No abstract

Bullying remains a familiar part of the health professional culture, despite the caring nature of doctors' work. Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it. Most people who bully are not intrinsically bad people, but they must be helped to change, in the interests of patients as well as staff.

A regulatory role of acute changes in plasma concentration of free fatty acids on glucagon secretion has been suggested. We have studied the effect of such changes on plasma levels of glucagon, insulin, and growth hormone in man. Basal plasma levels of immunoreactive glucagon (IRG) were only slightly raised in 11 healthy subjects when the mean concentration of free fatty acids (FFA) was depressed to levels as low as 0.3 15 f 0.043 (SEM) mM by infusion of nicotinic acid. Basal levels were increased modestly when the mean FFA level was elevated to 3.027 f 0.184 mM by infusion of a triglyceride emulsion (Intralipid) with heparin. The plasma IRG response to intravenous arginine was unaffected by high or low levels of plasma FFA. These findings contrasted with the effects upon plasma levels of immunoreactive insulin (IRI) and growth hormone (IGH). During elevation of F7A levels, the mean basal level of plasma IRI increased by lOO%, and the IRI response to arginine increased by 50%. Concomitantly, basal IGH levels and the plasma IGH response to arginine were suppressed markedly by elevation of FFA levels. The results of these studies do not offer support for a significant role of variation in plasma level of FFA as a regulator of acute changes in plasma IRG in man. An influence of changing levels of FFA on insulin secretion was found, and an effect on levels of growth hormone was confirmed. M ETABOLIC SUBSTRATES such as glucose, amino acids, and free fatty acids (FFA) have important regulatory effects on a variety of hormones that influence the transfer of these substrates to or from energy stores. Rising plasma levels of glucose stimulate secretion of insulin and suppress secretion of glucagon and growth hormone. Opposite effects occur when plasma glucose levels are falling or hypoglycemia is induced. Rising levels of certain amino

Insulin fixation and glucose uptake have been studied in the forearm tissues of nine lean non-diabetic men for three consecutive hours, during a fasting state, an intra-arterial infusion of a small dose of insulin (25-100 mU) and a recovery period. When insulin was administered, the arterial plasma immune-reactive insulin rose to levels ranging from 15 to 65 ~U/ml; the tissue insulin fixation was significantly increased during this period, but no effect on tissue glucose uptake was observed. A close correlation was found between the arterial plasma insulin concentration and the tissue insulin fixation.-The injection of 200 nag glucose intraarterially at the end of the study resulted in a reversal of the arterio-venous gradient of plasma insulin concentration.-The results show that large amounts of circulating insulin can be bound to the forearm tissues without exerting an effect on glucose uptake. It is suggested that the binding of insulin occurs at the vascular endothelium and that it is reversible by increased concentrations of blood glucose. die Glucoseaufnahme ausiiben. Man muB annehmen, dab die Insulinbindung am Gef/~Bendothel erfolgt und de2 sic durch steigende Konzentration der Blutglucose reversibel ist.