The objective of this study was to examine the effects of plant sterols and/or glucomannan on lipid profiles and cholesterol kinetics in hyperlipidemic individuals with or without type 2 diabetes. It was hypothesized that plant sterols and glucomannan reduce circulating cholesterol levels and may have an additive or synergistic effect when combined by reducing cholesterol absorption. Thirteen type 2 diabetics and sixteen non-diabetics all mildly hypercholesterolemic free living subjects participated in a randomized crossover trial consisting of 4 phases, 21 days each. Subjects consumed plant sterols and glucomannan during the trial. Overall reductions in total and LDL-cholesterol levels were greater (P<0.05) after consumption of the combination supplement. Effects of supplements were not different between diabetics and non-diabetics. No significant changes were observed in cholesterol absorption or synthesis in both diabetics and non-diabetics. The intake of plant sterols and glucomannan together may be an alternative approach in reducing blood cholesterol levels.

Daughters of gestational diabetes (GDM) affected pregnancies are at greater risk for the development of type 2 diabetes mellitus (DM) later in life. Adiponectin is an early marker of DM risk. Dietary fat quality has been proposed to be involved in the development of insulin resistance. Plasma fatty acids are a marker of recent dietary exposure. The objectives of this research were to determine whether differences in adiponectin exist in daughters of GDM pregnancies, and to describe how dietary fatty acids impact adiponectin concentrations. Fasting adiponectin and plasma fatty acids were examined for 180 adolescent daughters born to mothers with and without GDM. No differences were observed in adiponectin between study groups, however; a significant difference was detected upon comparison of daughters from mothers who were presently diabetic with those from healthy mothers. The association between fatty acids and adiponectin varied by visceral adiposity. Adiponectin was inversely associated with monounsaturated and omega-3 (n-3) fatty acids in the high waist group. Further knowledge on the interactions between fatty acids, desaturase activity and adiponectin would be helpful in planning early interventions for individuals at risk for diabetes.

This ethnobotanical project screened and evaluated the use of traditional medicine of the Cree Nation of Quebec as part of a study directed at preventing complications associated with Type 2 diabetes (T2D). Antidiabetic plants used by the Cree that treat T2D symptoms were identified. Quantitative ethnobotany and analysis of antioxidant activity were conducted. Results from Whapmagoostui were compared with those found in Mistissini and also the literature. Twenty-one plant species were cited during the survey. Although Cree medicine throughout Quebec and Canada is homogenous, geographical and vegetation gradients show some variations. Medicinal plants have better antioxidant potential than non-medicinal plants and have a higher phenolic content. Rankings based upon the ethnobotany, the bioassays and the quantitative tools showed positive correlations. This evidence supports the beneficial effects of Cree TM and medicinal plants selected by the Cree Nation in the prevention of T2D and its complications.

One of the earliest recorded references to polyuria is found in the Papyrus Ebers (1500 BC) and much later the occurrence of "honey urine" was noted by an ancient Hindu physician, Sushrutha, in old Indian Sanskrit (400 BC). However, the first good clinical description of the disease is ascribed to Celsus, although the name "diabetes" was introduced by Aretaeus of Cappadocia. The body of knowledge which has accumulated since these early recordings to the present state of the art reflects a most impressive sojourn, punctuated by many milestones, each adding impetus to future attempts in a relentless endeavour to unravel the aetiopathogenesis of this common malady. However, this "sweet evil" (diabetes) remains an enigma in many ways. There is little doubt today that there are 2 major types of diabetes: juvenile onset diabetes, presently known as insulin-dependent diabetes mellitus (IDDM) and maturity onset diabetes, referred to as non-insulin dependent diabetes mellitus (NIDDM). In NIDDM aggregation of HLA types, evidence of cell mediated immunity and the presence of circulating islet cell antibodies, which are characteristically associated with IDDM, are not found. There is also a vast difference in concordance of diabetes in the co-twins between the two types of diabetes suggesting that a different mixture of genetic and environmental factors is operative in the pathogenesis of these two types of diabetes. In I960, Fajans and Conn drew attention to the existence of a form of diabetes with an onset before the age of 35 years. Their patients showed a substantial improvement in glucose tolerance when treated with an oral hypoglycaemic agent, tolbutamide. Subsequent to this report numerous studies from various parts of the world confirmed this entity of non-insulin dependent diabetes in the young (NIDDY) in White Caucasians. There are, however, several different syndromes presenting as mild carbohydrate intolerance in the first two to three decades of life. The classical form of NIDDY is a mild non-insulin requiring form of diabetes in which the disorder is inherited as a dominant trait; there is little progression of glucose intolerance, if any, with time, and the diabetes is rarely accompanied by vascular complications. This subtype of diabetes is referred to as MODY (maturity onset diabetes in the young) and thus constitutes a subset under the broad umbrella of NIDDY. However, recently compelling evidence for heterogeneity within MODY has been presented. This evidence is based on the prevalence of certain HLA antigens, insulin responses to oral glucose, occurrence of vascular complications, progression of hyperglycaemia to the stage of insulin requirement and failure to demonstrate autosomal dominant inheritance in some families studied. In the South African Indian population which has a high prevalence of diabetes, Campbell was the first to draw attention to NIDDY in Indians more than two decades ago. Since this initial report, nobody has really studied NIDDY in any depth in South Africa and certainly not in the Indian population. NIDDY in the local Indian population is of particular interest for the obvious reason that diagnostic and management problems arise daily in a population with a high prevalence of non-insulin dependent diabetes. It is vital that the clinical features, endocrine and associated biochemical aberrations be known in detail if this condition is to be managed appropriately and adequately. A study of these aspects therefore became the primary task of this thesis. To pre-empt any challenge that patients were not really diabetic, the strict criteria of the W.H.O. for the diagnosis of diabetes were chosen. It should therefore be borne in mind throughout this study that a group of rather severe diabetics were selected by design. The patients studied represent the rather extreme end of the spectrum. But, in the event, this selection proved advantageous in that it covered an unstudied part of the spectrum and some light could be shed on the natural history of the disorder. In the long term the purpose was to prepare the ground for what must become the thrust of future studies, namely the biochemical pathogenesis of NIDDM. If it is true that some forms of NIDDY are inherited dominantly, existing techniques should make it possible to identify a gene(s) locus and if this is done the biochemical basis of this disorder must be identifiable. In the present study direct examination of these aspects were not undertaken, but an attempt was certainly made to pinpoint those biochemical abnormalities which are perhaps primary or central to the whole disorder. / Thesis (M.D.)- University of Natal, Durban. 1982.

Although the benefits of exercise to non-insulin-dependent diabetes mellitus (NIDDM) are well-known, individuals with NIDDM are at risk for macrovascular and microvascular complications associated with an abnormal systolic blood pressure (SBP) elevation during exercise. In order to compare the SBP and rating of perceived exertion (RPE) response between individuals with NIDDM and apparently healthy controls during submaximal exercise, eight individuals representative of each group completed a 10-minute submaximal treadmill exercise trial at 65% of functional capacity. Heart rate, blood pressure and RPE were monitored throughout the trial. Between group comparisons were made for SBP and RPE response, and the frequency of exercise SBP response _> 200 mmHg was investigated. No significant differences were observed in either SBP or RPE response between groups during the submaximal treadmill trials. In addition, none of the subjects from either group achieved a SBP ? 200 mmHg. While this study indicates that exercise at 65% of functional capacity is safe for this particular group of subjects with NIDDM, additional research is warranted to investigate cardiovascular response to exercise in a broader subject pool representative of the entire NIDDM population. / School of Physical Education

The use of Rate of Perceived Exertion (RPE) by those with Diabetes Mellitus participating in physical activity has not been clearly addressed. The American College of Sports Medicine has suggested that RPE may be used with diseased populations, including those with Non-insulin Dependent Diabetes Mellitus (NIDDM), but no specific guidelines for RPE use have been established for this population. The purpose of this study was to compare the RPE during graded exercise for the individuals with NIDDM and apparently healthy individuals. Specific comparisons of the RPE at the ventilatory threshold and at 60% and 80% of maximal oxygen uptake were made.Seven subjects with NIDDM were paired with seven apparently healthy CONTROLS of similar age, weight, and gender. All subjects performed a maximal graded exercise test (GXT) on a motor driven treadmill per Bruce Ramp protocol. Rate of perceived exertion was taken every minute using Borg's 6-20 point scale (Borg 1973). All subjects were given the same instructions for use of the RPE scale and were queried by the same technician. An analysis of variance was performed with a significance level set of ps0.05. Statistical analysis revealed no significant differences between the two groups for all demographic variables measured including age, weight, height, body mass index (BMI) and percent body fat. No significant difference was seen for maximal exercise data including RER, RPE, V02, and heart rate. Maximal V02 was 31.1 ± 8.2 ml•kg-lmin-l SD for the NIDDM group and 38.7 ± 11.6 for the CONTROL group when expressed in weight relative terms. Maximal heart rates for the NIDDM and CONTROL groups were 176.9 ± 17.9 bpm and 176.4 ± 8.8 bpm respectively. Ventilatory threshold (VT), heart rate at VT and percentage of VO2 at which VT occurred were not significantly different between groups.No statistically significant differences were seen between the NIDDM or the CONTROL group for RPE at the selected intensities. RPE at the VT was 13.0 ± 3.6 and 12.3 ± 1.8 for the NIDDM and CONTROL groups respectively. RPE at 60% of functional capacity was 13.3 ± 3.5 for the NIDDM group and 12.0 ± 1.7 for the CONTROL group. Likewise, no statistical difference was seen at 80% of functional capacity. The NIDDM group RPE was 16.1 ± 2.5 and the CONTROL group rating was 15.9 ± 2.0, respectively. Under the terms of this study those individuals with NIDDM perceived exertion similarly to the CONTROL group. / School of Physical Education

The focus of this qualitative phenomenological research study was the lived experience of married couples between the ages of 60 and 70, one of whom has type 2 diabetes. The author sought to discover additional meanings concerning the experience of diabetic education, adherence to medications plans, modifications in lifestyle, and the role of the non-diabetic spouse in the experience. Participants were six married couples between the ages of 60 and 70. Three wives and three husbands had been diagnosed with type 2 diabetes. Two one hour interviews were conducted with each couple, both spouses present. Each couple was asked the question "Tell me what it is like living with diabetes." Interviews were audio taped and transcribed by the researcher. Informant volunteers were identified using the snowball method of sampling. The author identified the two domains of experience with the health care system and experience with the spouse..Themes of the first domain were identified as relationship with health care provider and education of patient and spouse at time of diagnosis. Themes in the second domain were spousal support, perceived compliance, and perceived risk of complications. Implications for adult education and advanced nursing practice include the importance of including the non-diabetic spouse in the education and treatment plan at time of diagnosis and offering a clear explanation of the relationship between adherence and long term complications of the disease. Suggestions for further research include investigation of the self reporting of behavior modification and outcomes of adherence, the effectiveness of provider interventions in monitoring behavioral changes, and to study women with diabetes married to men without diabetes. / Department of Educational Studies

Studies show that vasomotor and sudomotor activity is compromised in individuals with Type 1 Diabetes (T1DM) which could lead to altered thermoregulatory function. However, recent work suggests that the impairments may only be evidenced beyond a certain level of heat stress. We therefore examined T1DM-related differences in heat loss responses of sweating and skin blood flow (SkBF) during exercise performed at progressive increases in the requirement for heat loss. Participants were matched for age, sex, body surface area and fitness cycled at fixed rates of metabolic heat production of 200, 250, and 300 W•m-2 of body surface area, each rate being performed sequentially for 30 min. Local sweat rate (LSR), sweat gland activation (SGA), and sweat gland output (SGO) were measured on the upper back, chest and forearm while SkBF (laser-Doppler) was measured on the forearm and upper back only. We found that despite a similar requirement for heat loss, LSR was lower in T1DM on the chest and forearm only, relative to Control and only different at the end of the second and third exercise periods. Differences in chest LSR were due to reduced SGA whereas the decreased forearm LSR was the result of a decrease in SGO. SkBF did not differ between groups. The reduction in the sweating response in the T1DM group was paralleled by a greater increase in core temperature. We show that T1DM impairs heat dissipation as evidenced by reductions in LSR and not SkBF. A compromised thermoregulatory response during and following physical exertion is of considerable concern due to the associated increased risk of post-exertion heat-related injury.

The potential effects of nutritional support with amino acids or dextrose and epidural blockade on the catabolic response to surgery were investigated in diabetic patients undergoing colorectal surgery. Protein and glucose metabolism were assessed with a stable isotope infusion technique using the two stable isotopes L-[1-13C]leucine and [6,6-2H2 ]glucose. / 1. The first intervention of a postoperative infusion of amino acids avoided pronounced hyperglycaemia in diabetic patients after colorectal surgery and achieved a positive protein balance compared to dextrose. / 2. The second intervention of a short term infusion of amino acids postoperatively blunted protein breakdown and stimulated protein synthesis. This resulted in a positive protein balance in patients with epidural blockade compared to patient controlled analgesia with intravenous morphine. With regard to glucose metabolism, amino acid supply after surgery decreased glucose clearance and endogenous glucose production independent from type of analgesia.

Peptide YY (PYY) is a gut-derived hormone that is renowned for its effects on satiety. Reduced satiety in obese people has been attributed to low fasting and postprandial PYY levels. However, it has not been determined whether low PYY levels are the cause or the outcome of obesity. Moreover, the long-term role of PYY in regulating energy balance is unclear. Results presented in this thesis, using PYY-deficient mice (PYY-/-) and PYY transgenic mice (PYYtg) highlight that PYY indeed has an important role in regulating energy balance and glucose homeostasis in vivo. PYY knockout mice became obese with ageing or high-fat feeding linked to a hyperinsulinemic phenotype associated with hypersecretion of insulin from isolated pancreatic islets. These findings suggested that PYY deficiency may be a predisposing factor for the development of obesity and type 2 diabetes. On the other hand, PYYtg mice exhibited decreased adiposity and increased metabolism under high-fat feeding. Furthermore, PYYtg/ob mice had improved glucose tolerance and decreased adiposity. These latter studies suggested that high circulating PYY levels may protect against the development of obesity and type 2 diabetes. Interestingly, both animal models support PYY as an important regulator of the somatotropic axis. These preliminary findings prompted investigations in understanding whether low PYY levels may be a predisposing factor for the development of obesity and type 2 diabetes in human subjects. In a population of healthy human subjects that had a predisposition to the development of type 2 diabetes and obesity, fasting PYY levels were lower than in normal subjects. Moreover, low fasting PYY levels strongly correlated with decreased insulin sensitivity and high levels of fasting insulin. Collectively, these findings suggest that low circulating levels of PYY could contribute to increased adiposity, insulin resistance and type 2 diabetes. Therefore determination of PYY levels may be a method of detecting whether people are predisposed to becoming obese and insulin resistant. This work also suggests that treatments that enhance circulating PYY levels may be protective in the development of obesity and type 2 diabetes.