised the study group. Thirteen children with a similar age and sex distribution, living in the same area served as healthy controls. All 40 children had a normal growth pattern. The mean serum selenium concentration in the diabetic children, determined by neutron activation analysis, was 7.4 +/- 0.8 micrograms/100 ml (mean +/- SD) and in the healthy controls 6.5 +/- 0.8 micrograms/100 ml. The difference between the two groups was statistically highly significant (p less than 0.01). Boys and girls in both groups had nearly identical mean serum selenium levels and no correlation was observed between the selenium concentrations and either the age, weight or height of the children or the indicators of diabetic control. The selenium status in diabetic children has not been reported previously. The possibility of elevated serum selenium in diabetic children in response to altered lipid metabolism is discussed.

Reevaluation of home urine glucose measurements in diabetic children. A computerized study of short-term control variables in the prediction of long-term diabetic control

The relationship between ClinitestR home control results and HbAI and triglycerides was analyzed by a computerized optimizing procedure. The morning urine glucose excretions in the 10 preceding weeks were strongly correlated with HbAI as were the evening excretions, while the afternoon records showed only weak correlations with HbAI. Maximal correlations between home glucose records and HbAI were achieved when mornings and evenings were added, with higher weights given to the mornings. The practical consequences are that home urine test results in the mornings and evenings are of most value when adding home scores for assessment of long-term diabetic control, whereas afternoon records should be ignored for this purpose. Serum triglycerides were correlated with glucose excretion during the week of triglyceride determination, but not with glucose excretion measured in the preceding weeks. Serum cholesterol did not reflect diabetic control at all.

Increased platelet aggregability in diabetic children: relation to serum lipid and fatty acid composition

Platelet aggregation was studied in 14 diabetic children with no signs of angiopathy and in 14 healthy matched control children. The magnitude of the platelet shape change after ADP stimulation was decreased in diabetic patients while the maximal aggregation after ADP and low dose collagen was significantly higher than in healthy control children. In 28 diabetic children the platelet shape change after ADP stimulation was positively correlated with the serum concentration of apolipoprotein A-I and negatively correlated with serum triglyceride concentration. The ratio between the fatty acids 20:3/20:4 in cholesterol esters was strongly correlated with the relative incidence of irreversible aggregation (p less than 0.001) and with the magnitude of the maximal aggregation (p less than 0.01) after ADP stimulation (3.3 mumol/l). The ratio between the polyunsaturated and saturated fatty acids in the triglyceride fraction was negatively correlated to the maximal aggregation after collagen stimulation (10 mg/l). This study shows tha platelet aggregation is increased early in the course of diabetes in childhood. It suggests that the abnormalities in platelet aggregation pattern in diabetic patients are related to several of the lipid factors associated with an increased risk of atherosclerosis.

Hypomagnesemia in diabetic children

Serum concentrations of iron, copper, zinc and magnesium were determined in 27 Swedish children with well controlled diabetes without longterm diabetic complications. Thirteen of the diabetic children had age- and sex-matched healthy controls. Significantly lower serum magnesium concentrations were found in the diabetic children than in the matched healthy controls (p less than 0.01). The levels of iron, copper and zinc did not differ in the diabetic children from those in the controls. A negative correlation between serum magnesium level and duration of diabetes was found (p less than 0.05). This is seemingly the first report of hypomagnesemia in diabetic children.

Increased platelet volume in manifest diabetic rats

Platelet function, evaluated as in vitro aggregability, has been reported to be disturbed in diabetes, both in humans and animals. Platelet number and mean volume greatly influence these aggregation tests. The present study was designed to evaluate the impact of two different degrees of experimentally induced glucose intolerance on platelet number and mean volume. For this purpose, we used manifest diabetic and chemically diabetic rats. In the control group, the female rats showed a significantly lower number of platelets compared to the males. The chemically diabetic rats exhibited a tendency towards increased mean platelet volume, whereas the platelet volume of the manifest diabetic females was significantly greater than all other groups. This increase was found to be mainly due to a general shift towards larger volumes of the individual platelets of the manifest diabetic females. It is suggested, that the enlargement of the mean platelet volume induced by increased severity of the diabetic state may reflect decreased mean age of the circulating platelets. This implies shorter survival time and an increased turnover of the platelet population in diabetes mellitus.

Cord blood platelet aggregation; quality control by a two-sample technique

Two blood samples were taken from the cords at 17 normal deliveries 2-4 min and 5-8 min after birth, respectively. The difference in platelet count between early and late samples in platelet-rich plasma was less than 5% in nine cords (Group A), and greater in eight cords (Group B). Platelet aggregation studies on the early and the late blood samples showed consistent results within each cord in Group A but not in Group B. The correlations between the responses were high for Group A. The aggregation responses were also slightly but significantly higher in the late samples in this group (p less than 0.01 in Group A; n.s. in Group B). The differences between responses in early and late blood samples could not be explained by acid-base dissimilarities. The variability in cord blood platelet aggregation results can be greatly reduced by platelet counting in PRP of two independent blood samples, accepting only samples with concordant platelet counts (less than 5% difference).

T wave changes in the right precordial leads in seven- and eight-year-old children during a Valsalva manoeuvre

The T waves in the right precordial leads were analyzed in 106 eight-year-old and 90 seven-year-old unselected healthy children. Recordings during relaxation were compared with those obtained during a Valsalva manoeuvre. In the relaxed state only three children in each age group showed a positive T wave in lead V1, while during the Valsalva manoeuvre 90 of the 106 eight-year-old and 55 of the 90 seven-year-old children converted to a positive T V1. The difference is highly significant in both age groups and both sexes (p much less than 0.001). Minor changes towards more positive T V2 and T V4 were also found.

Smooth muscle effects of lidocaine, prilocaine, bupivacaine and etiodocaine on the human umbilical artery

The smooth muscle effects on human umbilical arteries of four different local anaesthetic agents - lidocaine, etidocaine, prilocaine and bupivacaine - were studied. Lidocaine and etidocaine relaxed the arteries, etidocaine more profoundly than lidocaine. Prilocaine in the concentration range 10-1,000 micrograms/ml caused pronounced contractions. Bupivacaine consistently evoked a contractile response in the concentration range 5-25 micrograms/ml, but at lower and higher concentrations the response to this drug was inconsistent. The concentrations of lidocaine were determined in six human umbilical arteries following maternal epidural block with this agent and were found to be 0.1 - 1.7 micrograms/g tissue. The contractile actions of prilocaine and bupivacaine on the human umbilical arteries are undesirable and might be hazardous if high concentrations are attained, e.g. during paracervical block.

Serum apolipoproteins A-I, A-II and B in diabetic children and matched healthy controls

Serum concentrations of apolipoprotein (apo) A-I. A-II and B were determined in 28 diabetic children (age 3-16 years) and 14 healthy matched controls. In the healthy children the serum apo A-I concentration was 120 +/- 20 arbitrary units (A.U.) (mean +/- S.D.), apo A-II 111 +/- 14 A.U. and apo B 100 +/- 34 A.U. (100 A.U. = mean concentration in adult blood donors). The apo A-I concentration was significantly higher in the diabetic children (134 +/- 13; p less than 0.02) than in the healthy controls. In diabetics apo A-II was 116 +/- 14 A.U. and apo B 106 +/- 21 A.U., values not significantly different from those in the controls. The serum cholesterol concentration in the healthy children correlated strongly to apo A-I and apo A-II, which was not the case in the diabetics. The differences between diabetic and healthy children with respect to correlations between the apolipoproteins and the serum lipids might indicate a different apolipoprotein/lipoprotein lipid relationship in diabetics.

Fatty acid composition of serum lipids in diabetic children and their matched healthy controls

The fatty acid compositions of the serum cholesterol esters, phospholipids and triglycerides were determined in 28 insulin-dependent diabetic children and 13 healthy controls. The diabetic children were on a regulated diet and the disease was under good control. The relative contents of linoleic and arachidonic acids were higher in the serum lipids of the diabetics than in the controls as could be expected from the dietary advice given. However, the degree of diabetic control was not significantly correlated to the fatty acid content of any lipid fraction. The serum concentration of apolipoprotein (apo) A-I was directly correlated to the content of polyunsaturated fat and the ratio between polyunsaturated and saturated fatty acids in the triglycerides. The apo A-II concentration was significantly correlated to the ratio between homo-gamma-linolenic and arachidonic acid in all serum lipid esters. No similar relationships were seen among the healthy controls. The different relationships between serum apolipoprotein concentrations and the fatty acid composition in serum in diabetics and controls is compatible with the hypothesis that not only the quantity but also the quality of the serum lipoproteins are different in these two categories of children.

Postischaemic hyperaemia studied with a transcutaneous oxygen electrode used at 33-37 degrees C

The hyperaemic response in the vasculature of the forearm skin following induced ischaemia was studied with a transcutaneous oxygen (tcpO2) electrode. Electrode temperatures of 35-37 degree C allowed optimal recordings of the postischaemic reaction. During arterial occlusion there was a fall in tcpO2 to zero in 1-3 min. Re-establishment of circulation resulted in a biphasic reaction, with a steep rise overshooting the baseline recording by 1-3 kPa and a slower return to baseline level. At higher electrode temperatures (greater than 39 degree C) there was no overshoot due to hyperaemia. The postischaemic peak response was well reproducible from one occasion to another in the same subject. Simultaneous recording of energy consumption for the heating of the electrode permitted detection of artifacts and environmental changes unrelated to postischaemic hyperaemia, therefore validating the tcpO2 recordings but only at electrode temperatures greater than 35 degree C. The tcpO2 technique used at 35-37 degree C easily detects relative blood flow changes and seems suitable for comparative studies. The method is non-invasive and permits continuous recordings in well-defined skin areas in human subject; significant advantages compared with other methods available.

Early reduction of vascular reactivity in diabetic children detected by transcutaneous oxygen electrode

Reactive hyperaemia in the skin was monitored by transcutaneous measurement of PO2 (tcPO2) (using electrode temperatures of 35 and 37 degrees C) in 13 well controlled diabetic children without clinical signs of vascular disease, and in healthy peers matched for age and sex. The tcPO2 increase was smaller in 12 of the 13 diabetic children than in individual controls. Taking the lower limit of the 95% confidence interval of the increases for the healthy children as a cut-off point, only 4 of the 13 diabetic children had values overlapping into the range of non-diabetics at 37 degrees C. This non-invasive technique, demonstrating a reduced postischaemic response in a group of well controlled diabetic children, may become a useful method for the early detection of diabetic microvascular disorders.

Fatty acid composition of human breast milk. Changes during the first week after delivery

Breast milk was collected daily from 11 healthy Polish mothers during the first week after delivery. The method of Folch was found suitable for fat extraction from breast milk. The concentration of total fat and of triglycerides and the fatty acid composition of total fat were determined. The concentration of total fat was 2.4 g/100 ml on the second day after delivery and 4.4 g/100 ml on the seventh day. There was a similar rise in the triglyceride concentration. No relation was found between the concentration of total fat and the relative concentrations of fatty acids. The major fatty acids were 18:1 and 16:0, which comprised about 70 per cent of the fatty acids. The essential fatty acids comprised about 10 per cent of the total fatty acids. The fatty acid spectrum changed during the sampling period. The proportions of 10:0, 12:0, 14:0 and 16:1 increased, those of 16:0, 18:2, 20:0 and 22:0 were unchanged, and those of 18:0 and 20:4 decreased. Very long-chained polyunsaturated fatty acids, e.g. 22:6, were also present. All the polyenoic acids - except 18:2 showed the highest concentrations on the first day after delivery.

Relation between hemoglobin AI and determinations of glucose in diabetics treated with and without insulin

The concentration in blood of hemoglobin AI is known to correlate well with glucose regulation if blood and urinary glucose values are carefully documented over several weeks. A slight increase of HbAI with age was found in 94 healthy subjects. In 41 adult diabetics treated with sulfonylurea drugs or diet alone, good correlations were obtained between HbAI and single random measurements of morning blood glucose (r = 0.69) and log urinary glucose/24h (r = 0.79) whereas in 47 adult patients with insulin-treated diabetes the corresponding correlation coefficients were only 0.42 and 0.49, respectively. In 29 insulin-treated children the HbAI-values were not correlated with single morning blood glucose determinations (r = 0.16 n.s.) but a correlation coefficient of 0.83 was found between HbAI and an index for regular testing of urinary glucose (Clinitest) at home. For the long-term monitoring of insulin-treated diabetics, single random determinations of blood and urinary glucose may often provide misleading information and particularly in these patients, routine determinations of HbAI should be of value.

Formation and action of prostacyclin in the isolated human umbilical artery

The transformation of [1-14C]arachidonic acid by homogenates of human umbilical arteries was studied. The major compound formed was the stable end product of PGI2, i.e. 6-keto-PGF1 alpha (lactol form) as analyzed by gas-liquid chromatography-mass spectrometry. PGI2 was generated by incubating PGH2 with a lyophilized pig aorta microsome preparation. PGI2 concentrations around 10 ng/ml relaxed the human umbilical artery preparation significantly. Formation of PGI2 by umbilical arteries during pregnancy might be a mechanism for regulation of blood flow to the fetus.

DDAVP in childhood nocturnal enuresis

A double-blind study of 18 children aged 6--12 years suffering from primary nocturnal enuresis without signs of underlying organic disease is reported. 20 microgram of DDAVP (desamino-D-arginine vasopressin, Minirin) was given intranasally at bedtime. The effect was prompt and satisfactory in 8 children and relatively good in another 8 children. No adverse effects were noted. DDAVP is advocated for temporary use in children with nocturnal enuresis needing immediate help.