A comparatively inexpensive microcomputer-based system of programmed diabetic instruction is described, matched to an interactive knowledge assessment questionnaire with or without prescriptive feedback. This provides an educational and assessment package for newly diagnosed and established diabetics, with additional analytical potential. The system is well accepted, demonstrates major areas of defective knowledge and allows cost-effective handling of large numbers of patients.

ELATION WITH GtI SECRETION AFTER TRH ADMINISTRATION. AND ADOLESCENTS.The frequency of GH elevation observed in subjects with IDDM prompted us to look for pituitary autoantibodies. An indirect immunofluorescence technique utilizing human and guinea pig hypophysis was used to detect their presence in GH, TSIi, and prolactin pituitary cells. Studies are now in progress to discrlmlnate these specific endocrine cells autoantibodies. 26 subjects (12 boys, 14 girls, ages 7-20, mean age 12 f yr) were tested after TRtl administration (7 pg/kg i.v., rnax. 200 pg). In controls, nonc had a significant response of plasma GH as defined by an increase to at least twice the baseline levels and greater than 5 ng/ml. In IDDM children, a significant GH elevation was observed in 17 of 26 cases (9 girls, 8 boys) with a mean + SE level of 17.1 + 2.9 ng/ml (range 7.2 -39 ng/ml) (p<0.02 witE normal). Among thF responders to TRH, 14/17 had positive serum pituitary autoantibodies, while in the 9 children with no GH rcsponse to TRH, 7/9 had a negative determination. However, it is of interest to note that all patlents except one had positive islet-cell antibodies in their serum In conclusion, these results are in agreement with the known paradoxical response of GH after TRH in IDDM patients, but not with the lower incidence reported in adult females. In addition, Lhe study of pituitary autoimmunity could partly explain the changes in GH secretion observed in IDDM patients. FASTING BLOOD GLUCOSE (BG) LEVELS IN TIIE LATENT PERIOD (LP) OF IDWM IN CHILDREN.We retrospectively analyzed the occasional fasting BG concentration o f 2 1 children and OGTT o f 7 subjccts who developed IDDM 60-8 months later. Approaching symptomatic diabetes the fasting BG levels (72-115 mg/dl) progressively increased with a r-value of 0.68(p 180 mg/dl)and in 3 q f them also at 180 min (> 140 rng/dl);glycosuria appeared in 2 subjects.In spite of these abnormalities BG levels were not further controlled bcfore the overt onsct o f IDDM. These retrospcctive data (rarely avail2 ble in the PL of IDDM in children) confirm that the abrupt clinical onset of diabetes may b e preceeded b y a long pcriod o f abnormal BG levels and insulin sccrctory capacity. Wc suggest that monitoring o f these parameters may constitute a n effective and non-cxpensivc measure to identify children at risk for IDDM and to admit them to immunological and genetic investigations NOCTURNAL SUBCUTANEOUS INSULIN INFUSION IN CHILDREN - EFFICACY AND ACCEPTABILITYMany younger children consider 24 hour Continuous Subcutaneous Insulin Infusion (CSII) unacceptably intrusive. We have attempted to test an alternative infusion system using a Nocturnal Subcutaneous Insulin Infusion (NSII) which is removed before breakfast at which time an intermediate-acting insulin is injected to cover daytime requirements.Ten ...

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