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The rate of gastric emptying of carbohydrate is a major determinant of postprandial glycemia. In healthy subjects and patients with uncomplicated type 1 diabetes, there is evidence that gastric emptying may be accelerated by insulin-induced hypoglycemia.The objective was to determine the effects of acute hypoglycemia on gastric emptying in long-standing type 1 diabetes and evaluate whether the response to hypoglycemia is influenced by the rate of gastric emptying during euglycemia and/or autonomic dysfunction.Gastric emptying of a solid/liquid meal (100 g (99m)Tc-minced beef and 150 ml 67Ga-EDTA-labeled water) was measured by scintigraphy on 2 separate days, during hypoglycemia and euglycemia.These studies took place at the Department of Nuclear Medicine, Positron Emission Tomography, and Bone Densitometry at the Royal Adelaide Hospital.Twenty type 1 patients (4 female, 16 male; age, 45.9 +/- 2.3 yr; duration of known diabetes, 18.0 +/- 2.7 yr) were recruited from outpatient clinics and the Diabetes Centre at the Royal Adelaide Hospital.Hypoglycemia (approximately 2.6 mmol/liter) was established 15 min before and maintained for 45 min after meal consumption. On one of the days, autonomic nerve function was evaluated using cardiovascular reflex tests.The main outcome measure was gastric emptying during hypoglycemia when compared with euglycemia.Twelve of the 20 subjects had autonomic neuropathy. Gastric emptying of both solid (P0.001) and liquid (P0.05) was faster during hypoglycemia. The magnitude of this acceleration was greater when the rate of gastric emptying during euglycemia was slower (solid, percentage retention at 100 min, r = -0.52, P0.05; liquid, 50% emptying time, r = -0.82, P0.0001, but not influenced by autonomic nerve function).Insulin-induced hypoglycemia accelerates gastric emptying of solids and liquids in long-standing type 1 diabetes, even in those patients with delayed emptying, and is likely to be an important mechanism in the counter-regulation of hypoglycemia.

Contains fulltext : 136938.pdf (Publisher’s version ) (Open Access) BACKGROUND: Low total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations have been associated with the metabolic syndrome (MetS) in men, but the reported strength of association varies considerably. OBJECTIVES: We aimed to investigate whether associations differ across specific subgroups (according to age and body mass index (BMI)) and individual MetS components. DATA SOURCES: Two previously published meta-analyses including an updated systematic search in PubMed and EMBASE. STUDY ELIGIBILITY CRITERIA: Cross-sectional or prospective observational studies with data on TT and/or SHBG concentrations in combination with MetS in men. METHODS: We conducted an individual participant data meta-analysis of 20 observational studies. Mixed effects models were used to assess cross-sectional and prospective associations of TT, SHBG and free testosterone (FT) with MetS and its individual components. Multivariable adjusted odds ratios (ORs) and hazard ratios (HRs) were calculated and effect modification by age and BMI was studied. RESULTS: Men with low concentrations of TT, SHBG or FT were more likely to have prevalent MetS (ORs per quartile decrease were 1.69 (95% CI 1.60-1.77), 1.73 (95% CI 1.62-1.85) and 1.46 (95% CI 1.36-1.57) for TT, SHBG and FT, respectively) and incident MetS (HRs per quartile decrease were 1.25 (95% CI 1.16-1.36), 1.44 (95% 1.30-1.60) and 1.14 (95% 1.01-1.28) for TT, SHBG and FT, respectively). Overall, the magnitude of associations was largest in non-overweight men and varied across individual components: stronger associations were observed with hypertriglyceridemia, abdominal obesity and hyperglycaemia and associations were weakest for hypertension. CONCLUSIONS: Associations of testosterone and SHBG with MetS vary according to BMI and individual MetS components. These findings provide further insights into the pathophysiological mechanisms linking low testosterone and SHBG concentrations to cardiometabolic risk.

Background: In older people, undernutrition is associated with increased hospitalization rates and mortality. Because weight loss in older people often reflects a disproportionate reduction of skeletal muscle, anabolic treatments may be beneficial. Objective: Our aim was to evaluate the hypothesis that testosterone treatment and a nutritional supplement have additive benefits. Design: Oral testosterone undecanoate (40 mg daily for women, 80 mg twice daily for men) and an oral nutritional supplement (475 kcal/d) were administered, alone or co mbined, for 1yt o 49 communitydwelling, undernourished people [Mini Nutritional Assessment score ,24 and low body weight (body mass index, in kg/m 2 : ,22) or recent weight loss (.7.5% over 3 mo)] aged .65 y (mean age: 77 y; 26 women and 23 men). Hospital admissions and other variables were assessed. Results: In subjects receiving combined testosterone and nutritional supplements (n ¼ 11), there were no hospital admissions, whereas there were 9 admissions (2 elective) in 13 subjects in the no-treatment group, 4 in the testosterone-treated group (n ¼ 12), and 5 in the supplement-treated group (n ¼ 13); P ¼ 0.06 with no-treatment compared with combined treatment. When compared with the notreatment group, the combined-treatment group had significantly fewer subjects admitted to hospital (0 compared with 5, P ¼ 0.03), fewer days in hospital (0 compared with 74, P ¼ 0.041), and a longer time to hospital admission (P ¼ 0.017). Conclusions: In undernourished older people, combined treatment with testosterone and nutritional supplementation reduced the number of people hospitalized and the duration of hospital admissions, which are important endpoints in this group. Larger, confirmatory studies are now needed. This trial was registered before commencement at clinical trials.gov as NCT00117000. Am J Clin Nutr 2009;89:880‐9.

The aim of the present study was to determine the effects on blood pressure response of 50 g carbohydrate drinks with differing glycaemic effects in ten healthy elderly subjects (age >65 years; randomized crossover design). Systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure, heart rate and plasma glucose levels were determined following ingestion of equal volumes (379 ml) of water and 50 g carbohydrate drinks with differing reported glycaemic indices (GI) (surrogate marker for glycaemic effect): (1) low-GI: Apple & Cherry Juice; (2) intermediate-GI: Fanta Orange; (3) high-glucose. Glucose (SBP and DBP PP=0·005) and Fanta Orange (SBP P=0·005; DBP and MAP PP=0·008; MAP P=0·005) from baseline following Apple & Cherry Juice ingestion. Water had no significant effect on postprandial blood pressure. Fanta Orange and Apple & Cherry Juice caused similar (P=0·679) glycaemic effects, which were significantly greater than water, but lower than glucose (Pr −0·123, P=0·509; DBP r −0·051, P=0·784; MAP r −0·069, P=0·712). Apple & Cherry Juice and Fanta Orange had similar glycaemic effects, but differing effects on blood pressure. Therefore, it is unlikely that the glycaemic effect of a drink can be used to predict the subsequent cardiovascular response.