A series of 148 diabetic patients were studied for the presence of soluble immune complexes using five different screening techniques. The percentage of positive results was 26% with direct nephelometry and PEG-C4, 27% with PEG-IgG, 33% with radiolabelled Clq binding and 57% with a specific technique for detection of insulin-anti-insulin immune complexes. The percentages of positivity in a group of 40 healthy donors were 2.5% for direct nephelometry and radiolabelled Clq binding, 5% for the PEG-C4 technique, and 10% for the PEG-IgG technique. Sixteen percent of the patients studied had positive results in three or more of the screening tests. When the results of the different screening tests in all patients and controls were compared among themselves, we found correlation coefficients between-0.01 (p = 0.854) when the direct nephelometry and the PEG-C4 tests were compared and 0.29 (p < 0.0003) when the direct nephelometry and PEG-IgG tests were compared. When the results of each test for the whole group of patients and the group of normal healthy donors were compared, significant differences were found for direct nephelometry (p = 0.004), PEG-IgG, PEG-C4, and insulin-anti-insulin immune complexes (p < 0.0001), as well as for anti-insulin antibodies (p < 0.001); no significant difference was observed when the results of radiolabelled Clq binding in diabetics and controls were compared (p = 0.2). Significant correlations were found between the results of several screening tests for soluble immune complexes, insulin dosage, and clinical or biochemical expressions of microangiopathy, nephropathy, or vasculopathy. These correlations were more consistent when we divided the patients into normal or abnormal groups for proteinuria, microangiopathy, and diabetic complications and considered the number of positive tests in each patient rather than the results of individual tests.

/pdf/soluble-immune-complexes-in-patients-with-diabetes-mellitus-5aryufurp2.pdf

Soluble immune complexes in patients with diabetes mellitus: detection and pathological significance

Results are presented of a comparative study of several methods for detection of ketone bodies in urine involving nearly 10,000 tests on urines containing no ketones, naturally occurring ketones, and added acetoacetate. Acetest (a tablet nitroprusside test) and Ketostix (a strip nitroprusside test) are more specific and accurate, and have the proper sensitivity in comparison with test tube Rothera nitroprusside modifications or the ferric chloride test. Both the tablet and strip are also satisfactory for detection of ketones and serum or plasma. The tablet test may be used with whole blood for detection of ketonemia.

A comparative study of qualitative tests for ketones in urine and serum.

Categorically, about 50 per cent of diabetic patients are well controlled by dietary restriction alone, while the remainder require insulin coupled with such dietary restriction.1Of the latter group "at least one half of them can be balanced without difficulty by the use of moderate amounts of almost any type of insulin."1a The remaining 25 per cent who comprise the third category are characterized as having severe diabetes.1aIf the clinician is not a "purist"2or a "free dieter"2he may achieve relatively good control in the vast majority of these severe cases. The "purist" approach is unwise here since it frequently invites hypoglycemic reactions. Conversely, the "free dieter" is often defeated in his therapeutic objective by repeated insults of severe hyperglycemia, glycosuria and even ketosis. Successful management in this group, therefore, is usually the reward of the "middle of the roader"2whose therapeutic

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=287765&pdfFileName=jama_142_3_007.pdf

An approach to the problem of the brittle diabetic patient; study of six cases.

The specific vascular lesions of diabetes mellitus. II. Retinopathy and intercapillary glomerulosclerosis.

Effective treatment of diabetic acidosis is based on three important prerequisites: 1. systematic efforts at prevention; 2. accuracy of diagnosis; 3. correct appraisal of severity. Prevention succeeds when both patient and physician are aware of the causes of acidosis and avoid them. Some of the most common are omission or delay in daily insulin administration; reduction in insulin dosage because food cannot be taken during illness; increased insulin need during acute infection and trauma; failure to test urine for ketones when heavy glycosuria exists; disdain toward warning symptoms, especially thirst, polyuria and nausea; complacent attitudes toward poor routine control of diabetes. Precise diagnosis often reveals a cause for acute illness in diabetes other than acidosis, even when glycosuria with some ketonemia, ketonuria, and lowered alkali reserve are present. A diabetic in coma is not necessarily in diabetic coma. Some of the sources of confusion are insulin shock; cerebral trauma, hemorrhage,

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=intemed&articleId=561359&pdfFileName=archinte_99_2_014.pdf

Treatment of diabetic acidosis.

Diabetes Mellitus in General Practice

A Manual for Diabetic Patients

Food Rationing and the Diabetic

Diabetic Patients After Discharge

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Diabetes Mellitus in General Practice

A Manual for Diabetic Patients

Food Rationing and the Diabetic

Diabetic Patients After Discharge