A familial type I hyperlipoproteinaemia is described in three members of a family of eleven; on the basis of LPL activity and HDL content of plasma three other members of the family have been diagnosed to be heterozygotes without other disturbances in their lipid spectrum. The distribution of this lipid disorder is in accordance with an autosomal recessive inheritance pattern. In this family a second hereditary condition, thyroxine binding globulin deficiency, was found in addition to the hyperlipoproteinaemia. The inheritance of this condition appears to be as an autosomal dominant. An interrelated inheritance pattern of both conditions could not be proved, but both traits may be located on the same chromosome at some distance from another to allow recombination.

P atients with NIDDM have a higher morbidity and mortality rate for cardiovascular disease than the nondiabetic population. Risks like hypertension, lipid-profile abnormalities, and increased platelet aggregability increase with deteriorating metabolic control. Studies are known regarding the effects of improving metabolic control in NIDDM on lipid profile, platelet aggregation, insulin levels, and insulin resistance (1). Improvement of metabolic control could be attained by treatment with oral hypoglycemic agents (OHAs), insulin, or combination therapy. We studied the effects of improvement of metabolic control by changing from OHAs to insulin in patients with poorly regulated NIDDM. Subjects were selected from among patients with NIDDM referred to our outpatient department because of poor metabolic control despite maximal use of OIIAs. All subjects changed from OHAs to insulin, and fasting blood samples were drawn immediately before initiation of insulin therapy and at 4 and 16 weeks after starting insulin treatment. Furthermore, at 0, 4, and 16 weeks, weight and blood pressure (after at least 5 min in supine position and after 1 min in standing position) were recorded. The observer (J.N. G.O.E.) was unaware of the outcome of previous blood pressure recordings.A total of 19 poorly regulated NIDDM subjects (62.7 ± 7.5 years; 7 men, 12 women) were included and treated with subcutaneous insulin injections. Laboratory measurements of glucose, GHb, and lipid profile were carried out in these fasting blood samples. Statistical analysis was performed with the Student's t test for paired samples. Values are given as means ± SE. Improved metabolic control was reflected by a significant decrease in fasting glucose (0 weeks: 15.0 ± 0.6 mmol/l; 4 weeks: 13.1 ± 0.8 mmol/1, P < 0.05 vs. baseline; 16 weeks: 11.0 ± 0.6 mmol/1, P < 0.05 vs. baseline) and GHb percentage (0 weeks: 11.9 ± 0.3%; 4 weeks: 10.0 ± 0.6%, P < 0.05 vs. baseline; 16 weeks: 8.3 ± 0.4%, P < 0.05 vs. baseline). This resulted in an increase of fasting HDL cholesterol (0 weeks: 1.1 ± 0.1 mmol/1: 4 weeks: 1.2 ± 0.1 mmol/1, P < 0.05 vs. baseline; 16 weeks: 1.3 ± 0.1 mmol/1, P < 0.05 vs. baseline) and a decrease in fasting triglyceride concentrations (0 weeks: 2.4 ± 0.3 mmol/1; 4 weeks: 1.9 ± 0.2 mmol/1, P < 0.05 vs. baseline; 16 weeks: 1.9 ± 0.2 mmol/1, P vs. baseline), while total cholesterol concentration did not change. This phenomenon was already observed after 4 weeks of insulin treatment.Before treatment, a significant difference was measured between the systolic arterial blood pressure recordings after 5 min lying down and blood pressure measurement after 1 min in an upright position. This orthostatic hypotension was no longer observed after 4 and 16 weeks of insulin treatment (Table 1). This phenomenon appears to be directly correlated with metabolic control. No significant correlation was observed between the change in HbA lc and the fall in systolic blood pressure upon standing after 16 weeks of insulin treatment. Several explanations can be given. Fir...