This study examined how children and adolescents with type 1 diabetes mellitus' (T1DM) glucose levels during and prior to academic performance impact the outcome on a variety of reading, writing, and mathematics tasks. The study sample was selected from a larger study. Participants wore a continuous glucose monitor for approximately six days and complete a neurobehavioral evaluation that consisted of a variety of tasks including tasks that assessed basic reading skills, reading fluency, reading comprehension, math fact fluency, math calculation, math problem solving, spelling, and writing fluency. Results indicated that individuals who experience extreme glucose levels (e.g. hyperglycemia or hypoglycemia) perform worse on spelling accuracy tasks. Additionally, when an individual is hyperglycemic his or her reading and writing fluency skills decrease. Moreover, poor glucose control prior to academic performance increased individual's risk for exhibiting impaired performance on reading and mathematics tasks. Overall, the study results suggest that one's glucose levels prior to and during academic performance potentially impact overall execution of reading, writing, and mathematics abilities. Therefore, these findings support the need to move beyond consideration of only overall glucose levels and review temporal influence of glucose levels on academic performance to track fluctuations on academic performance and determine necessary accommodations to buffer glycemic dysregulation effects. In particular, individuals whose glucose levels are frequently within the hyperglycemic range are at greatest risk for performing below their optimal level.

Better disease care behaviors in youth with type 1 diabetes (T1D) are strongly related to better metabolic control (HbA1c). However, HbA1c results are only available, on average, every three months, and may not accurately capture intricacies of blood glucose fluctuations. Youth then must rely on blood glucose levels obtained throughout the day to determine which disease care behaviors to perform to maintain optimal metabolic control. Youth may have difficulty performing these disease care behaviors properly or consistently, which makes parental monitoring a crucial aspect of the diabetes regimen. Additionally, youth who experience frequent or severe hypoglycemia may develop a fear of hypoglycemia, which may impact their disease care behaviors and blood glucose levels directly. Average blood glucose levels strongly related to HbA1c which verifies HbA1c as a good indicator of average blood glucose levels. The Average Daily Risk Range (ADRR) index had a stronger relation to HbA1c than Mean Amplitude of Glycemic Excursions (MAGE) index; however, the percentage of blood glucose levels below, within, and above range may be the best indicator of glycemic variability, as it is more easily calculated and understood. More parental monitoring related to more diabetes prevention behaviors but not intervention behaviors or less glycemic variability.

Obesity has grown to epidemic proportions, and in lack of efficient life-style and medical treatments, the bariatric surgeries are performed in rising numbers. The most common surgery is the Gastric Bypass (GBP) surgery, with the Biliopancreatic diversion with duodenal switch (DS) as an option for the most extreme cases with a BMI>50 kg/m2. In paper I 20 GBP-patients were examined during the first post-operative year regarding the natriuretic peptide, NT-ProBNP, which is secreted from the cardiac ventricles. Levels of NT-ProBNP quickly increased during the first post-surgery week, and later established itself on a higher level than pre-surgery. In paper II we report of 5 patient-cases after GBP-surgery with severe problems with postprandial hypoglycaemia that were successfully treated with GLP-1-analogs. The effect of treatment could be observed both symptomatically and in some cases using continuous glucose measuring systems (CGMS). In paper III three groups of subjects; 15 post-GBP patients, 15 post-DS, and 15 obese controls were examined for three days using CGMS during everyday life. The post-GBP group had high glucose variability as measured by MAGE and CONGA, whereas the post-DS group had low variability. Both post-operative groups exhibited significant time in hypoglycaemia, about 40 and 80 minutes per day <3.3mmol/l and 20 and 40 minutes < 2.8mmol/l, respectively, longer time for DS-group. Remarkably, only about 20% of these hypoglycaemic episodes were accompanied with symptoms. In Paper IV the hypoglycaemia counter regulatory system was investigated; 12 patients were examined before and after GBP-surgery with a stepped hypoglycaemic hyperinsulinemic clamp. The results show a downregulation of symptoms, counter regulatory hormones (glucagon, cortisol, epinephrine, norepinephrine, growth hormone), incretin hormones (GLP-1 and GIP), and sympathetic nervous response. In conclusion patients post bariatric surgery exhibit a downregulated counter regulatory response to hypoglycaemia, accompanied by frequent asymptomatic hypoglycaemic episodes in everyday life. Patients suffering from severe hypoglycaemic episodes can often be treated successfully with GLP-1-analogues.

Introduction: Relation of diabetes mellitus (DM) to the diabetic keratopathy and various stages of corneal nerve fiber damage has been well accepted. A possible association between changes in the cornea of diabetic patients and diabetic retinopathy (DR), DM duration, and age at the time of DM diagnosis were evaluated. Neuropathies are among the most common long-term complications of diabetes mellitus. Good glycemic control is essential in prevention of this complication. DM patients with similar mean glucose levels or glycated hemoglobin (HbA1c) levels often exhibit differences in evaluation of diabetic complications. One reason for these differences may be the differences in glucose variability. DM patients with similar mean glucose levels or HbA1c levels often exhibit differences in glucose variability Hypothesis: Diabetes mellitus damages the subbasal nerve fibers of the corneal and affects the density of epithelial, endothelial and stromal cells. Corneal changes in patients with DM are dependent on the degree of diabetic retinopathy (DR), age at diagnosis, duration of DM, and compensation parameters. Purpose: To compare changes in cell density in individual layers of cornea and status of subbasal nerve fibers in patients with type 1 DM (DM 1) and in healthy subjects. To evaluate the dependence...