Summary Subcutaneous insulin absorption kineticswere assessed in 50 healthy study subjects (21 female, 29 male; age 26 + 3 years, BMI 22.5 + 1.8 kg/m2; mean + SD) during 45 min after periumbilical injection of soluble human U40-or U100-insulin (0.15 IU/kg). Subcutaneous fat thickness was measured by ultrasound, and skin temperature at the injection site was registered. Serum insulin concentrations increased within 30 min from basal values of 37 + 15 to 140 + 46 pmol/1 after U40-insulin and from 36 + 10 to 116 _+ 37 pmol/1 after U100-insulin (p < 0.001). After 45 min serum insulin concentrations were 164 _+ 43 pmol/1 with U40-insulin and 128 + 35 pmol/1 with U100-insulin (p < 0.001).Decline in blood glucose levels and suppression of Cpeptide were comparable. The serum insulin levels reached 30 and 45 min after U40-and U100-insulin injection were positively correlated with skin temperature (p < 0.0008), and negatively correlated with subcutaneous fat thickness (p < 0.009). In conclusion, the lower insulin concentration of U40-insulin, higher skin temperature, and a thinner subcutaneous fat tissue at the injection site are associated with accelerated and enhanced subcutaneous insulin absorption. [Diabetologia (1994) 37: 377-380]
Background: Injuries from footwear are common in elderly people, particularly in those with diabetes mellitus and polyneuropathy. A common cause is a mismatch between foot and shoe. Objective: To assess the length and the breadth of the feet by an automatic measuring device in 568 patients with diabetic polyneuropathy and in 100 nondiabetic control subjects of the same mean age of 64 years. Results: While the foot length in all cases matched well with the size of the normal footwear available on the market, more than two thirds of the feet were considerably broader than the normal footwear available. The foot breadth correlated variably with the foot length. Tables of foot dimensions for men and women are provided over the complete range of shoe sizes. Conclusions: This anthropometric data set on feet, which is the first conducted in elderly people, proves that most feet of elderly people with or without diabetic neuropathy do not fit ordinary casual footwear. Therefore, the construction of shoes according to the anthropometric data of elderly people is required in order to prevent foot injuries in this particular population.
The impact of 'half shoes' in the treatment of neuropathic forefoot ulcers was studied in two groups of diabetic patients, who were treated either by standard treatment alone (retrospective controls, n = 22), or by standard treatment plus 'half shoes' (cases, n = 26). The groups were matched for sex, age, type, and duration of diabetes and ulcer grading. The 'half-shoe' cases' vs controls' median overall healing time was 70 vs 118 days, the median difference being 48 (95% CI: -5 to 82) days (NS). In the case group, hospitalization was required in 1/26 (4%) of patients, vs 9/22 (41%) of the control patients (chi-square, p < 0.01). The home nursing service was required in 23% of the cases vs 18% of the controls (NS). It is concluded that the use of half-shoes, in conjunction with standard treatment provided by a specialized diabetic foot clinic, may reduce the overall healing time and does reduce the hospitalization rate. This has implications for a rational strategy of treating unilateral diabetic neuropathic foot ulcers.
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