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Metabolic rhythms in adolescent diabetes mellitus

Hocking, Michael David; (1991) Metabolic rhythms in adolescent diabetes mellitus. Doctoral thesis (M.D), University of London, Royal Free Hospital School of Medicine. Green open access

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Abstract

Circulating concentrations of intermediary metabolites and hormones were studied in a group of insulin dependent adolescent diabetic patients over a twenty four hour period. Despite conventional treatment many patients were found to have high concentrations of blood glucose and other metabolites. In particular a rise in blood total ketone body concentration was identified occurring early in the night before the morning rise in glucose. The patients were past their initial partial remission phase of diabetes but some were still secreting small amounts of endogenous insulin as indicated by circulating C-peptide. Conventional methods of assessing endogenous insulin were discussed and a new method suggested as most appropriate for these patients. The small amounts of endogenous insulin produced by these patients was found to have only minimal effect on the metabolic profiles. Some of the patients underwent a program of home blood glucose monitoring which lead to the use of more insulin. Some of the metabolites improved with a lowering of total ketone bodies and glycerol concentration but blood glucose was not always significantly lower and blood lactate rose. In patients treated similarly with either porcine or human insulin there was very little difference in overall blood glucose control but there were significant differences in other metabolites. In the formulations used the human insulin had a quicker but shorter duration of action. In conclusion, strenuous efforts to preserve small amounts of endogenous insulin secretion in adolescent diabetic patients is unlikely to be beneficial. Modest attempts to improve control were not successful particularly at lowering the nocturnal hyperketonaemia. Insulin species had little effect on overall control.

Type: Thesis (Doctoral)
Qualification: M.D
Title: Metabolic rhythms in adolescent diabetes mellitus
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10120810
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