Hyperinsulinemia Abstracts 1

Kraft Criteria

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Detection of Diabetes Mellitus In Situ (Occult Diabetes)

         (Kraft 1975) Download

Letter: Insulin values and diagnosis of diabetes

         (Kraft and Nosal 1975) Download

IMx (Abbott) Immunoassay of Insulin: A Practical Alternative to RIA Hyperinsulinemia Identification in Idiopathic Neurootology and Other Hyperinsulin Metabolic Disorders

         (Kraft 1997) Download

Hyperinsulinemia identification as defined by glucose/insulin tolerance has been established as the prime etiological factor in idiopathic neurootological disorders. Insulin assays by radioimmunoassay (RIA) and the IMx (Abbott) immunoassay yielded in 558 of 595 glucose/insulin tolerance a concurrence of 93.7%. The latter measures insulin without cross-reaction with proinsulin. The RIA methodology includes proinsulin. The IMx (Abbott), a micro-particle enzyme immunoassay (MEIA), gave lower values due to its nondetection of proinsulin. Based upon defined insulin values, the dynamic patterns of euinsulinemia, hyperinsulinemia with elevated fasting insulin levels and hyperinsulinemia with impaired and/or hyperglycemia glucose tolerance were concurred 100% by MEIA. All of the nonconcurrences were with normal glucose tolerances when the second and/or third hour insulin values were borderline. The limited utilization of RIA technology and the potential availability of enzymatic immunoassay which requires less technical skills presents MEIA as a practical and precise alternative to RIA hyperinsulinemia identification. The increasing world-wide significance of the clinical pathology of hyperinsulinemia becoming manifest in all disciplines of medicine, warrants the identification and/or exclusion of hyperinsulinemia by cost-effective technology.


Hyperinsulinemia: A Merging History with Idiopathic Tinnitus, Vertigo, and Hearing Loss

         (Kraft 1998) Download

The history of neurootology and the history of diabetes mellitus have their earliest but separate recognition in ancient Egyptian medicine. Both the polyuric condition resembling diabetes and "humming in the ear" now known as tinnitus were described. Yallow's refinement of a radioimmunoassay for insulin demonstrated increased insulin (hyperinsulinemia) in known diabetics. Glucose-insulin tolerances corroborated Yallow's findings. Specific hyperinsulinemia patterns of non-insulin-dependent diabetes mellitus, type II (NIDDM) have been identified. Hyperinsulinemia precedes hyperglycemia. Hyperinsulinemia with normal glucose tolerance is the earliest identifier of NIDDM. In 1977, Updegraff identified hyperinsulinemia with idiopathic Meniere's disease. Sustained clinical response was achieved in all who maintained nutritional management. This finding was the first major impact of hyperinsulinemia in the clinical arena. Subsequently, Updegraff's studies were substantiated by others. As a result, the clinical pathology of hyperinsulinemia has become a major factor in multiple medical disciplines. The hyperinsulinemia associated with idiopathic tinnitus, vertigo, and hearing loss and the hyperinsulinemia of NIDDM, without regard for glycemia status, are one and the same entity. The merging relationship preceded the clinical recognition of both entities. A retrospective relationship to ancient Egyptian medicine and before is considered to be most probable.

Diabetes--a silent disorder

         (Kraft and Wehrmacher 2009) Download

The earliest diagnosis of diabetes is a mandate to arrest the worldwide epidemic of diabetes. The insulin assay with the oral glucose tolerance provides the earliest diagnosis. The pathology of diabetes occurs in those with normal blood sugars. With earliest diagnosis, the 'diabetes epidemic' can be arrested and then reversed.


Blood levels of glucose and insulin in Meniere's disease

         (Kirtane, Medikeri et al. 1984) Download

It has been reported that a very commonly overlooked cause of vertigo is disorder of glucose metabolism. This may not be reflected in the glucose tolerance test alone, but becomes obvious when the insulin levels in blood are evaluated simultaneously. Thirty-one patients with Meniere's disease underwent a 5-hour glucose tolerance test with radioimmune assay of insulin. The results were compared with the normal and abnormal patterns suggested by Kraft. On this basis, it was found that 67.7% of our patients showed some abnormality in the relationship between the blood levels of glucose and insulin. These patients were put on a special diet with a limited carbohydrated content prescribed by a qualified dietitian. The effect of this diet was highly variable and the possible reasons for this are also discussed.

Hyperinsulinemia and tinnitus: a historical cohort

         (Lavinsky, Oliveira et al. 2004) Download

Tinnitus affects millions of people worldwide, and it signals the presence of several underlying diseases, including hyperinsulinemia. The aim of this study was to evaluate the response to dietary treatment in 80 patients with associated tinnitus and hyperinsulinemia. On the basis of data obtained by a questionnaire, two groups were established: One included patients who followed the prescribed diet; the other group included patients who did not comply with the treatment. The likelihood of improving tinnitus symptoms was fivefold higher in hyperinsulinemic patients who followed the diet than in those who did not (relative risk [RR], 5.34; 95% confidence interval [CI], 1.85-15.37; p < .05). In addition, resolution of tinnitus was reported by 15% of the patients who followed the diet as compared to 0% of those who did not. These findings underscore the importance of including hyperinsulinemia in the routine diagnostic investigation of patients with tinnitus regardless of whether associated with neurosensory dysacusis or vertigo (or both).

Joseph Kraft: Why Hyperinsulinemia Matters        

         (Schofield 2013) Download


Shape of glucose, insulin, C-peptide curves during a 3-h oral glucose tolerance test: any relationship with the degree of glucose tolerance?

         (Tura, Morbiducci et al. 2011) Download

We aimed to analyze the shape of the glucose, insulin, and C-peptide curves during a 3-h oral glucose tolerance test (OGTT). Another aim was defining an index of shape taking into account the whole OGTT pattern. Five-hundred ninety-two OGTT curves were analyzed, mainly from women with former gestational diabetes, with glycemic concentrations characterized by normal glucose tolerance (n = 411), impaired glucose metabolism (n = 134), and Type 2 diabetes (n = 47). Glucose curves were classified according to their shape (monophasic, biphasic, triphasic, and 4/5-phases), and the metabolic condition of the subjects, divided according to the glucose shape stratification, was analyzed. Indices of shape based on the discrete second-order derivative of the curve patterns were also defined. We found that the majority of the glucose curves were monophasic (n = 262). Complex shapes were less frequent but not rare (n = 37 for the 4/5-phases shape, i.e., three peaks). There was a tendency toward the amelioration of the metabolic condition for increasing complexity of the shape, as indicated by lower glucose concentrations, improved insulin sensitivity and beta-cell function. The shape index computed on C-peptide, WHOSH(CP) (WHole-Ogtt-SHape-index-C-peptide), showed a progressive increase [monophasic: 0.93 +/- 0.04 (dimensionless); 4/5-phases: 1.35 +/- 0.14], and it showed properties typical of beta-cell function indices. We also found that the type of glucose shape is often associated to similar insulin and C-peptide shape. In conclusion, OGTT curves can be characterized by high variability, and complex OGTT shape is associated with better glucose tolerance. WHOSH(CP) (WHole-Ogtt-SHape-index) may be a powerful index of beta-cell function much simpler than model-based indices.


References

Kirtane, M. V., S. B. Medikeri, et al. (1984). "Blood levels of glucose and insulin in Meniere's disease." Acta Otolaryngol Suppl 406: 42-5. [PMID: 6382920]

Kraft, J. R. (1975). "Detection of Diabetes Mellitus In Situ (Occult Diabetes)." Laboratory Medicine 6(2). [PMID:

Kraft, J. R. (1997). "IMx (Abbott) Immunoassay of Insulin: A Practical Alternative to RIA Hyperinsulinemia Identification in Idiopathic Neurootology and Other Hyperinsulin Metabolic Disorders." Int Tinnitus J 3(2): 113-116. [PMID: 10753372]

Kraft, J. R. (1998). "Hyperinsulinemia: A Merging History with Idiopathic Tinnitus, Vertigo, and Hearing Loss." Int Tinnitus J 4(2): 127-130. [PMID: 10753400]

Kraft, J. R. and R. A. Nosal (1975). "Letter: Insulin values and diagnosis of diabetes." Lancet 1(7907): 637. [PMID: 47979]

Kraft, J. R. and W. H. Wehrmacher (2009). "Diabetes--a silent disorder." Compr Ther 35(3-4): 155-9. [PMID: 20043611]

Lavinsky, L., M. W. Oliveira, et al. (2004). "Hyperinsulinemia and tinnitus: a historical cohort." Int Tinnitus J 10(1): 24-30. [PMID: 15379344]

Schofield, G. (2013). "Joseph Kraft: Why Hyperinsulinemia Matters         ."   Retrieved Jan 9, 2014, from http://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/.

Tura, A., U. Morbiducci, et al. (2011). "Shape of glucose, insulin, C-peptide curves during a 3-h oral glucose tolerance test: any relationship with the degree of glucose tolerance?" Am J Physiol Regul Integr Comp Physiol 300(4): R941-8. [PMID: 21248305]