Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia and progressive insulin resistance, leading to macro and microvascular dysfunction. Passive heating has potential to improve glucose homeostasis and act as an exercise mimetic. We assessed the effect of acute passive heating before or during an oral glucose tolerance test (OGTT) in people with T2DM. Twelve people with T2DM were randomly assigned to 3 conditions:1) 3 h OGTT (CON); 2) 1 h passive heating (40 °C water) 30 min before an OGTT (HOT-OGTT); and 3) 1 h passive heating (40 °C water) 30 min after commencing an OGTT (OGTT-HOT). Blood [glucose], insulin sensitivity, extracellular heat shock protein 70 (eHSP70), total energy expenditure (TEE), heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP) were recorded. Passive heating did not alter blood [glucose] (CON, 1,677 (386) a.u.; HOT-OGTT, 1,797 (340) a.u.; OGTT-HOT, 1,662 (364) a.u.; P = 0.28), insulin sensitivity (P = 0.15), or SBP (P = 0.18), but did increase [eHSP70] in both heating conditions (CON, 203.48 (110.81) pg·mL-1; HOT-OGTT, 402.47 (79.02) pg·mL-1; OGTT-HOT, 310.00 (60.53) pg·mL-1; P < 0.001), increased TEE (via fat oxidation) in the OGTT-HOT condition (CON, 263 (33) kcal; HOT-OGTT, 278 (40) kcal; OGTT-HOT, 304 (38) kcal; P = 0.001), increased HR in both heating conditions (P < 0.001) and reduced DBP in OGTT-HOT condition (P < 0.01). Passive heating in close proximity to a glucose challenge does not alter glucose tolerance but does increase [eHSP70] and TEE, and reduce blood pressure in people with T2DM.
Nutritional OsteomalaciaSi r . \ p=m-\ We have read the article by Dwyer et al (Journal 133:134-140, 1979) and have recently observed an adult case of nutritional osteomalacia \psimilar to those presented. Report of a Case.\p=m-\A 25-year-old woman came to this hospital with a chief complaint of increasing bone pain in the lower back and hips, which caused difficulty in walking for one year. For the past eight years, she had been on a strictly vegan diet that also excluded fish. Soy products were her only dietary supplement. Her four children (from 11 months to 7 years of age) are also on the same diet. Since the birth of her last child, the patient has continued to lactate and admitted to a 7-kg weight loss in the Past year. The patient was referred to the department of rehabilitation medicine due to severe muscle weakness, wasting, and lethargy. She walked with the aid of a cane.Physical examination showed a 34-kg Woman, with a pigeon chest, a left kyphoscoliosis, a positive Chvostek's sign, patellar hyperreflexia, and cephalotruncal disproportion. Dentition was poor and a positive Gowers' sign was noted. Roentgenograms showed the classic pseudofractures (Looser's lines) of the ribs, a widening of the symphysis pubis, mild osteoporosis, diffuse osteopenia, and cupping of the diaphyses of the long bones.Laboratory findings showed the following levels: total serum calcium, 7.6 mg/dL; magnesium, 1.7 mg/dL; phosphate, 2.6 mg/ dL; albumin, 3.9 g/dL; iron, 60.0 ug/dL, with total iron-binding capacity, 426 fig/ dL; total serum protein, 6.6 g/dL; serum alkaline phosphatase, 216.4 mU/mL; and serum parathyroid hormone, 406 picogram equivalents (pe)/mL (normal, 163 to 347 pe/mL). Fat was also present in the fecal samples, as well as protein ( + 2) and ketones ( + 4) in the urine.The history, physical examination, laboratory, and roentgenographic findings all point to a diagnosis of vegetarian osteomalacia secondary to inadequate diet, lack of exposure to sunlight, and persistant lactation. The patient discharged herself against medical advice, and hence the children could not be examined.Comment.-We believe that a vegan diet, as described earlier, with soy substitution is inadequate to prevent metabolic bone disease in adults as well as in children. Paul Elinson, DO
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