Erythrocyte Insulin Receptors in Non-Insulin-Dependent Diabetics before and after Treatment

On 40 non-insulin-dependent diabetes mellitus (NIDDM) patients who were hospitalized for the purpose of control and education of diabetes mellitus, erythrocyte insulin receptor assay was conducted with the used of 126l-insulin at the time of admission and the results obtained were compared with the results obtained from 98 normal subjects. After an average of 20 days of treatment, erythrocytes insulin receptor assay was repeated and the effect of diabetes mellitus treatment on insulin receptor was examined. The mean specific 125l-insulin binding to erythrocytes in untreated NIDDM patients was significantly decreased (5.64 ± 0.30%, mean ± SEM) when compared with that of normal subjects (7.35 ± 0.20 %, p<0.001). The average native insulin concentration required for half maximum binding (HMB) of normal subjects and NIDDM patients before treatment were 3.1 and 5.4 ng/ml, respectively, and the mean affinity constants of the receptors of high affinity site (Ke) were 1.49 ± 0.05 and 0.75 ± 0.05 x 109M-1 (p<0.001), respectively. The insulin receptor number of high affinity site in untreated NIDDM patients was 33 ± 1.2 sites/cell, being significantly higher (p < 0.001) than that of normal subjects (22 ± 0.9 sites/cell). After treatment of these patients, a marked decrease of blood glucose and a slight decrease of total cholesterol and triglycerides were observed with a concomitant significant increase of 126l-insulin binding to erythrocytes (from 5.64 ± 0.30% before to 6.68 ± 0.29% after treatment, p < 0.001). The average native insulin concentration required for HMB after treatment decreased to 4.2 ng/ml and Ke significantly increased to 1.12 ± 0.07 x 109M-1 (p<0.001). The mean concentration of receptors of high affinity site decreased to 28 ± 1.5 sites/cell after treatment. The changes observed in erythrocytes insulin receptors by diabetes aimed at normalization of blood glucose level were similarly observed in the insulin (n = 13), sulfonylurea (n = 16), and diet treatment groups (n = 11). No difference in the mean fasting plasma immunoreactive insulin (IRI) concentration was observed between normal subjects and untreated NIDDM patients and also no significant relationship could be demonstrated between fasting plasma IRI and specific 125l-insulin binding (%) to erythrocytes. A significant inverse correlation was observed between Ke and plasma lipids (total cholesterol r = -0.301, p < 0.02 and triglyceride r = -0.291, p<0.05), but no direct significant correlation could be demonstrated between Ke and fasting blood glucose (r = -0.220, p = NS). These results indicate that: 1. Even in the absence of hyperinsulinemia in untreated NIDDM patients, there is a decrease in specific 125I-insulin binding to erythrocytes, which was found to be attributable to reduced affinity of the insulin receptors. 2. The number of erythrocyte insulin receptors of high affinity site was increased in untreated NIDDM patients, which was considered to be a phenomenon to compensate for decrease in affinity. 3. The affinity of the insulin receptors of NIDDM patients improved following treatment and the receptor number of high affinity site also approached that of normal level, suggesting reversibility. 4. The effect of treatment on erythrocytes insulin receptors of NIDDM patients was similarly observed in the insulin, sulfonylurea and diet treatment groups, indicating that it could not be a direct effect of the drugs. 5. Normalization of intracellular metabolism of the post receptor level after treatment may have served as an important factor in the improvement of erythrocyte insulin receptors of NIDDM patients.This study was supported by the Postgraduate Fellowship Program of the Japanese Ministry of Education, Science and Culture

Asosiasi dan Disosiasi Insulin-Antibodi Insulin pada pasien Sindrom Autoimun Insulin.

Abstrak Sindrom autoimun insulin (SAI) ditandai oleh pembentukan autoantibodi pada pasien yang sebelumnya tidakpernah menggunakan insulin. Pasien SAI biasanya mengalami hiperglikemia diikuti dengan hipoglikemiasesudah makan, yang terjadi karena asosiasi dan disosiasi insulin dari kompleks antibodi insulin-insulin. Studi inidilakukan untuk mengevaluasi perubahan konsentrasi insulin imunoreaktif bebas (IIB), insulin imunoreaktif total(IIT), antibodi anti insulin dan gula darah pada saat uji toleransi glukosa oral 75 g (TTGO). Pada fase pertama,setelah dimulai uji toleransi, konsentrasi antibodi insulin turun dari 54% ke 45%, selama 120 menit. Hal itumenunjukkan terjadi ikatan insulin dengan antibodi hingga menyebabkan kenaikan insulin terikat (IIT) padawaktu bersamaan. Gula darah naik sampai 200 mg% dalam 60 menit karena IIB relatif tidak cukup untukmenekan kenaikan gula darah sesudah uji toleransi glukosa. Fase kedua, 120 menit sesudah TTGO, konsentrasiIIT dan antibodi insulin kembali ketingkat basal. Perubahan itu menunjukkan disosiasi insulin dengan kompleksinsulin-antibodi. Gula darah turun menjadi 33 mg% pada waktu 240 menit, mungkin karena ekses IIB yangdihasilkan kompleks insulin-insulin antibodi. Hal itu menunjukkan bahwa asosiasi insulin terhadap antibodimenyebabkan hiperglikemia 60 menit setelah TTGO dan disosiasi dari kompleks insulin-insulin antibodimenyebabkan hipoglikemia 240 menit setelah TTGO. Kata kunci: antibodi insulin, glukosa darah, asosiasi, disosiasi. Abstract The insulin autoimmune syndrome ( IAS ) is characterized by the autoantibodies formation in patient withoutprevious insulin usage. Patient affected by IAS usually developed hyperglycemia followed by hypoglycemiaafter meal due to association of insulin to its antibody and dissociation of insulin from insulin-insulin antibodiescomplexes. This study was carried out by evaluation of the changes of the free immunoreactive insulin (FIRI)concentration and the total immunoreactive insulin (TIRI) concentration. Insulin antibody and blood sugar during75 g oral glucose tolerance test (75 g OGTT) also evaluated. There were two distinct time courses could beidentified during the OGTT. The insulin antibody concentration gradually decreased from 54% to 45% at 120minutes. That change indicates consumption of the antibody or association of the insulin to its antibody, results inthe increase of bound insulin or TIRI at the same time. The blood sugar increased to 200 mg% in 60 minutes dueto relativity insufficient of FIRI to supress blood sugar elevation after OGTT. After 120 minutes of OGTT theconcentrations of TIRI and the insulin antibodies were returned to the basal level and these changes were stronglyindicated the dissociation of the insulin–insulin antibodies complexes. Blood sugar was decreased to 33 mg% at240 minutes, may be due to the relativity excess of FIRI released from insulin-insulin antibodies complexes.These data indicated that association of the insulin to its antibody result in hyperglycemia 60 minutes after OGTTand dissociation of the insulin-insulin antibodies complexes result in hypoglycemia 240 minutes after OGTT. Keywords: insulin antibody, blood glucose, association, dissociation

Diabetes Melitus Tipe 1 pada Orang Dewasa

Abstrak Diabetes melitus (DM) merupakan sindrom klinis yang ditandai oleh hiperglikemia karena resistensi insulin dan atau defisiensi insulin relatif hingga absolut. Menurut klasifikasi American Diabetes Association (ADA), DM dibagi menjadi empat tipe yaitu: DM tipe 1 (defisiensi absolut insulin), DM tipe 2 (resistensi insulin), DM tipe lain, dan DM gestasional. Awitan penderita DM tipe 1 biasanya pada masa anak-anak dengan dijumpainya antibodi antiinsulin sedangkan variasi DM tipe 1 yang dijumpai pada usia dewasa disebut sebagai latent autoimmune diabetes in adult (LADA). Pasien LADA pada awalnya tidak membutuhkan insulin, namun setelah enam bulan, biasanya jumlah sel beta pankreas berkurang begitu pula dengan insulin sehingga akhirnya pasien tergantung pada insulin. Pengenalan dini terhadap penderita LADA membantu dalam pengelolaan pasien dan mempertahankan sel beta pankreas.Kata kunci : antibodi anti insulin, DM, LADA Abstract Diabetes mellitus (DM) is a clinical syndrome with hyperglycemia as a main feature caused by insulin resistance and or relative to absolute insulin deficiency. American Diabetes Association (ADA) classified DM into four groups: type 1 DM (absolute insulin deficiency), type 2 DM (insulin resitance), other type DM, and gestational DM. The clinical onset of type 1 DM usually at childhood marked by the occurrence of antibody anti insulin, meanwhile variation of DM type 1 with adult onset is define as latent autoimmune diabetes in adult (LADA). At the time of diagnosis patient with LADA did not require insulin, but after six months the function of beta cell of pancreas is decreases and the patient is then becoming absolutely dependent on insulin. Early detection of LADA helps in the management and preservation of pancreatic beta cells.Key word : antibody anti-insulin, DM, LAD

Value of Tygerberg Scoring for the Diagnosis and Management of Tuberculous Pericarditis

Abstract Extra pulmonary tuberculosis occurs in 20% of patients with tuberculosis. Tuberculosis pericarditis is seen in 1-8% of these patients. Tuberculosis has been reported to be the cause of acute pericarditis in 60-80% of the patients in the developing world. We reported a case of 19 years old male who presented with right chest pain, cough, breathlessness, night sweat, fever, fatigue, and weight loss. From the physical examination, jugular venous pressure was high and on auscultation, the heart sounds were muffled and associated with a pericardial rub. The chest x-ray revealed enlargement of cardiac silhouette. Transthoracic echocardiography showed pericardial effusion, and mantoux tuberculin skin test were positive. Since the pericardiocentesis is not feasible in our hospital, the tygerberg tuberculous pericarditis score was applied. Furthermore, patients were given anti-TB treatment, and showed a good response to treatment.Key words: extra pulmonary tuberculosis, tuberculous pericarditis, tygerberg score Abstrak Tuberkulosis dapat menyebabkan kelainan di luar paru. Prevalensinya berkisar sekitar 20% dan dapat menyebabkan kelainan diberbagai organ seperti perikarditis pada jantung. Tuberkulosis telah dilaporkan menjadi penyebab perikarditis akut pada 60-80% pasien di negara berkembang. Pada tulisan ini dilaporkan seorang laki-laki berusia 19 tahun dengan keluhan nyeri dada kanan disertai batuk, sesak nafas, keringat malam, lemas, dan penurunan berat badan. Pada pemeriksaan fisik ditemukan peningkatan tekanan vena jugularis, dan pada auskultasi ditemukan bising jantung sesuai dengan gesekan perikardium. Pada pemeriksaan foto polos dada ditemukan pembesaran ruang jantung. Pada ekokardiografi ditemukan efusi perikardial. Karena perikardial drainase tidak dapat dilakukan, diterapkan skor tygerberg untuk diagnosis perikarditis tuberkolosis. Selanjutnya pasien diberi pengobatan anti TB, dan menunjukkan respons yang baik terhadap pengobatan.Kata kunci: tuberkulosis ekstra pulmoner, perikarditis tuberkulosis, skor tygerber

PREVALENSI DAN FAKTOR RISIKO PENYAKIT GINJAL KRONIK PADA PASIEN DIABETES MELLITUS DI RSU UKI PERIODE AGUSTUS 2013 – JULI 2016

Diabetes Mellitus (DM) merupakan penyakit metabolik dengan karakteristik hiperglikemia, terjadi karena kelainan sekresi insulin, kerja insulin atau kedua-duanya. Hiperglikemia kronik pada diabetes mellitus berhubungan dengan kerusakan jangka panjang, disfungsi atau kegagalan beberapa organ tubuh, terutama mata, ginjal saraf, jantung dan pembuluh darah. Data di Indonesia menunujukkan terdapat 10 juta penderita diabetes melitus pada tahun 2015 dan diperkirakan akan meningkat menjadi 16 juta tahun 2040. Diabetes melitus dapat menyebabkan komplikasi berupa penyakit ginjal kronik. Persentase penderita penyakit ginjal kronik akibat diabetes melitus di United States sebesar 44%, sedangkan di Indonesia presentasenya belum diketahui. Penelitian ini bertujuan untuk mengetahui prevalensi dan faktor risiko terjadinya penyakit ginjal kronik pada pasien diabetes melitus di RSU UKI periode Agustus 2013 – Juli 2016. Penelitian ini dilakukan dengan desain deskriptif retrospektif dengan mengumpulkan data sekunder dari rekam medik. Hasil penelitian menunjukkan prevalensi penyakit ginjal kronik pada pasien diabetes melitus periode Agustus 2013 – Juli 2016 di RSU UKI sebesar 39,2%, usia 50-59 tahun sebesar 50,3%, wanita sebesar 62,9%

Fase Honeymoon pada Diabetes Melitus Tipe 1

Abstrak Seorang laki-laki berusia 18 tahun dirawat karena menderita diabetik ketoasidosis (DKA), yang dipicu oleh infeksi saluran kemih. Sebelumnya pasien telah didiagnosis menderita diabetes mellitus (DM) tipe 1. Tiga tahun yang lalu, untuk pertama kali pasien dirawat dengan diagnosis yang sama. Pada perawatan kali ini, pasien dianggap mengalami fase honeymoon karena meskipun tidak menggunakan insulin selama beberapa bulan namun tidak mengalami dekompensasi metabolik. Kata kunci : Fase honeymoon, insulin, faktor metabolik. Abstract A man aged 18 years were admitted to the hospital for diabetic ketoacidosis (DKA), which was triggered by a urinary tract infection. Previously, patients have been diagnosed with type-1 diabetes mellitus (DM). Three years ago, for the first time patients was also admitted to the hospital with the same diagnosis. At this admission, he was considered to have honeymoon phase because even though he did not use insulin for several months but did not experience metabolic de-compensation. Keywords : Honeymoon phase, insulin, metabolic factors. &nbsp