For this form of therapy we recommend that rehydration should be done with fluids that do not contain glucose or large amounts of bicarbonate. A loading dose of 05 units of neutral insulin should be given followed by an infusion of neutral insulin at a rate of 40 mU/min (24 U/hr) until the plasma glucose has reached a satisfactory level. Increasing the infusion rate is without additional effect, for the reasons outlined above. The infusion solution consists of 500 ml of physiological saline containing 10 g of human serum albumin and 20 units of neutral insulin. This solution is used over eight hours at 60 ml/hr and is generally suffioient for completion of therapy. Plasma glucose should be measured every second hour when the previous measurement is above 300 mg/100 ml and should be estimated hourly when below this level.In addlition to being a simple form of therapy for all degrees of hyperglycaemia and ketoacidosis low dose insulin infusion may offer a more efficient means of preparing diabetics for surgery.

SummaryRecent changes in the structure of the examination for M.R.C.P. (U.K.) have prompted a review of these together with a historical outline of the examinations which preceded it at the Royal Colleges of Physicians of Edinburgh, Glasgow, and London.Part I of the examination continues to fulfil its role as a screen and a slight change in the marking system appears to have improved its discriminating powers still further. The major change in part II is the substitution of a more objective written test in place of the essay papers.

We compared red cell deformability (filtration rate through 5 µ sieves), blood viscosity (rotational viscometer), haematocrit, plasma fibrinogen and plasma viscosity in young male diabetics (age ˂50 years) and normal controls matched for age and smoking habit. Diabetics with no retinopathy or other vascular complications (n = 20) had normal red cell deformability, but increased blood viscosity at shear rates of 100s-1(p ˂0. 05) and 1s-1(p ˂0. 01), due in part to moderate elevations of haematocrit, fibrinogen and plasma viscosity. Diabetics with retinopathy (n = 10) had a more marked increase in viscosity and also reduced red cell deformability (p ˂0. 05). Increased blood viscosity is present prior to the onset of detectable vascular complications in male diabetics, while reduced red cell deformability is associated with complications.

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Two patients who had severe unstable diabetes mellitus with frequent hypoglycemic episodes and who required soluble insulin for control are described. Both developed hepatomegaly. Quantitative and qualitative studies of liver glycogen and its related enzymes were performed. The liver glycogen content was high (8 per cent) but its molecular structure was virtually normal. Both the [3-amylolysis limit and the phosphorylase activity appeared to be lower than normal but did not approach the levels associated with glycogen storage disorders. The values of the other enzymes tested were normal. Therefore it appears that the elevated liver glycogen levels seen in some patients with brittle diabetes mellitus are not the result of enzyme deficiency but are secondary to wide fluctuations in blood sugar and frequent doses of soluble insulin. DIABETES 17:13-16, January, 1968.