The old discussion on the real nature of the relation between DM and hyperglycemia, on the one hand, and heart-angiopathies, on the other hand, has not probably until now solved by UKPDS Study. However, as allows us to state a 45 years- long clinical experience, the fact that diabetic patients, with glycemic blood levels higher than the average diabetic patients, do not present the most severe complications, which really are observed also in patients whose glycemia is light elevated, the positive results of statins, ACE-inhibitors and sartans in secondary prevention, and, ultimately, the results of anthypertensive drugs in primary prevention of diabetic complications ought to remember all of us to think deeper, since, although the discussion could seem academic, it really urges us to find new, original pathways of primary prevention and ameliorate DM definition, especially in initial stage and particularly in the phase of diabetic constitution.
To conclude this necessary introduction, we think that DM is somewhat very different from the “simple” pathological increasing of glycemia and that it is possible now recognize since birth-day individuals at “real” risk of this metabolic disorder, conditio sine qua non for the “primary” prevention of type 2 DM (NIDDM) and consequently of its dangerous complications.
Due to these reasons, deeply illustrated and discussed later on, we differentiate the science, a large number of doctors practise at beginning of third millennium, i.e. glycemology, in which we are not concerned, from the clinical diabetology (1, 2, 3, and the site, cited above).
Some preliminary considerations, useful in biophysical-semeiotic diagnosis of diabetic constitution and diabetes mellitus.
Before learning biophysical semeiotic diagnosis of both diabetic constitution and diabetic syndrome, in our opinion, the readers must pay all attention to our former researches, we carried out over the last three decades, which allow us to state that the very initial stage of whatever “degenerative” disorders begins really as microcirculatory modifications, both functional and structural, particularly at the level of Endoarterial Blocking Devices (EBD) of related biological system, that in the course of years will be involved by the disease itself (1, 2, 3).
In addition, these microcirculatory alterations, well localized in a gland, apparatus, organ, only apparently “healthy”, can be evaluated at the bed-side in a “quantitative” manner, permitting thus the therapeutic monitoring of interesting pre-pathological conditions, characterizing the “gray zone”, the real site and moment of “primary” prevention, located between the “white zone” (physiology) and the “blach zone” (pathology).
In other words, as we formerly described, as regards biophysical semeiotic constitutions (See above-cited site, Page Constitutions; “Oncological Terrain”; and www.Staibene.it, November 2001; www.Piazzetta.sfera.it, Cose Serie, Professione Medica), interestingly, genetic factor reveals in both parechymal and related microangiological level, allowing doctor nowadays to assess this pathological symptomless condition, starting from the first decade of individual life.
As far as DM is concerned, from technical biophysical-semeitoc view-point, it is necessary to remember that the “mean” intensity stimulation of trigger-points of VI thoracic dematomere – in practice, the skin of epigastrium immediately below costal arch at right and/or at left, about 5 cm. away from sternal angle, where are localized the pancreatic trigger-points – brings about pancreatic-“middle” urethral reflex, which permits the assessment of both structure and function of Endoarterial Blocking Devices (EBD), located in pancreatic small arterioles and arterioles, according to Hammersen: in individuals involved by diabetic constitution and in those with “real” diabetic risk, in IGT-subjects, and, of course, in “all” diabetic patients, such microcirculatory structures show abnormalities since birth-day, revealing alterations of different severity, varying from patient to patient: “middle” urethral reflex lasts for < 20 sec. (NN = 20 sec.) and then disappears for > 6 sec. (NN = 6 sec.), indicating a shorter opening and a prolonged closure of EBD, and consequently reduced capillary-venular blood-flow in Langheran’s islets (Fig. 1).
|In our case, in fact, EBD show opening duration (= duration of the “middle” urethral reflex) < 20 sec. (NN = 20 sec.) and/or closure duration (= duration of the reflex disappearance) more than 6 sec. (physiological value), which becomes particularly intense during stress tests, as the test of two pressures, which is easy to perform also by physician with scarce experience in Biophysical Semeiotics: firstly, doctor has to evaluate the diverse reflex parameters during stimulation of pancreatic trigger-points, illustrated above, by a lasting pinch of “mean” intensity. Then, after an interval of at least 10 sec., he assesses for the second time the identical parameters during “intense” stimulation, that activates physiologically the pancreatic microvessels, bringing about, speaking technically, according to Clinical Microangiology terms, associated microcirculatory activation, type I [ = small arteries and arterioles as well as capillaries and venules oscillate maximally: in practice, upper urethral reflex and, respectively, the lower one fluctuate 6 time per minute with “maximal” intensity, 1,5 cm., lasting the highest opening, 7-8 sec. (NN “basal” value = 6 sec.)]
In subjects at “real” risk of diabetes mellitus, the duration of EBD opening does not modify (NN > 20 sec.) or ameliorates in a not statistically significant manner, while the duration of closure does not become shorter (NN < 6 sec.). These very interesting EBD modifications, caused by diverse stress, aim to increase the blood supply to the histangium of pancreatic isles, thus providing pancreatic isles with matter-energy-information, and, obviously, they play a major role in the activation of the Functional Microcirculatory Reserve (FMR).
Fig.1: Figure shows clearly the correct location of the bell-piece of stethoscope and lines upon which must be applied digital percussion, direct and light, in an individual in supine position, psycho-physically relaxed, in order to outline the limits of kidneys and ureters cutaneous projection area.