The Potential Effect of Metabolic Alkalosis on Insulin Sensitivity in an Adolescent with New-Onset Type 1 Diabetes

Metabolic alkalosis induced by ingestion of alkaline water may enhance insulin sensitivity in type 1 diabetes mellitus

Increased Systemic Th17 Cytokines Are Associated with Diastolic Dysfunction in Children and Adolescents with Diabetic Ketoacidosis

Diastolic dysfunction suggestive of diabetic cardiomyopathy is established in children with T1DM, but its pathogenesis is not well understood. We studied the relationships of systemic inflammatory cytokines/chemokines and cardiac function in 17 children with T1DM during and after correction of diabetic ketoacidosis (DKA). Twenty seven of the 39 measured cytokines/chemokines were elevated at 6–12 hours into treatment of DKA compared to values after DKA resolution. Eight patients displayed at least one parameter of diastolic abnormality (DA) during acute DKA. Significant associations were present between nine of the cytokine/chemokine levels and the DA over time. Interestingly, four of these nine interactive cytokines (GM-CSF, G-CSF, IL-12p40, IL-17) are associated with a Th17 mediated cell response. Both the DA and CCL7 and IL-12p40, had independent associations with African American patients. Thus, we report occurrence of a systemic inflammatory response and the presence of cardiac diastolic dysfunction in a subset of young T1DM patients during acute DKA

Increased Systemic Th17 Cytokines Are Associated with Diastolic Dysfunction in Children and Adolescents with Diabetic Ketoacidosis

Diastolic dysfunction suggestive of diabetic cardiomyopathy is established in children with T1DM, but its pathogenesis is not well understood. We studied the relationships of systemic inflammatory cytokines/chemokines and cardiac function in 17 children with T1DM during and after correction of diabetic ketoacidosis (DKA). Twenty seven of the 39 measured cytokines/chemokines were elevated at 6–12 hours into treatment of DKA compared to values after DKA resolution. Eight patients displayed at least one parameter of diastolic abnormality (DA) during acute DKA. Significant associations were present between nine of the cytokine/chemokine levels and the DA over time. Interestingly, four of these nine interactive cytokines (GM-CSF, G-CSF, IL-12p40, IL-17) are associated with a Th17 mediated cell response. Both the DA and CCL7 and IL-12p40, had independent associations with African American patients. Thus, we report occurrence of a systemic inflammatory response and the presence of cardiac diastolic dysfunction in a subset of young T1DM patients during acute DKA

Figure 7 shows the linear regression plot for SBP-Non DA and DBP-Non DA over time.

<p>Mean age related normal valued is plotted in relation to patient SBP-Non DA/DBP-Non DA values for comparison.</p

Figure 5 shows the mean SBP (mmHg) and DBP (mmHg) across 19 time points.

<p>For comparison, age specific normal measurements are included as the last measurement on the X-axis.</p

Figure 9 shows mean DBP (mmHg) for groups DA or Non-DA across 19 time points.

<p>Age specific normal measurements are included as the last measurement on the X-axis.</p

Demographic data for 17 patients in data set.

*<p>Fisher's Exact chi-square analysis indicates a significant association between the Diastolic Abnormality and the African American race (p = 0.0319).</p

a–i.

<p>*Identifies statistically significant (p<0.05) differences between DA and Non-DA groups for the same time point (5a–i). + identifies statistically significant (p<0.05) differences within DA or Non-DA groups across time points (5a–i). T1 (6–12 hrs post admission); T2 (2–3 wks); T3 (3 months).</p

Figure 2 shows that the difference in MDT at T2 minus T1 for the patients identified with mitral DA.

<p>The magnitude of the difference was statistically smaller (Z = −3.2684; p = 0.0011 : T1 not shorter than T2) in the DA group patients implying abnormal adaptation to sinus tachycardia at T1.</p