OBJECTIVE -The purpose of this study was to test the effect of high glycemic index (HGI) and low glycemic index (LGI) meals on blood glucose levels using continuous blood glucose monitoring in youths with type 1 diabetes. RESEARCH DESIGN AND METHODS-A total of 20 youths on basal-bolus regimens consumed macronutrient-matched HGI and LGI meals 1 day each in a controlled setting in varying order following consumption of a standardized evening meal. Medtronic MiniMed Continuous Glucose Monitoring Systems were used to assess blood glucose (BG) profiles.RESULTS -Participants demonstrated significantly lower daytime mean BG, BG area Ͼ180 mg/dl, and high BG index when consuming LGI meals but no differences for daytime BG area Ͻ70 mg/dl, daytime low BG index, or any nighttime values. Significantly more BG values Ͻ80 mg/dl were treated on LGI days. CONCLUSIONS -Findings indicate that consumption of anLGI diet may reduce glucose excursions, improving glycemic control. Diabetes Care 31:695-697, 2008W hile American Diabetes Association recommendations for dietary management emphasize the amount rather than the source of carbohydrate (1), research suggests that a low glycemic index (LGI) diet may improve glycemic control (2-4). However, the utility of an LGI diet remains controversial (5), and it is unknown whether it affords meaningful benefit over careful insulin-to-carbohydrate dosing or whether dietary glycemic index could affect insulin dose. Two studies using continuous glucose monitoring system (CGMS) conducted with healthy adults (6,7) and another with adults with type 2 diabetes (8) suggest that an LGI diet confers a more favorable blood glucose (BG) profile. However, insufficient research exists in type 1 diabetes, particularly with contemporary insulin regimens. The purpose of this study was to test the effect of HGI andLGI meals on BG levels using CGMS in youth with type 1 diabetes on basal-bolus regimens.RESEARCH DESIGN AND METHODS -Participants were recruited from a pediatric endocrinology practice; inclusion criteria included diagnosis of type 1 diabetes Ն1 year, insulin dose Ն0.5 units ⅐ kg Ϫ1 ⅐ day Ϫ1 , and age 7-16 years. Informed consent and assent were obtained. The study was approved by the institutional review board of the National Institutes of Health. A withinsubject crossover trial was used; participants consumed 1 day of HGI meals and 1 day of LGI meals in a controlled setting. The order of conditions was counterbalanced, with a washout day between and a standardized evening meal before each condition. Diets were matched for calories and macronutrients; mean glycemic index of the HGI diet was 64 (e.g., corn flakes, white bread, mashed potatoes) and of the LGI diet was 40 (e.g., peaches, kidney beans, brown basmati rice) (onlineonly appendix table [available at http:// dx.doi.org/10.2337/dc07-1879]). Meal timing and activity levels were consistent across conditions. The CGMS (Medtronic MiniMed, Northridge, CA) was used to assess BG profiles. Subjects were given standard BG meters, and BG checks were p...

Long-acting somatostatin analogues may be of benefit in certain hypersecretory endocrine and gastrointestinal disorders. The 24 h hormonal and metabolic profiles of six normal male subjects receiving a twice daily subcutaneous injection of one such analogue SMS 201-995, 50 micrograms, has been compared to that obtained following placebo injection. Spontaneous daytime peaks of GH secretion were delayed until 1400 h following SMS 201-995 but nocturnal and total 24 h GH secretion were unaffected. The nocturnal rise in thyrotrophin was abolished by SMS 201-995 but thyroid function was unaffected. Insulin levels were suppressed following SMS 201-995 and the response to meals was inhibited. Glucose intolerance followed main meals. Glucagon levels were suppressed for up to 6 h. Circulating alanine levels were raised between 1200 h and 0600 h and there were intermittent elevations in lactate, pyruvate, glycerol and 3-hydroxybutyrate. Amino acid levels, including branched chain amino acids, were also increased. All six subjects suffered gastrointestinal side-effects. SMS 201-995, 50 micrograms, given twice daily shortly before meals does not suppress 24 h GH secretion, but demonstrates significant effects on metabolism and causes side effects in normal subjects.

The purpose of this study is to develop and validate a toddler silhouette scale. A seven‐point scale was developed by an artist based on photographs of 15 toddlers (6 males, 9 females) varying in race/ethnicity and body size, and a list of phenotypic descriptions of toddlers of varying body sizes. Content validity, age‐appropriateness, and gender and race/ethnicity neutrality were assessed among 180 pediatric health professionals and 129 parents of toddlers. Inter‐ and intrarater reliability and concurrent validity were assessed by having 138 pediatric health professionals match the silhouettes with photographs of toddlers. Assessments of content validity revealed that most health professionals (74.6%) and parents of toddlers (63.6%) ordered all seven silhouettes correctly, and interobserver agreement for weight status classification was high (κ = 0.710, r = 0.827, P < 0.001). Most respondents reported that the scale represented toddlers aged 12–36 months (89%) and was gender (68.5%) and race/ethnicity (77.3%) neutral. The inter‐rater reliability, based on matching silhouettes with photographs, was 0.787 (Cronbach's α) and the intrarater reliability was 0.855 (P < 0.001). The concurrent validity, based on the correlation between silhouette choice and the weight‐for‐length percentile of each toddler's photograph, was 0.633 (P < 0.001). In conclusion, a valid and reliable toddler silhouette scale that may be used for male or female toddlers, aged 12–36 months, of varying race/ethnicity was developed and evaluated. This scale may be used clinically or in research settings to assess parents' perception of and satisfaction with their toddler's body size. Interventions can be targeted toward parents who have inaccurate perceptions of or are dissatisfied with their toddler's body size.

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The 24-h hormonal and metabolic profiles obtained in five non-insulin-dependent diabetics receiving twice daily s.c. injections of the long-acting somatostatin analogue SMS 201-995 (50 micrograms) have been compared with those obtained following placebo injection. Injections were given 30 min before breakfast and the evening meal. GH secretion was not suppressed by the analogue administered in this manner. Despite suppression of serum insulin levels following breakfast and the evening meal, blood glucose levels were similar during the two study periods with no evidence of worsening in diabetic control. Prolonged suppression of plasma glucagon levels was observed and the nocturnal elevation in serum TSH levels was abolished. Free T4 levels fell significantly following the analogue but total T3 levels were unaffected. Blood alanine levels were elevated throughout the study period following SMS 201-995 but changes in lactate, pyruvate, glycerol and 3-hydroxybutyrate were minor. All five subjects suffered gastrointestinal side-effects. SMS 201-995 (50 micrograms) given twice daily before meals does not cause a deterioration in metabolic control, does not suppress 24-h GH secretion and causes significant side-effects in patients with non-insulin-dependent diabetes mellitus.