The effects of long-term physical training on 1251-insulin binding to erythrocytes were studied in 18 normals and 12 non-insulin-dependent obese diabetics. The specific insulin binding in 10 well-trained athletes (5.33±0.51) was significantly higher than that in 8 sedentary subjects (4.08±0.54)(p<0.05). The binding variation was due mainly to an increase in insulin receptor concentation rather than a change in receptor affinity. The fasting plasma insulin levels were comparable in the sedentary subjects and well-trained athletes. These results suggest that increased insulin binding to insulin receptor may contribute, at least in part, to enhanced insulin sensitivity in well-trained athletes. On the other hand, no significant changes in receptor affinity or receptor number were observed between 7 trained diabetics (VO2 max 40%, 6 months) and 5 sedentary diabetics. Studies are now in progress to clarify the reasons for this discrepancy in results between the normal and diabetic groups.
To clarify the efficacy of home blood glucose monitoring in the management of diabetic pregnancy, 11 patients (IDDM 1, NIDDM 9, gestational diabetes 1) began home monitoring at 3-25 weeks of gestation. Seven of the 11 were B and 4 were C by White's classification. The protocol to be followed was: 1) FBG daily, 2) full profile weekly, 3) spot checks. According to the data obtained, the diet schedule was reconsidered and the insulin prescriptions were adjusted on an insulin sliding scale. After starting home monitoring, the FBG and HbAi levels improved from 115±23 mg/dl to 99±27 mg/dl and from 8.6±0.6% to 7.2±0.8%, respectively. During home monitoring, 8 insulin-treated patients increased their insulin dosage from 13±5 U/day to 30±13 U/day at delivery. Three cases treated by diet alone had to begin insulin at 25-35 weeks of gestation and their maximum dosage was 8-28 U/day. They returned to diet therapy after delivery. The pregnancy was uneventful except in one case. 5 delivered vaginal and 5 by cesarean section at 37-38 weeks of gestation. They gained weight by 6.8+3.0 kg during pregnancy. The mean body weight of the infants was 3100±267 g, which was not large for date. Neonatal hypoglycemia was observed in 6. No remarkable retinal changes were detected. The results obtained suggest that home monitoring si highly effective in controlling diabetic pregnancy.
It is well known that glycosylated hemoglobin, designated as hemoglobin AI (HbAI), and glucosylated albumin can provide useful information regarding long-term blood glucose control in diabetic patients. The present study was undertaken to determine whether the values of HbAi and glucosylated albumin might increase in dialyzed uremic patients without diabetes mellitus. In 16 subjects among 37 dialyzed uremic patients, the chromatographically determined HbAi values (8.23±1.54%, mean ±SD) were more than 2 SD above the mean for normals (7.70±0.41%). On the other hand, the glucosylated albumin values obtained by the thiobarbituric acid method indicated no significant increase in the dialyzed uremic patients (6.84±1.06%) as compared of normals (6.29±0.98%). In vitro studies of the HbAt values in red blood cells from normals showed significant increases at 5 days after incubation with a high concentration, of urea. When compared to the HbAI values without urea. However, in the dialyzed uremic patients, there were no significant correlation between HbAI values and serum urea (r=-0.14) and serum creatinine (r=0.22). Further studies are required to clarify the reasons for the increase in HbAi values in renal failure.