Several points of difference can be made between features of diabetics of the Western world and the tropical countries. In addition to a lower incidence of juvenile diabetes and diabetic coma in the tropics there is a high incidence of marked underweight among diabetics of the older age group as well as the young. Observations on ninety-six patients at Cuttack, India, reveal that apart from a few cases of juvenile diabetes and a moderate number of elderly-obese patients there is a high incidence of atypical cases. Some of these are young and very lean but require large doses of insulin for control and are not prone to ketosis (“J”) type. Others are middle-aged and generally responsive to sulfonylurea compounds but are very lean even at onset of disease (elderly-lean type). Division of the patients into two groups, one seen in the hospital wards and the other in the private clinics (domiciliary), makes it apparent that the unusual types of diabetics are for the most part the poorer hospital (ward) patients. Of these 39.8 per cent are “J” type and 43.7 per cent are elderly-lean types compared with zero and 4.9 per cent, respectively, in the domiciliary group. The hospital patients have been subject to chronic undernutrition and most of them take large carbohydrate meals at long intervals, often only one a day. It is postulated that imposition of this dual stress of intermittent starvation and overload on carbohydrate metabolism may be related to the atypical patterns of clinical diabetes.

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Estimation of triglycerides (Tg), total cholesterol (Tc), HDLs, LDLc, and VLDLc was carried out in 46 undernourished diabetic subjects (UND); 21 untreated and 25 on insulin; 44 well-nourished diabetic subjects (WND); 22 untreated and 22 on insulin; together with 25 patients with protein energy malnutrition (PEM) and 25 healthy controls less than 50 yr of age. Compared with controls, in the untreated diabetic subjects Tg, Tc, LDLc, and VLDLc were significantly higher in both classes, while HDLc was lower only in WND. Among the treated diabetic subjects, Tg were higher in WND, LDLc lower in UND, and VLDLc higher in both. With regard to relative distribution of cholesterol in the untreated patients, HDLc/Tc was lower in WND, but this was not so in UND. HDLc/Tc was higher in treated UND. Between undernourished and well-nourished groups of diabetic subjects in the untreated patients, HDLc was significantly higher and LDLc lower in the former. Both Tc and LDLc were lower in UND on insulin compared with WND. HDLc/Tc was higher and LDLc/Tc lower in both untreated and treated UND. In adults with PEM, mean values of Tg, Tc, and LDLc were much lower than in controls, as well as in both groups of UND. On the other hand, values of HDLc/Tc were higher and LDLc/Tc lower in PEM compared with controls, but this was not so for treated UND. It is evident from the results of this study that the undernourished have lower levels of plasma lipids and a favorable distribution of cholesterol among the lipid fractions from the point of view of vulnerability to development of atherosclerosis.

This study reports four children who developed complete stricture of pylorus and antrum of the stomach following accidental ingestion of corrosive agent (toilet cleaner).