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A proportion of individuals with type 1 diabetes mellitus for more than 50 years (medallists) may be protected from developing nephropathy, retinopathy and neuropathy. Detailed neuropathy phenotyping was undertaken in a cohort of 33 medallists aged 63.7 ± 1.4 years with diabetes for 58.5 ± 0.8 years and HbA1c of 65.9 ± 2.1 mmol/mmol. Medallists had a significantly higher HbA1c (P

Impaired awareness of hypoglycaemia (IAH) affects around a quarter of patients with diabetes who receive insulin treatment. This condition is characterised by a progressive reduction in symptomatic and behavioural responses to hypoglycaemia, increasing risk of deeper drops in blood glucose, unconsciousness, and collapse. Thus, patients with IAH experience severe hypoglycaemic episodes more frequently, resulting in significant morbidity and mortality. IAH is thought to develop as a consequence of whole-body adaptations to repeated insulin-induced hypoglycaemia (RH), with widespread deficits in the hypoglycaemia counter-regulatory response (CRR). Despite this important insight, the precise pathophysiology by which RH leads to an attenuated CRR is unknown. Studies into the underlying mechanisms of IAH have employed a variety of protocols in humans and experimental species. The use of animal models has many investigational benefits, including the unprecedented increase in the availability of transgenic strains. However, modelling impaired hypoglycaemia-associated counter-regulation remains challenging and appropriate interpretation of findings across species and protocols even more so. Here, we review the experimental modelling of IAH and impaired hypoglycaemia-associated counter-regulation, with a focus on understanding species-specific variation in glucose homeostasis. This review will aid investigators in interpreting outputs from different studies in IAH and aid progress in the field.

Water lettuce (Pistia stratiotes) was used in the study to extract cellulose biopolymer. Cellulose extraction was carried out by alkali treatment followed by bleaching. Different methods for extraction of cellulose were carried out and the method which gave high yield was selected. Functional properties like bulk density, packed density, hydrated density, water retention capacity, oil retention capacity, emulsifying activity and setting volume of the extracted cellulose were studied. Quantitative analysis of cellulose was carried out by the anthrone method and the cellulose content was found to be 38.94 ± 0.10%. Preliminary confirmation of cellulose biopolymer was done using the study of functional groups using FT-IR analysis. Further characterization studies like SEM, XRD, DSC and TGA were done to understand the molecular architecture and purity of cellulose extracted. Fabrication of cellulose sheets were carried out using starch as plasticizer. Biodegradation studies were carried out in garden soil for four weeks and a high degradation rate of 78.22 ± 0.71% was observed in the fourth week of soil burial.

Production of polyhydroxyalkanoate (PHA) using commercially available carbon sources like glucose or sucrose makes the bioprocess economically nonviable, thereby hindering its commercialization. As an alternative to this issue, inexpensive and easily available agro-industrial wastes are now being exploited as feedstock for PHA production. Fruit wastes are generally discarded as they are considered to be the non-product leftovers which do not have any economic value when compared with the cost of their collection and recovery steps for reuse. But through the use of appropriate technological applications, these wastes can be converted to valuable by-products, which can increase the value of the products much higher than the cost associated with recovery steps. By recycling and reprocessing the fruit wastes, they can be channeled into many applications, and thereby the amount of fruit wastes discharged into the environment can be completely reduced along with their detrimental effects. Large amounts of fruit wastes are produced by fruit-based industries. The waste products can be both solids and liquids, and these wastes are of high nutritional and biomass values for microorganism; thus their addition to waterbodies can make them highly polluted (high BOD or COD). These fruit-based wastes still have a promising potential for bioconversion into products of commercial importance or can be successfully exploited as cheap raw materials for industrial production of commercially important metabolites. This chapter deals with the strategies for production of PHA from fruit waste substrates, extraction and characterization of PHA, and their applications in diverse sectors.

The advent of the industrial revolution and intensified agricultural practices have posed irreversible impairment in the soil by accumulating various xenobiotic compounds. Soil, being a core constituent of Earth, not only supports plant growth but also acts as a water filter, buffering pollutants and conserving myriad microorganisms. Untreated industrial effluents, dumping of plastics, and overuse of pesticides are some of the major contaminants enrooted for soil pollution causing severe threats to living beings and the biosphere. Bioremediation using microbes has been recommended as a safe and viable method for the soil fertility restoration due to their adaptive nature modulated by the environment. Among the microbes, Bacillus sp is considered as an effective bioremediating agent as they are the warehouse of copious enzymes, eco-friendly products, and plant growth-promoting metabolites that play a key role in agriculture, textile, food, leather, and beverage industries and thereby ensure soil sustainability.

Introduction: Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed Anti-hypertensives which are first line treatments in patients with Diabetes. We report a rare but significant side-effect of ACE inhibitor treatment, relevant to Diabetic and non-diabetic patients alike. Case Details: We report the case of a 79 year male, with a background of Hypertension (HTN), established on Ramipril and Bendroflumethiazide, who was admitted following an episode of unresponsiveness secondary to Hypoglycaemia, which was initially presumed secondary to Alcohol, the intake of which was minimal. He did not have a history of Diabetes Mellitus. 7 weeks later, he had a similar presentation and as found to be profoundly Hypoglycaemic. On arrival, his observations were unremarkable except for CBG 1.9 and GCS of 14/15, which responded well to IM glucagon, and IV Dextrose. Relevant investigations revealed significantly impaired renal functions and normal CT imaging. There was no history of alcohol intake or intoxication. Management: Following acute management and stabilisation, he was admitted under the Endocrine and Diabetes team, who suspended his regular medications, including his ACE-I. As an inpatient, he underwent extensive biochemical investigations which were unremarkable followed by a prolonged 72 hours fasting test and an Oral Glucose Tolerance Test, wherein no significant drop in Blood Glucose was noted in both. Subsequently, there were no further episodes of hypoglycaemia and he remained asymptomatic whilst off his ACE-I and he was safely discharged. He was followed up in our Endocrine clinic and was found to have no episodes of Hypoglycaemia since discharge and remained asymptomatic. Discussion: We report the rare presentation of recurrent hypoglycaemia in a non- diabetic secondary to ACE-I. Hypoglycaemia may be defined by the Whipple’s triad, a classical triad of hypoglycaemic symptoms, low Blood Glucose levels and relief of symptoms following ingestion of glucose. The mechanism by which ACE-I treatment leads to hypoglycaemia remains unclear. It has been postulated that ACE-I related alterations in the Kininogen-Kinin system, are associated with hypoglycaemia. This mechanism may lead to an increase in Insulin sensitivity, mediated by increased muscle tissue uptake and diminished hepatic glucose production. Another proposed mechanism is the suppressive effect that ACE-inhibitors exhibit on the peripheral sympathomimetic overactivity, thus causing Hypoglycaemia. Exacerbating factors comprise of concurrent renal impairment, as in this case. The first case of ACE-I induced Hypoglycaemia was reported in 1985, with the usage of Captopril. To the best of our knowledge, this is one of the rare peculiar cases wherein an ACE-I has been implicated as the underlying aetiology causing Hypoglycaemia in a Non-Diabetic.

Aims: To examine the contribution of demographic, social, clinical and psychological factors to emotional distress in patients with painful diabetic neuropathy (DN). Methods: In total, 142 patients with confirmed painful DN underwent detailed clinical and self-assessment measures (Neuropathic Pain Scale, Hospital Anxiety and Depression Scale, Pain Acceptance Questionnaire and Pain Catastrophizing Scale). Results: The prevalence of emotional distress was 51.4% in this cohort. Age, sex, marital status, employment history, pain intensity, duration of diabetes and the presence of diabetic and non-diabetic complications were significantly correlated to anxiety and depressive symptom scores. Multiple regression analysis confirmed that the presence of catastrophic thinking was an independent contributor to greater symptoms of anxiety and depression. Being young, single and unemployed significantly contributed to greater anxiety symptoms. Pain-related restriction of quality of life was associated with greater depression symptom scores. Conclusions: This study found a high prevalence of emotional distress in patients with painful DN. It highlights that the differing independent contributors to anxiety and depressive symptoms are based on an individual’s circumstances and experience. We conclude by highlighting the importance of adopting a holistic approach to pain management, incorporating interventions to increase psychological flexibility alongside conventional pharmacological treatments to improve emotional distress in painful DN.

OBJECTIVE Diabetic peripheral neuropathy (DPN) has hitherto been considered a disease of the peripheral nervous system only, with central nervous system (CNS) involvement largely overlooked. The aim of this study was to investigate any differences in brain structure in subjects with DPN. RESEARCH DESIGN AND METHODS Thirty-six subjects with type 1 diabetes (No DPN [n = 18], Painful DPN [n = 9], Painless DPN [n = 9]) underwent neurophysiological assessment to quantify the severity of DPN. All subjects, including 18 healthy volunteers (HVs), underwent volumetric brain magnetic resonance imaging at 3 Tesla. RESULTS Adjusted peripheral gray matter volume was statistically significantly lower in subjects with painless and painful DPN (mean 599.6 mL [SEM 9.8 mL] and 585.4 mL [10.0 mL], respectively) compared with those with No DPN (626.5 mL [5.7 mL]) and HVs (639.9 mL [7.2 mL]; ANCOVA, P = 0.001). The difference in adjusted peripheral gray matter volume between subjects with No DPN and HVs and those with Painful DPN and Painless DPN was not statistically significant (P = 0.16 and 0.30, respectively). Voxel-based morphometry analyses revealed greater localized volume loss in the primary somatosensory cortex, supramarginal gyrus, and cingulate cortex (corrected P < 0.05) in DPN subjects. CONCLUSIONS This is the first study to focus on structural changes in the brain associated with DPN. Our findings suggest increased peripheral gray matter volume loss, localized to regions involved with somatosensory perception in subjects with DPN. This may have important implications for the long-term prognosis of DPN.