Insulin and Insulin Antibody: What a Family Physician should Know ?

Antibodies develop to injected insulin frequently. The development of anti-insulin antibodies is maximum to conventional bovine insulin compared to the porcine variety. The immunogenicity of the insulin is not only due to the species from which the insulin is prepared but also the impurities that are present in the preparation like proinsulin and other islet ceil hormones. Hence the purified insulins produce lesser amount of antibodies and among the purified insulins, the least is produced by human insulin. The production of these antibodies depends on the insulin preparation, the route of administration, age and sex and the genetic status of the individuals. These antibodies produce various complications. They include allergy, lipoatrophy, insulin resistance, alteration of metabolic control, hypoglycemia, reduction in the duration of remission period and fetal hypoglycemia when given during the gestational period. These can be overcome by the use of purified insulins

BNP AND NT-PRO BNP AS INDEPENDENT DIAGNOSTIC BIOMARKERS FOR CARDIOVASCULAR DISEASE IN TYPE 2 DIABETES MELLITUS

The risk of developing heart failure (HF) with a reduced and preserved ejection fraction is known to increase with pre-diabetes and diabetic mellitus (DM). Natriuretic peptides (NPs) have been shown to be an important tool for assessing the risk of cardiovascular diseases (CVD) in people with pre-diabetes and Type 2 diabetes (T2DM), regardless of HF characteristics. Elevated levels of NPs were associated with an increased risk of readmission for HF, all-cause mortality, CVD mortality, HF progression, and readmission due to HF, according to earlier clinical investigations. In pre-diabetes and T2DM populations, the discriminative power of NPs for CVD death and HF-related clinical events has not been established beyond conventional CVD risk variables. The purpose of the review is to gather details regarding the predictive value of circulating NPs based on pre-diabetes and established T2DM presentation. Researchers have found that HFrEF or HFpEF in T2DM patients may necessitate a change in NP cutoff values to diagnose primary HF and identify HF-related risks. The relationship between clinical outcomes and the dynamic of circulating levels of NPs in diabetics treated with glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors has to be clarified in big clinical trials in the future

The burden of diabetes mellitus during pregnancy in low- and middle-income countries : a systematic review

Peer reviewedPublisher PD

AUTONOMIC NEUROPATHY AND DIABETIC FOOT SYNDROME

Introduction Autonomic Neuropathy in diabetics, contrary to the general belief that it is a late complication, can occur not only early in the natural course of the disease but even precede the diagnosis of diabetes, the best example being impotence. The assessment of autonomic neural involvement is usually done by evaluating cardiac autonomic reflex functions. The current evidence suggests that these tests reflect autonomic nervous damage not only in the heart but also elsewhere in the body. In the present study ninety six diabetic patients were screened for cardiovascular autonomic dysfunction using the four standard tests of cardiac autonomic functions namely (1) The heart rate response to Valsalva manoeuvre, (2) Heart rate variation during deep breathing (3) Blood pressure response to sustained hand grip and (4) immediate blood pressure response to standing from lying. The results of the study were correlated with the clinical symptoms of autonomic neuropathy and peripheral neuropathy in the patients tested. Materials and Methods Ninety six diabetic patients attending the Diabetic Clinic of the Govt. General Hospital, Madras formed the subjects of this study. Out of these ninety six subjects ten were insulin dependent diabetics and the rest were non-insulin dependent diabetics. The age group of the study subjects ranged from 20-60 years and the duration of diabetes from one year to 23 years. All were subjected to a careful clinical assessment, particular attention being given to the presence of clinical evidence of peripheral and autonomic neuropathy. A routine resting twelve lead ECG was done and detailed fundus examination was carried out. Patients with ECG evidence of IHD and those who had proliferative diabetic retinopathy were excluded from this study. Twenty age matched healthy controls were also assessed for the presence of cardiac autonomic neural dysfunction. Department of Diabetology, Madras Medical College & Govt. General Hospital, Madras-3. January, 1988 90 Study Protocol: All the ninety six subjects were subjected to the tests in the morning hours between 10 AM and 12 Noon. No smoking was allowed on the morning of the study and subjects were instructed not to take medications like aspirin, vitamins or anti-histamines for atleast 48 hours before the test. The results of the four tests were categorised and depending on it the subjects were put into one of the following four groups

NADPH oxidase mediated oxidative stress in hepatic fibrogenesis

NADPH oxidase (NOX) is a multicomponent enzyme complex that generates reactive oxygen species (ROS) in response to a wide range of stimuli. ROS is involved as key secondary messengers in numerous signaling pathways, and NADPH oxidases complex has been increasingly recognized as key elements of intracellular signaling of hepatic fibrogenesis. In the liver, NADPH oxidase is functionally expressed both in the phagocytic form and in the non-phagocytic form. The non-phagocytic NADPH oxidase complex is structurally and functionally similar to the phagocytic NADPH, resulting in reduction of molecular oxygen to generate superoxide. There are six homologous NOX proteins in the non-phagocytic forms of NADPH oxidase. An emerging concept is that both phagocytic and nonphagocytic NADPH oxidase components in hepatic stellate cells (HSCs) mediate hepatic fibrosis, suggesting its potential role as a pharmacological target for anti-fibrotic therapy. The molecular components and signaling pathways of various NADPH oxidase homologues that are critical for the fibrotic activity in HSCs need to be more clearly identified

Glucose Monitoring During Pregnancy

Self-monitoring of blood glucose in women with mild gestational diabetes has recently been proven to be useful in reducing the rates of fetal overgrowth and gestational weight gain. However, uncertainty remains with respect to the optimal frequency and timing of self-monitoring. A continuous glucose monitoring system may have utility in pregnant women with insulin-treated diabetes, especially for those women with blood sugars that are difficult to control or who experience nocturnal hypoglycemia; however, continuous glucose monitoring systems need additional study as part of larger, randomized trials