sodium-pertechnetate-tc-99m and Diabetes-Mellitus--Type-2

The aim of this study was to investigate the frequency and mechanisms of hypothyroidism observed in diabetic patients with advanced diabetic nephropathy, including outcomes of management for this condition. A controlled study was designed using 32 diabetic and 31 non-diabetic patients not receiving hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) who excreted mean urinary protein greater than 0.5 g/day examined on three consecutive days during admission to our hospital. Thyroid hormones in both serum and urine, anti-thyroid antibodies, renal function and iodine concentrations in serum were measured during admission in all patients included. In particular, in patients who showed overt hypothyroidism, further studies including large-needle biopsies of the thyroid and iodine-perchlorate discharge tests were performed. All patients in the two groups revealed negative antithyroid antibody titers, and the mean serum total iodine levels did not significantly differ between the two groups. Mean serum FT4 levels significantly decreased, and the TSH level was significantly elevated in the diabetic group compared to those in the non-diabetic group (p < 0.005, p < 0.02, respectively). The frequency of overt hypothyroidism in the diabetic group (22%; 7/32) was significantly higher (p < 0.05) than that in the non-diabetic group (3.2%; 1/31). The daily urinary thyroid hormone excretion in both groups did not show any significant correlation with serum thyroid hormone levels. Seven patients who revealed overt hypothyroidism in the diabetic group showed elevated serum total iodine levels during hypothyroidal status, ranging between 177 and 561 microg/l. Also, the iodine-perchlorate discharge tests carried out in six of these patients all showed a positive discharge. After management based on iodine restriction, normalization of serum thyroid hormone levels in accordance with definite decreases in the serum total iodine level was achieved, accompanied by a significant weight reduction. In conclusion, we found a significantly high prevalence of non-autoimmune primary hypothyroidism in patients with advanced diabetic nephropathy compared to those with non-diabetic chronic renal dysfunction, which may partly relate to earlier development of oedematous status. Clinical and laboratory findings suggest that impaired renal handling of iodine resulting in an elevation of serum iodine levels, rather than autoimmune mechanism or urinary hormone loss, may play a princ

Topics: Aged; Antibodies; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Female; Goiter; Humans; Hypothyroidism; Kidney Failure, Chronic; Luminescent Measurements; Male; Middle Aged; Proteinuria; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones; Treatment Outcome

To maximize deposition of an aerosolized dose of insulin (mean +/- SD = 0.99 +/- 0.06 U/kg of body weight) in the lungs of subjects with non-insulin-dependent diabetes mellitus (NIDDM), and investigate its efficacy in normalizing plasma glucose levels during the fasting state.. Nonrandomized, placebo-controlled trial.. A primary care facility.. Six nonobese, nonsmoking volunteers with NIDDM. No subjects withdrew from the study.. Aerosolized insulin was administered by oral inhalation after a 12-hour period of fasting. Aerosol was generated by a raindrop nebulizer from regular 500 U/mL pork insulin. During inhalation, inspiratory flow was regulated at 17 L/min. Plasma samples were collected after inhalation and analyzed for insulin and glucose levels.. Plasma insulin and glucose levels.. Deposition of the aerosol was maximized within the lungs, with 79% +/- 17% of the inhaled dose depositing below the larynx. Geometric mean fasting plasma insulin level was 71 pmol/L (11.8 microU/mL), rising to 269 pmol/L (44.8 microU/mL) after insulin inhalation. Average time to peak insulin level was 40 +/- 34 minutes. The mean fasting plasma glucose level (12.63 +/- 2.59 mmol/L [225.5 +/- 46.3 mg/dL]) was reduced to within the normal range in five subjects and was almost normal in the sixth subject (5.52 +/- 0.89 mmol/L [98.6 +/- 15.9 mg/dL]). Average maximum decrease in plasma glucose from baseline was 55% +/- 10% (n = 6) vs 13% +/- 9% after placebo aerosol inhalation (n = 3). No side effects were reported following insulin or placebo aerosol inhalation.. These preliminary results indicate that a dose of approximately 1.0 U of aerosolized insulin per kilogram of body weight, delivered by oral inhalation and deposited predominantly within the lungs, is well tolerated and can effectively normalize plasma glucose levels in patients with NIDDM.

Topics: Administration, Inhalation; Adult; Aerosols; Blood Glucose; Diabetes Mellitus, Type 2; Humans; Insulin; Lung; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Left ventricular function of 20 diabetic patients was investigated at rest and during hand-grip test using radionuclide ventriculography. The aim of the study was to discuss the correlation of cardiac function with autonomic cardiac neuropathy (ACN) in diabetic subjects. ACN was tested using heart rate response to valsalva maneuver, standing up, deep breathing; blood pressure response to standing up, sustained hand-grip, and additionally corrected QT (QTc) measurements. Plasma glucose regulation was screened with fructosamine levels. Ejection fraction (EF), peak ejection (PER) and filling rates (PFR), times to peak ejection (TPE) and filling (TPF), time to endsystole (TES), TES/T, TPE/T, TPF/T, 1/3 PER, 1/3 PFR, 1/3 EF, 1/3 FF (filling fraction) we calculated. Thirteen patients had ACN. Six patients (30%) had a low EF at rest. As a response to hand-grip, 14 patients (70%) showed a decrease in EF (9 ACN). PFR was low in 10 patients (50%) at rest and in 12 (60%) during hand-grip. The mean rest PER value of ACN+ patients (4.4 +/- 1.3) was significantly higher than that of controls (2.9 +/- 0.5) and patients without ACN (3.4 +/- 0.4; p < 0.05) as well as the mean 1/3 PER value (1.7 +/- 0.5 vs. 1.3 +/- 0.5; p < 0.05). Fourteen patients (70%) had a fall in PER 10 ACN) as a response to hand-grip. The mean TES/T value of patients with ACN (0.44 +/- 0.05) was significantly higher than of those without ACN (0.38 +/- 0.05; p < 0.05). In conclusion, diastolic dysfunction was detected frequently at rest. Systolic parameters were markedly impaired as a response to hand-grip in patients with ACN. Sympathetic overactivity was noted in ACN+ group at rest. Our results indicated that the patients with diabetes and ACN have subclinical left ventricular diastolic dysfunction and symphatic overactivity.

Topics: Adult; Autonomic Nervous System Diseases; Cardiomyopathies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Female; Gated Blood-Pool Imaging; Heart; Humans; Male; Sodium Pertechnetate Tc 99m; Ventricular Function, Left

Topics: Aged; Diabetes Mellitus, Type 2; Erythrocyte Deformability; Foot; Humans; Microcirculation; Middle Aged; Regional Blood Flow; Sodium Pertechnetate Tc 99m