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Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Monika Dobrovodová Supervisor of master thesis: PharmDr. Miroslav Kovařík, Ph.D. Advisor of master thesis: prof. MUDr. Karel Martiník, DrSc. Title of master thesis: Relation among BMI, hyperinsulinemia and selected biochemical indicators This thesis is focussed on specification of relations among BMI, insulinemia, age of the patients, C-peptid blood levels and glycemia and also searching relations among selected parameters of lipid spectrum in group of selected patients. Measuring of body height and weight and investigation of fasting glycemia, insulinemia, total cholesterolemia, blood levels of HDL and LDL and also C-peptid were done at 3472 patients. Afterwards few basic indexes of insulin resistance and sensitivity were counted. In this group was proven, that fasting insulinemia and C-peptid levels are increasing in according to increasing BMI. Also fasting glycemia is increasing modestly. Insulin resistance and sensitivity indexes used in this theses depends on BMI. Although statistically significant differences between age groups were proven according to insulin resistance and sensitivity indexes, we can't see clearly increasing or decreasing tendency in according to...

It is not always easy to classify diabetes (DM) diagnosed in adults, with a significant group of patients initially classified and treated for type 2 diabetes mellitus (DM2T) presenting signs indicating the presence of autoimmune insulitis (AI), which is characteristic of type 1 diabetes mellitus (DM1T), or latent autoimmune diabetes mellitus in adults (LADA).Identify the proportion of patients entered with DM2T who present AI signs, and the number of patients of that proportion, who at the same time present low insulin secretion, and what clinical and laboratory manifestations could be used to differentiate between these patients.Cohort and methods: A randomized clinical trial with a pre-determined set of assessed parameters for n = 625 patients, who were hospitalized during the first 6 months of 2016 at the National Endocrinology and Diabetology Institute (NEDU), Lubochna. Apart from the standard parameters, C-peptide (CP) and autoantibodies to glutamic acid decarboxylase (GADA) were examined for each patient. GADA positive (GADA+) patients were compared to GADA negative (GADA-) patients in the following parameters: gender, age, age at the time of dia-gnosing DM, duration of DM, HbA1c, incidence of hypoglycemia, lipidogram, fasting C-peptide levels, BMI, waist circumference, incidence of hypoglycemias, presence of microvascular and macrovascular complications, treatment of dia-betes and incidence of other endocrinopathies. GADA+ with low CP were subsequently compared to GADA+ patients with normal CP.Of 625 patients originally classified and treated as DM2T, 13 % were GADA+. 31 % of them had low CP (0.2 nmol/l) and 28 % had CP levels within the intermediary range (0.2-0.4 nmol/l). Females made up a larger proportion of GADA+ patients, with a lower BMI, smaller waist circumference, lower CP, higher HDL cholesterol levels, a greater incidence of hypoglycemias and lower total daily dose of insulin. GADA+ patients with low CP differed from GADA+ patients with normal CP in higher HDL cholesterol levels, lower triglyceride levels and earlier need of insulin thera-py. The testing for GADA and CP levels with regard to the other relevant characteristics led to re-classification, or more precisely adding of DM1T/LADA (as the main, or parallel cause of DM) for 2.9 % of all the patients included and a clinically significant proportion of AI could be assumed in 6.1 % of the patients.The results of our study show that the pathogenesis of DM in patients initially diagnosed and registered with DM2T and with concurrent presence of GADA includes mechanisms characteristic of both DM2T (insulin resistance) and DM1T (autoimmune insulitis) acting in parallel, with different intensity, in differing proportions and time sequence as a fluid continuum, which also accounts for the differences between individual patients. The characteristics highlighting the presence and role of AI based on our results include high titre of GADA+, low CP levels, early need of insulin therapy, presence of thyroid disorder, higher HDL cholesterol levels and lower triglyceride levels. The characteristics highlighting the dominance of mechanisms characteristic of DM2T (insulin resistance) included higher BMI and waist circumference values, normal CP levels, low HDL cholesterol levels, higher triglyceride levels, higher blood pressure and borderline titre of GADA.autoimmune diabetes mellitus - C-peptide - GADA - HDL-cholesterol - classification.

To determine basic anthropometric characteristics and their relationship with the metabolism of saccharides in women with PCOS in the Olomouc region.Retrospective study of the results of 72 women with PCOS examined in the endocrinology clinic.The study entailed the processing of data gained on the basis of examination of women sent to endocrinology clinic for examination in the years 2008-2010, who corresponded to the diagnostic criteria for PCOS according to the Rotterdam consensus. The obtained results of anthropometric measurement and characteristic saccharide metabolism were compared with a group of healthy women.In groups of women of comparable age (PCOS average age 31.6, control group average age 31.4) the average BMI in women with PCOS was 26.76 kg m(-2), the average waist measurement was 84.43 cm, the waist/hips ratio was 0.79, in the control group the average BMI was 24.73 kg m(-2), the waist/hips ratio was 0.76, the differences between the two groups were not statistically significant. There was a statistically significant difference between women with PCOS and the healthy control group in C peptide values, even in comparable anthropometric parameters. Levels of fasting glycaemia and glycated haemoglobin were comparable. Waist measurement, as a parameter for evaluating the level of visceral accumulation of fat in women with PCOS, was related to all monitored characteristics of saccharide metabolism (statistically significant correlation with fasting glycaemia, glycated haemoglobin and C peptide). Unlike the waist measurement, the waist/hips ratio indicated a smaller percentage of women with abnormal obesity in both groups, in women with PCOS it correlated with fasting glycaemia and C peptide.On the basis of our results it can be stated that women with PCOS do not necessarily differ from the healthy control group in anthropometric parameters. However, with comparable age, BMI and level of visceral obesity, women with PCOS require a greater amount of insulin to maintain normoglycaemia than healthy women.

Diabetes mellitus (DM) as part of chronic pancreatitis (ChP) belongs into the group of secondary DM with typical insulin deficiency. The prevalence and incidence of DM in ChP depends on the selected diagnostic criteria, geographical conditions and duration and grade of pancreatitis. Based on our findings during a 15-year investigation of impaired glucose tolerance and insulin secretion in patients with ChP the authors submit some partial (published and unpublished) results. The largest investigated group were 122 patients with ChP diagnosed according to the morphological appearance during ERCP. The authors detected a mutual close relationship between the extent of morphological damage of the efferent system of the pancreas on one hand and impaired glucose metabolism and endogenous insulin secretion on the other hand. It was revealed that values of C-peptide are in patients with ChP and normal glucose tolerance significantly lower as compared with the healthy population, and in patients with ChP and DM they are significantly lower as compared with non-obese type 2 diabetics. With the persistence of ChP the C-peptide levels decline gradually and the incidence of diabetes increases but even when DM persists in ChP C-peptide does not reach zero values as in type 1 DM. For detection of diabetes in ChP assessment of the fasting blood sugar level does not suffice and an oral glucose tolerance test must be made.

Thiazolidindione derivates (glitazones) make a very promising group of peroral antidiabetic drugs. They are represented by rosiglitazon which is available on our market to type II diabetics. As far as sugar metabolism is concerned, rosiglitazon can reduce glycaemia and insulin level both when fasting and postprandially.The goal of the authors' work was to gain their own experience with rosiglitazon treatment in type II diabetics in the Czech Republic.The monitored sample consisted of 388 patients with insufficiently compensated type II diabetes when treated by sulphonylurea compounds or metformine.95 diabetologists from diabetology medical offices started a 6-month-long treatment with rosiglitazon (Avandia) dose of 4 mg a day as stated in European recommendations. In order to assess changes in sugar metabolism (compensation of diabetes) glycaemia and C peptide were monitored when fasting and postpradially and HbA1c was monitored in 2-month-long intervals.Weight, waist-hip ratio (WHR) and C-peptide levels remained unchanged. Statistically significant (p0.0001) was a HbA1c decrease over 6 month from 9.61% to 8.48%. Fasting glycaemia decreased by 2.49 and postprandial glycaemia by 2.71 mmol/l. No significant side effects were identified.Rosiglitazon administration combined with administration of sulphonylurea compounds or metformine significantly improved compensation of diabetes compared to initial therapy.

Patients with cirrhosis of the liver suffer from hyperinsulinaemia and a certain degree of insulin resistance. More frequently than in the rest of the population they have diabetes. Transjugular intrahepatic portosystemic shunts (TIPS) as a therapeutic method in complications of portal hypertension lead to rapid haemodynamic changes in the liver. The objective of the submitted work was to assess whether TIPS has an impact on insulinaemia and whether it influences insulin resistance in patients with cirrhosis of the liver.The authors evaluated a group of 22 patients with cirrhosis of the liver (10 diabetics and 12 subjects without diabetes) indicated for TIPS. They investigated the insulin and C-peptide concentration in blood obtained by catheterization from the hepatic and portal vein before and after TIPS and in the peripheral blood before TIPS, 1 hour, 1 day, 1 week and 1 month after TIPS. The insulin resistance was examined by the method of the hyperinsulin euglycaemic clamp (HEC) before TIPS, 1 day, 1 week, and 1 month after TIPS. The levels of C-peptide and insulin were assessed by the IRMA method. The blood sugar level in HEC was measured by means of a Hemocue apparatus. The results were evaluated by the non-parametric Wilcoxon test for two dependent samples.Both groups (diabetics and non-diabetics) were comparable as to age, sex, etiology of liver cirrhosis and indication for TIPS. After introduction of TIPS a change of insulin clearance occurred (p = 0.01) and a change of the insulin level in the hepatic vein immediately after TIPS (p = 0.02). Insulin clearance before TIPS was 37-90% (median 54%) and after TIPS it declined to 0-79% (median 38%) (p = 0.01). Already 1 hour after the operation the authors observed a rise of the insulin level in peripheral blood as compared with baseline values (p = 0.002). Statistically significant hyperinsulinaemia persisted one month after TIPS (p = 0.005). Values of C-peptide did not change significantly in time, neither in the hepatic vein nor in the peripheral blood. On examination of IR no statistically significant changes occurred after TIPS. On evaluation of different groups of diabetics and non-diabetics the IR was more marked in patients with DM (mean M = 1.7 mg/kg/min.) than in patients without DM (3.7 mg/kg/min.) (p = 0.03). The authors did not record significant changes of IR in time in different groups. Compensation of DM was not influenced by TIPS. The fasting blood sugar levels before TIPS and 1 month after TIPS were comparable.After TIPS a rise of the insulin level in peripheral blood occurred due to the reduced insulin clearance in the liver. Despite hyperinsulinaemia which persisted for one month after the operation, the insulin resistance did not deteriorate. Compensation of diabetes was not affected by TIPS.

The main objective was to seek, based on defined groups of diabetics, C-peptide levels on fasting and after stimulation which would help to differentiate diabetes mellitus type 1 from diabetes mellitus type 2 in patients with manifestation of diabetes in adult age. GROUPS: Group A comprised 65 non-obese diabetics type 2 with failure of PAD treatment. Group B included 304 newly manifested diabetics type 1 and 2 aged 31-65 years. Group C was formed by 424 patients with diabetes mellitus type 1 and type 2 with different duration of diabetes.Group A: mean C-peptide levels on fasting 0.32 and after stimulation with a standard breakfast 0.59 pmol/ml suggest absolute insulin deficiency in type 2 diabetics with failure of PAD treatment. Group B: 29.2% diabetics type 1 had already during manifestation of diabetes C-peptide levels on fasting0.43 pmol/ml and 47.9% C-peptide of0.6 after a meal. There were 1.9 and 4.9% subjects among type 2 diabetics with such low C-peptide levels. After a six-year follow up the mean C-peptide levels on fasting declined in type 1 diabetics from 0.49 to 0.16 pmol/ml and in patients originally with type 2 diabetes reclassified to type 1 the levels dropped from 0.56 to 0.26 pmol/ml. Group C served as the basic group for statistically (linear regression method) detected discrimination values of C-peptide differentiating diabetes mellitus type 1 and diabetes mellitus type 2--the liminal value being 0.59 pmol/ml on fasting and 1.0 pmol/ml after a meal.In clinical practice it is not possible to assess reliably slowly manifesting diabetes type 1 (LADA by age, BMI and compensation of diabetes. Positivity of antiGAD antibodies does not rule out diabetes mellitus type 1. In unequivocal cases the decisive factor is therefore the C-peptide level on fasting and after a meal.

Iron is an important factor in the process of oxidation stress and atherogenesis which is as a rule potentiated in subjects with the insulin resistance syndrome. Hypertension is one of the main components of this syndrome. Ferritin due to its relationship with impaired insulin sensitivity becomes a candidate for a new indicator of insulin resistance. The subject of the present study was to assess whether we shall find in young healthy offspring of hypertensive parents changes in the ferritin level, oxidizability of LDL and whether these are related to parameters of glucose tolerance, insulin secretion and sensitivity. Twelve young (27 +/- 3.6 years) non-obese, normotesive offspring of hypertensive parents were compared with a group of 14 controls. Glucose tolerance, insulin secretion and sensitivity were examined by means of a hyperglycaemic clamp and oGTT. As to the ferritin level, the offspring of hypertensive parents did not differ significantly from controls, differences were not fond in the oxidizability of LDL-C. The glucose tolerance was comparable in the two groups. Offspring of hypertensive parents had however a significantly higher insulin and C peptide level when using the clamp and during the glucose tolerance test (p0.05), and a reduced insulin sensitivity (p0.05). The negative correlation between the index of insulin sensitivity and ferritin suggests that ferritin could be associated with the syndrome of insulin resistance.

While the effect of neurohormones is often studied in congestive heart failure, their role in aortic stenosis needs to be elucidated.54 consecutive patients with symptomatic aortic stenosis without overt heart failure were studied at the age of 64.4 +/- 9.3 yrs with echocardiography, x-ray and catheterization. Levels of circulating atrial natriuretic factor endothelin-1, catecholamines, plasma renin activity, immunoreactive insulin and C-peptide were assessed, related to hemodynamic data and compared to those in 23 healthy controls, aged 59.2 +/- 12.8 yrs.Patients had significantly higher plasma levels of endothelin-1 (z-value 0.64 +/- 1.19, p = 0.019), atrial natriuretic factor (z-value 2.46 +/- 2.46, p0.001) and dopamine (z-value 0.91 +/- 2.33, p = 0.02). Levels of endothelin-1 and ANF positively correlated with mean (r = 0.631, p0.001) and wedged pulmonary artery pressures and with left atrial diameter index (r = 0.602, p0.001). Endothelin-1 levels correlated negatively with aortic valve area (r = -0.306, p = 0.041). No correlation was found between neurohumoral plasma concentrations and left ventricular mass index.In patients with symptomatic aortic stenosis without overt heart failure, elevated plasmatic levels of endothelin-1, atrial natriuretic factor and dopamine were documented. The increase of ET-1 levels is related to pulmonary hypertension and severity of the disease. Left ventricular hypertrophy is not related to neurohormonal levels. Neither circulating system renin-angiotensin nor noradrenaline are activated in these patients.

The objective of the presented work was to evaluate the short-term administration of octreotide on the development, onset and persistence of remission in recent insulin-dependent diabetics. The importance of remission means for the patient a clinically favourable condition with satisfactory metabolic compensation and a greater metabolic stability during the subsequent course of the disease. The period of remission is important from the aspect of prevention of late organ complications. Two-week treatment with octreotide, 150 micrograms/day, administered during the first month after establishment of the diagnosis was not associated with serious undesirable effects. Treatment with octreotide led to more frequent development of remission, partial and complete, as compared with a control group. In the majority of diabetics in the intervened group remission started immediately after administration of octreotide. The serum value of peptide-C as part of the glucagon test made at the time of diagnosis had a predictive value for the development of induced and spontaneous remission. Octreotide administration increased the probable development of remission even in patients with a substantially lower peptide C value at the time of diagnosis as compared with controls. The preliminary results indicate also a protraction of the remission period.

In 18 patients with pernicious anaemia (PA) the authors assessed the blood glucose level, C-peptide level and immunoreactive insulin (IRI) during the oral glucose tolerance test (o-GTT). They calculated the body mass index (BMI), assessed the level of the thyroid-stimulating hormone (s-TSH), free thyroxine (fT4), triiodothyronine (T3) and took repeatedly blood pressure readings. In one female patient they confirmed the diagnosis of insulin dependent diabetes mellitus (IDDM), in another six subjects they detected non-insulin dependent diabetes mellitus (NIDDM), incl. two persons where it was detected newly. In four patients impaired glucose tolerance was revealed. In the remaining seven patients non-classifiable glucose tolerance was found, none of the patients had a quite normal o-GTT. In five patients, hitherto not diagnosed latent hypothyroidism was detected. Eleven subjects were obese, four patients suffered from hypertension, another six from systolic hypertension, in eight patients a significantly elevated C-peptide level on fasting was found, in the majority of patients an elevated, or protracted response of C-peptide and insulin to orally administered glucose was found. Patients with pernicious anaemia must be considered subjects with cumulation of risk factors for atherosclerosis; these risk factors must be actively sought and treated.

Increased glucose release from the liver which is responsible to a considerable extent for fasting hyperglycaemia in type 2 diabetics is associated with hepatic insulin resistance. Assessment of insulin extraction in the liver can therefore be useful in investigations of all pathophysiological conditions with deviations of glucose tolerance, or in the course of insulin secretion. The control group was formed by 8 healthy men, mean age 43.6 +/- 5.9 years, mean BMI 24.7 +/- 2.8. The authors examined also a group of 7 men with diabetes mellitus type II, mean age 46.7 +/- 5.9 years, BMI 31.4 +/- 8.9 and 6 men with hypertriacylglycerolaemia, mean age 44.2 +/- 3.1 years and mean BMI 26.2 +/- 1.4. All were examined by the intravenous glucose tolerance test with frequent blood sampling. In every sample the blood sugar level, insulin level and C-peptide level were assessed. The data were evaluated and the "hepatic insulin extraction index" was thus obtained. The "hepatic insulin extraction index" was significantly lower in type 2 diabetics throughout the experimental period (0-180 min.) as well as during individual intervals evaluated (0-20 min. and 20-180 min.). In subjects with hypertriacylglycerolaemia this index was lower only during the 0-20 min. interval. Changes of the "hepatic insulin extraction index" in patients with hypertriacylglycerolaemia do not reach the intensity recorded in diabetics and may thus indicate a milder grade of hepatic insulin resistance.

Hyperinsulinaemia and insulin resistance are associated with essential hypertension irrespective of obesity and non-insulin-dependent diabetes mellitus. One of the mechanisms whereby hyperinsulinaemia may play a role in the increase in blood pressure, is an increased activity of the sympathetic nervous system. The authors studied the incidence of hyperinsulinaemia, and the possibility of modulating it by 12-week administration of the ACE inhibitor (ACEI) lisinopril (Prinivil by MSD) at a dose of 20-40 mg/day. Compared with normotensive subjects, hypertensives showed a degree of hyperinsulinaemia and insulin resistance (higher blood glucose at higher immunoreactive insulin and C-peptide concentrations, and a higher IRI/blood glucose ratio) as well as manifestations of enhanced sympathetic activity (higher adrenaline levels). Lisinopril had a favourable effect not only on blood pressure but, also, on hyperinsulinaemia and adrenaline levels. It can be reasonably concluded that therapy with ACEI, in addition to its antihypertensive effect, may also favourably modulate some pathogenic and metabolic factors in essential hypertension.

The authors analyzed in 145 patients with Type 2, diabetes, persisting on average for 10 years, influences affecting the blood pressure reading. 1. In patients treated on account of hypertension (40%) the increase of systolic and diastolic pressure persisted and the fasting concentrations of C peptide were elevated. 2. In patients with elevated levels of diastolic blood pressure and C peptide the rate of cerebrovascular attacks in direct relatives was higher. 3. Higher blood pressure readings were associated with a higher C peptide concentration, signs of ischaemia on the ECG tracing and left ventricular hypertrophy respectively. 4. The higher blood pressure levels were associated also with other manifestations of insulin resistance, i.e. elevated triacylglycerols, low HDL cholesterol levels, raised uric acid levels. 5. Also in stepwise regression analysis the fasting concentration of C peptide held one of the important places among variables which contribute towards variations of systolic blood pressure. 6. These findings support the idea on common pathogenic influences of raised insulin concentrations on metabolism, blood pressure and the development of complications of atherosclerosis.

Intensive insulin treatment in a recent stage of IDDM promotes metabolic compensation of the disease regardless which regime of conventional or unconventional treatment is used. In thus treated patients more frequently complete or partial metabolic remission is achieved. C-peptide in patients in remission is much higher than in other patients, and conversely there are fewer persons without residual B-cell secretion. The manifestation of diabetes has an impact also on the clinical course of the disease. Normoglycaemia with possible metabolic remission associated with easy insulin administration a flexible lifestyle have a favourable effect on the onset of the life-long disease and eliminate to a minimum factors which have a negative psychosomatic impact on the patient.

The concentration of C peptide which is an indicator of the secretory capacity of the beta-cells of the pancreas was assessed in 109 patients with type II diabetes, hospitalized on account of prolonged difficulties as regards compensation. The values on fasting, the maximal values after stimulation following an experimental meal and increments were greater than in age- and weight-matched controls. In diabetic patients some highly significant relationships were revealed between the C peptide concentration on fasting and indicators of the risk of ischaemic heart disease [IHD]. They included HDL cholesterol, the body mass index and uric acid. The relationship between the maximal C peptide concentration and serum sodium may be associated with a greater disposition for hypertension. Thirty-one patients with symptoms of an ischaemic myocardial lesion had a significantly elevated C peptide concentration on fasting. The increments of C peptide concentration after an alimentary stimulus correlated indirectly with indicators of the actual and long-term compensation of diabetes. In relation to the reduced increments also the need of insulin therapy was reflected. Data obtained by examination of the C peptide concentration in the blood of type II diabetics can contribute to the objectivization of needs of insulin treatment and to the detection of the link between cardiovascular risk and hyperinulinaemia.

Based on an analysis of data obtained in a group of 145 men and women with type 2 diabetes perssiting for 10.1 +/- 6.6 years who were hospitalized on account of unsatisfactory compensation of diabetes, the authors provided evidence that the fasting blood sugar level is associated with a reduced response of C peptide to an alimentary stimulus, while the excessive weight of the patients has a bearing on the elevated concentration of C peptide on fasting and causes their insulin resistance. The body weight has a bearing on the level of risk factors, i.e. HDL cholesterol, uric acid and in women also triacylglycerols. The elevated blood sugar level influences in a mirror image manner the sodium and potassium level. The relations between the blood sugar level and glomerular filtration draw attention to the interference with the water economy even at blood sugar levels which are still tolerated. The trend of rising potassium levels must be foreseen in case of a poor compensation even in case of insulin treatment of diabetes. The risk of elevated potassium should be taken into account also with regard to indications of antihypertensive treatment. The authors also draw attention to the need of acloser compensation of type 2 diabetes. Early adjustment of the energy metabolism in diabetics deserves priority. When insulin treatment is needed, the all-day requirement should be met by 2-3 doses.

The authors investigated in 28 type 2 diabetics the effect of addition of 21 g Sinecal fibre to the normal diet on the glucose and lipid metabolism. The value of C,peptide was significantly influenced after breakfast and a single dose of Sinecal. The other investigated parameters (blood sugar on fasting and after a meal, glycosuria, glycosylated proteins, C-peptide on fasting and after a meal, triacylglycerol and cholesterol) were not influenced by a single nor by long-term intake of Sinecal. Further development of fibre preparations with better tolerance and a greater effect on the glucose metabolism is desirable.

Authors examined levels of glucose, insulin, and C-peptide in the plasma of 6 infants and small children with the isolated transposition of the great arteries (3 pts) and ventricular septal defect (3 pts) in the course of open-heart surgery in deep hypothermia. The mean age of the patients was 7.2 months (6 to 15) and weight 5.6 kg (5.2-7.5). Exogenous intake of glucose during the operation was excluded. Methods of anaesthesia, operation technique, and conduction of extracorporeal circulation (ECC) were constant in all patients. Fresh ACD blood diluted with Hartman solution approximately 1:1 was used for the prime of ECC circuit (content 800 ml) to get the hematocrit 0.27 +/- 0.2 after mixing the prime with the patient's blood volume. Glycemia was determined by Beckman ERA 2001 analyzor, and levels of insulin and C-peptide by radioimmunoassay kits MJ-96 (Poland) and Novo (Denmark). Significant hyperglycemia was found in all patients during the period of hypothermia, and was overlasting to the rewarming period until the end of the operation and 1 hour postoperatively. Then level of glycemia was decreasing to the normal values which were found in the last sample (17 hours post-op). The raise of glycemia was not a stimulus to the proportional increase of insulin and C-peptide levels in plasma. It proved transitional suppress of insulin secretion in the beta cells of the pancreas in the cooling period. Levels of insulin and C-peptide significantly and concordantly increased after 20 min. of rewarming (r = 0.83). However, hyperglycemia overlasted during the course of rewarming, too.(ABSTRACT TRUNCATED AT 250 WORDS)