Nine male patients 35 to 60 years old received 100 pg synthetic thyrotropin-releasing hormone (TRH) after both an overnight and a 36 hour fast and the serum prolactin response was measured by radioimmunoassay. The prolonged fast significantly (p < 0.05) decreased the mean peak prolactin response from 86.3 ± 25.9 to 32.0 ± 6.2 and the increment above basal from 76.8 ± 24.3 to 27.5 ± 5.5 ng/mJ. There was no change in the pattern or timing of the response and basal values were insignificantly lowered. These observations are discussed in relation to the effects of Casting on glucose, insulin, growth hormone, free fatty acid, ketones and water and electrolyte metabolism.

Diabetes is a widespread condition in South Africa and is often managed at primary level health facilities. This study aimed to assess the quality of diabetes management using a rapid assessment approach, focusing on three indicators as proxy measurements of quality: the regularity of blood glucose level (BGL) measurement; the percentage of patients whose BGLs were within 'acceptable' limits (under 10.0 mmol/l) on at least 75% of visits; the rate at which action was taken in response to high BGLs. Five sites were included in the study, including public and private, doctor- and nurse-based facilities. A total of 128 records were examined. Only 33% of all records were found to be well-managed according to the study criteria. None of the individual facilities were found to have more than 40% of patients achieving BGLs within the study limits. Some obstacles to good glycaemic control were costs to patients, transport problems, a lack of health education and shortcomings in clinical expertise. Policy implications and recommendations are suggested.

The pituitary responses to the intravenous administration of 200 mg of Thyrotropin Releasing Hormone were investigated in 14 poorly controlled insulin dependent diabetic males and in nine matched controls. The mean TSH and prolactin responses in the two groups were similar although both tended to be lower in the diabetics. There was a small FSH rise in 11 of the 23 subjects.

The effects of tolbutamide infusion (1 gm. over forty minutes) on plasma pancreatic glucagon-like immunoreactivity (PGLI), serum insulin, and blood glucose were studied in six patients with chronic pancreatitis and six matched controls.asal PGLI levels were significantly higher in the patients, despite higher fasting glucose concentrations. Tolbutamide infusion had no significant effect on mean PGLI levels in controls but was associated with significant elevation in pancreatitis patients, despite higher circulating glucose levels in the latter. The data suggest that chronic calcific pancreatitis patients hypersecrete immunoreactive glucagon, possibly from a nonpancreatic source and that this immunocreactive material may be stimulated by sulfonylureas.

There are paraIleIs in the abnormalities of glucose-stimulated insulin-(IRI) release, and glucagon (IRG) responses to arginine in maturity onset diabetes (MOD) and patients with a1coholic chronic pancreatitis (ACP) (Kalk, Vinik, Bank et a1. 1974a; Kalk, Vinik, Bank et a1. 1974b). We therefore investigated IRI and IRG responses to i.v. secretin and cholecystokininpancreazymin (CCK-PZ) in patients with MOD and ACP. Patients and MethodsFive male patients with proved chronic pancreatitis but normal glucose tolerance, 5 age-and weight-matched males with MOD, and 5 matched controls received Lv. bolus injections of secretin (2iu/kg), and CCK-PZ (1.5u/kg) (Karolinska Institute). Blood was drawn for estimation of glucose, IRI and IRG (Unger's 30k antibody). Molar IRI: IRG ratios were calcufäted for the basal states and maximum responses. ResultsFasting levels of glucose, IRI and IRG were similar in controls and ACP; but elevated in MOD; mean basaliRI :lRG ratios were similar (Table). Secretin caused a fall in mean glucose, and a rise in mean IRI and IRG in a11 groups; the IRI rise was impaired in MOD and ACP, but their IRG responses were supranormal and thus peak IRI :IRG ratios rose suboptimally. CCK·PZ caused a significant fall in glucose in controls and in 4 of 5 MOD, and inconsistent responses in ACP. IRI respon-----D.abetlcs --Pancrtatltlcs