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Unexplained hypoglycemia in a pediatric diabetic patient can perplex even the savviest health care providers and lead to an extensive medical workup. We present here the cases of 2 children with type 1 diabetes mellitus treated with insulin pumps who were hospitalized for episodes of hypoglycemia. Review of their insulin pumps revealed normal basal and bolus insulin delivery. However, subsequent review of the priming history in the pump revealed that both children were receiving additional insulin under the manual-prime function, which is not included in the daily totals and, therefore, was initially unnoticed. Ultimately, both children confessed to surreptitiously using this priming function to self-administer extra insulin. It is important that health care professionals who are caring for diabetic patients be aware of this possibility.

The present study was designed to examine the incorporation of phytosterols (PS) in membranes and tissues of rats fed a diet containing 2% PS in the presence of 0.2% cholic acid for 22 days. The control diet contained 12 mg PS/100 g compared with 2,012 mg/100 g. Liver, kidney, testis, and prostate microsomes, plasma, and epididymal fat pads were examined for sterols. Fatty acid composition and phospholipid pattern were also examined in some tissues. The PS diet resulted in a fivefold increase in plasma PS compared with controls. PS was found to accumulate in adipose tissue and liver microsomes in rats fed the PS-supplemented diet. There was no effect of PS incorporation on microsomal cholesterol content, except in the testes, in which dietary PS reduced cholesterol content by 25%. Dietary PS increased 20:4n-6 and 22:5n-3 fatty acids in membranes of the liver, testis, and prostate but decreased 16:1 in liver microsomes. PS incorporation had no effect on the phospholipid pattern of the liver and testis.

Aim: To identify those obese minority youth at greatest risk for having an abnormal oral glucose tolerance test (OGTT) indicating impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM2). Study Design and Methods: 167 children, who met the ADA criteria for T2DM screening, underwent an OGTT. Logistic regression models were derived for girls, boys, and both. Based on significant variables, algorithms yielding 100% sensitivity were derived to identify candidates for screening. Results: 12% of children screened had an abnormal OGTT. Girls who met the algorithm criteria for screening (HOMA >4.5) had an abnormal OGTT with a sensitivity of 100% (95% confidence interval [CI] 0.988-1.0) and specificity of 53.7% (95% CI 0.41-0.648). Boys who met the algorithm screening criteria (HOMA >13, or HbA, c >5.8%, or total cholesterol >200 mg/dl) had an abnormal OGTT with a sensitivity of 100% (95% CI 0.979-1.000) and specificity of 76.6% (95% CI 0.632-0.849). The model was validated using a large patient sample, yielding similar results. Conclusions: In obese pubertal minority youth meeting the ADA criteria for DM2 screening, these algorithm screening criteria can be useful in identifying those at risk youth who should undergo an OGTT.

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