Relationship between diabetes control and pulmonary function in insulin-dependent diabetes mellitus

Article Abstract:

This study investigated the effects of glycemic control (control of blood sugar levels) on pulmonary function in patients with type I insulin-dependent diabetes mellitus. Eighteen nonsmoking patients chose either intensive treatment with a subcutaneous insulin infusion device, consisting of an insulin pump implanted under the skin, (eight patients) or standard treatment, consisting of two or fewer injections of insulin daily (10 patients). The subjects were evaluated at regular intervals during a six-year period, and their pulmonary function was tested once at the end of the six-year period. The results showed that the standard treatment group had higher levels of glycosylated hemoglobin (indicating excess levels of glucose in the blood) than the intensive treatment group throughout the study. At the six-year point, the forced vital capacity (the amount of air that can be exhaled after a maximum inspiratory effort) was higher for the intensive treatment group, as was the diffusing capacity for carbon monoxide. These results, evaluated in the context of other outcomes of pulmonary function tests, indicate that patients receiving the standard treatment suffered from a restrictive type of lung disease. Because other factors associated with such disease, such as obesity or neuromuscular problems, were absent, the authors suggest that this was the result of changes in lung tissue, possibly due to increased glycosylation (addition of glucose molecules) of collagen in the lungs. Lung abnormalities of the type shown here may limit the ability of diabetics to exercise properly. It appeared that the diabetics who received intensive treatment had much better pulmonary function than those treated with the standard regimen, suggesting that programs aimed at keeping glucose levels near normal can protect lung tissue from the deleterious effects of hyperglycemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diabetics, Lung diseases, Hyperglycemia

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Hypoglycemia induced by angiotensin-converting enzyme inhibitors in patients with non-insulin-dependent diabetes receiving sulfonylurea therapy

Article Abstract:

The angiotensin-converting enzyme (ACE) inhibitors, captopril and enalapril, are effective in treating hypertension (high blood pressure) particularly when it is associated with diabetes. These drugs decrease the excretion of the blood protein, albumin, and improve the sensitivity of the tissues to insulin. Increased insulin sensitivity may decrease hyperinsulinemia, or high blood insulin levels, but may increase the risk of hypoglycemia, or abnormally low blood glucose levels. These risks are increased in patients treated with hypoglycemic, or blood glucose-lowering, agents such as the sulfonylurea compounds. The cases are described of two patients with non-insulin-dependent diabetes mellitus who developed hypoglycemia after taking enalapril or captopril for hypertension. These two patients were being treated with the sulfonylurea compound, glyburide, for diabetes. No further attacks of hypoglycemia occurred after the dose of glyburide was reduced or glyburide was discontinued. Other studies have reported the occurrence of hypoglycemia after ACE inhibitor treatment of hypertensive patients who were taking hypoglycemic agents. The hypoglycemia resolves when the hypoglycemic agent is withdrawn or the dose is decreased. ACE inhibitors dilate blood vessels and increase blood flow, which may enhance glucose uptake into tissues and result in hypoglycemia. ACE inhibitors may also increase the levels of bradykinin, which was shown to decrease the liver production of glucose. Therefore, clinicians should be aware that ACE inhibitors may cause hypoglycemia in hypertensive diabetic patients who are being treated with hypoglycemic agents. However, ACE inhibitors may be beneficial in reducing insulin resistance, or the inability of tissues to respond to insulin action, in hypertensive, diabetic patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Causes of, ACE inhibitors, Angiotensin converting enzyme inhibitors, Type 2 diabetes, Hypoglycemia, Sulfonylurea compounds, Sulfonylureas

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Effective treatment of bulimia with fluoxetine, a serotonin reuptake inhibitor, in a patient with type I diabetes mellitus

Article Abstract:

The eating disorder bulimia is characterized by recurrent and uncontrolled binge eating, followed by self-induced vomiting, and overconcern about body shape and weight. This abnormality is prevalent among adolescent and young adult women and occurs in 5 to 19 percent of female college seniors. The incidence of bulimia is higher in patients with type I insulin-dependent diabetes mellitus. Because the control of blood glucose levels in type I diabetic patients depends on a balance between caloric intake and insulin administration, bulimia may upset this balance, thereby disturbing control of blood glucose levels and leading to increased blood glucose levels (hyperglycemia). Studies show that type I diabetics with bulimia also have excessive levels of glucose-bound hemoglobin, the oxygen-carrying pigment of red blood cells. A case is described of a 21-year-old woman with type I diabetes, bulimia, and long-term hyperglycemia. The antidepressant agent fluoxetine, which may have appetite-inhibiting properties, improved depression, changed bulimic behavior, and improved blood glucose control in this patient. Her glycosylated hemoglobin levels dropped from 13.4 to 8.6 percent after fluoxetine treatment, and she was free of bulimic behavior for more than two years. Fluoxetine increases the bioavailability of the naturally occurring substance serotonin, which has been shown to inhibit appetite. This antidepressant drug was recently approved by the Food and Drug Administration. Further investigation is needed to establish the effectiveness of fluoxetine in treatment of patients with bulimia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Bulimia, Fluoxetine

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