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Diabetes mellitus has been reported to be associated with an increased risk for colorectal cancer. The review analyzes current epidemiological data on the association of diabetes and the risk for colorectal cancer. Hyperinsulinemia, hyperglycemia, and inflammation are suggested to play a key role in the pathophysiology of cancer in diabetes. Data regarding potential treatment-related risks, particularly in conjunction with the use of insulin and insulin analogues, are also presented. Furthermore, the impact of glycemic control and cardiorespiratory fitness on cancer prognosis is considered. Finally, the preventive potential of aspirin and other nonsteroidal anti-inflammatory drugs, and the recommendations concerning colonoscopy-screening are presented.

Intracutaneous testing was done in 85 patients with allergic reactions during insulin treatment. Six patients showed immediate reactions (type I), 76 showed allergic late reactions (type IV) and three showed combined allergy (type I/IV) to intracutaneous undiluted insulin. Whereas immediate and combined allergies were exclusively pure insulin allergies, several allergens were shown to be responsible in late reactions: nine patients had pure surfen allergy, 34 patients pure insulin allergy (against all insulins) and 11 pure bovine insulin allergy. A further 22 patients reacted to various allergens, 16 of them to surfen and all insulins, and 6 to surfen and bovine insulins. Estimation of the diameter of the erythema showed a significantly better skin tolerance of neutral than of acid insulins. Intracutaneous pig insulin led to less erythema than bovine insulin. Neutral pig insulins thus have the least antigenicity.

A woman with normal metabolism but addictive tendency injected insulin, as was proven by the presence of insulin antibodies in serum. Another woman with a normal metabolism caused hypoglycaemia by taking sulphonylurea preparations, apparently from self-destructive motives. After all laboratory and other tests had at first pointed to organic hyperinsulinism, the diagnosis of self-inflicted hypoglycaemia was finally made by demonstrating the drug in plasma. A young diabetic who required insulin caused hypoglycaemia by injecting additional insulin. The complete absence of C-peptide and especially the strict supervision confirmed the diagnosis.

The effectiveness of combined insulin and glibenclamide was compared with that of insulin alone in a multicenter double-blind trial of secondary sulphonylurea failures. Protocols of 176 patients at 26 centers were available, but only 68 could ultimately be included in the analysis. Combined insulin and glibenclamide (Euglucon N) had been taken by 37 patients, combined insulin and placebo by 31. The final criterion, postprandial one-hour blood sugar level of less than or equal to 220 mg/100 ml after 24 weeks, was attained by nearly 75% of patients in both groups. Fasting blood sugar and postprandial one-hour blood sugar as well as HbA1 did not differ during the entire test period of 24 weeks. Mean daily insulin dose was 20 IU in the insulin/glibenclamide group, 35 IU in the insulin/placebo group. This increased the number of second evening insulin injections by 50% in the insulin/placebo group compared with the insulin/glibenclamide group. The frequency of mild hypoglycemia was similar in the two groups. The results indicate that combined insulin/glibenclamide, given over a period of six months to patients with secondary sulphonylurea failure, provided metabolic results as good as those with insulin alone. The required insulin dosage was thus reduced by more than a third.

Twelve metabolically normal subjects were given 0.325 g/kg fructose or glucose dissolved in water 30 minutes after intravenous infusion of insulin, 0.05 U/kg. Blood glucose concentration was then measured for up to 60 minutes or until the onset of hypoglycaemia (study I). In study II two bread units (BU) were given to six subjects in the form of dark bread, as well as 12 g of butter and water. In two other groups, of six subjects each, 1 BU was substituted either by fructose or sorbitol. Seven subjects who had been given insulin but only water to drink afterwards served as the control group. In study I, both glucose and fructose achieved a clear slowing in the blood-sugar drop compared with the control group. But with glucose there was initially a slight rerise and the final hypoglycaemic level was somewhat delayed. This minor difference between glucose and fructose was not demonstrable in study II with the addition of fat and carbohydrate substitution. Each carbohydrate combination similarly influenced the course of blood sugar concentration. The results indicate that diabetics should continue to be given glucose rather than fructose or sorbitol if hypoglycaemia occurs. On the other hand, both fructose and sorbitol, although acutely less effective in raising blood glucose concentration, do counteract as carbohydrates the development of insulin-induced hypoglycaemia.

Type 2 diabetes and its complications must now be recognized as a large and growing health threat and a serious issue for policy consideration at the national and international level. It ranks as a leading cause of blindness, chronic kidney failure requiring dialysis and transplantation, coronary heart disease and stroke and, central to the purpose of this meeting, chronic, immobilizing foot ulceration, often culminating in lower limb amputation. In many societies, diabetes is responsible for more limb amputations than all other medical causes combined. In the present state of knowledge, much, perhaps most, of this disability should be preventable. It would be prevented were present knowledge incorporated into current health-care practice. The diabetes problem is growing and growing fast. If current trends continue, the number of people with diabetes will double by 2025 to almost 300 million globally, with most of the new burden of disease falling on the developing countries-those least well able to afford it. By 2025, about 75% of people with diabetes will live in developing countries, with Asia and Africa chief among them. Paradoxically, this is the penalty of human success. People are living longer and diabetes is largely a disease of the middle and later years of life. Improving access to food encourages increasing fat storage, a well-recognized risk factor for diabetes. Increasing aid from machines is reducing the need for the physical labor that protects from diabetes. The rising incidence of type 2 diabetes is thus an unwanted effect of modernization. The disease has emerged as a serious health problem, affecting the settled populations of the industrialized world but striking most savagely at societies undergoing rapid social, cultural, demographic, and nutritional change. Epidemic is not too strong a word to apply to the phenomenal rises in diabetes incidence seen in living experience. More than 50% of some population groups can expect to become diabetic if they enjoy reasonable life expectancies-and a lifetime risk of 10-25% is becoming common. The conquest of the infective and parasitic diseases leaves the noncommunicable disorders like diabetes, hypertension, and coronary heart disease to play a leading and a rapidly growing role as a cause of human suffering, disability, and premature death. The demographic landscape is changing around us. The 600 million older persons we see around us today will grow to nearly 2 billion by 2050. This growth will be most spectacular in the developing countries.

As to correctness and accuracy the Reflolux system is comparable to the conventional measurement of blood glucose under laboratory conditions. Its handling is simple and safe so that diabetic patients are able to check their blood sugar reliably by self-control. Skilled patients achieve just as good results as laboratory personnel.