In order to study the interrelationship of GH, somatomedin (SM), and growth in insulin-dependent diabetes mellitus (IDDM), concentrations of serum glucose, serum GH, and plasma SM were determined at 2-h intervals for 48 h in 19 ambulatory children with IDDM of at least 2-yr duration (mean duration, 6 yr) and in 9 normal age-matched controls. Serum glucose was significantly elevated (P less than 0.001) in subjects with IDDM compared to controls [287 +/- 15 mg/dl vs. 99 +/- 2 mg/dl (mean +/- SEM)] as was the hemoglobin A1C (11.0 +/- 0.40% vs. 4.59 +/- 0.08%) and the serum GH (8.4 +/- 0.4 ng/ml vs. 5.6 +/- 0.6 ng/ml; P less than 0.002). Despite evidence of inadequate diabetes control and elevated GH levels, the subjects with IDDM had normal SM levels (1.82 +/- 0.14 U/ml) compared to their age-matched controls (mean, 1.66 +/- 0.19 U/ml) and normal growth. Furthermore, SM levels did not show any significant diurnal variation in either group. There was no significant correlation in either group between the mean plasma SM concentrations and the mean serum GH or mean serum glucose concentration of each subject. These findings of normal SM levels and elevated GH levels in these children with normal stature and IDDM suggest a partial block in GH action.
The placental membrane radioreceptor assay was used to measure the levels of somatomedin (SM) peptides in plasma. Displacement of both [125I]somatomedin A ([125I]SM-A) and [125I]somatomedin C ([125I]SM-C) by normal whole plasma, the peptide fraction of acid-chromatographed plasma, and a partially purified, insulin-free SM preparation were compared. The peptide fraction of plasma was isolated by acid chromatography over Sephadex G-50 in 0.25 M formic acid with a yield of greater than or equal to 90%, as determined by bioassay and [125I]SM. In the case of [125I]SM-A, the dose-response curves for whole plasma, acid-chromatographed plasma, and the standard SM preparation were parallel (P less than 0.2). In contrast, for [125I]SM-C, the dose-response curves for acid-chromatographed plasma and the purified SM preparation were parallel (P less than 0.2), but both differed significantly from that of whole plasma (P less than 0.001). In addition, there was less variability in the assay of acid-chromatographed plasma compared to whole plasma. The results indicate that radioreceptor assay of unextracted normal plasma using [125I]SM-A is a valid measure of SM peptide concentration, while radioreceptor assay of unextracted normal plasma using [125I]SM-C, in our hands, is not. Acid chromatography of plasma before its assay is an uncomplicated procedure which allows valid and precise measurement of SM peptide content using either [125I]SM-A or [125I]SM-C.
This case raises awareness of the interaction between fluticasone propionate and lopinavir/ritonavir and adverse effects in children receiving both medications.
The internal consistency and validity of the Diabetes Regimen Responsibility Scale (DRRS) were examined in a sample of 49 youths. The DRRS demonstrated adequate internal consistency, and most subscales correlated significantly with diabetes knowledge. Only the parent report on the insulin administration scale and the child report on dietary management correlated with metabolic control (glycosylated hemoglobin, HbA1c). Implications for research and practice are discussed.
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