The Endocrine Pancreas and Juvenile Diabetes

208 Pages·1979·5.585 MB·English

by  Rachmiel Levine (auth.), David M. Klachko, Ralph R. Anderson, Thomas W. Burns, Harold V. Werner (eds.)

THE ENDOCRINE
PANCREAS AND
JUVENILE DIABETES
ADV ANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY
Editorial Board:
NATHAN BACK, State Univer8ity of New Yark ot Buffalo
N. R. DI LUZIO, Tulane Unit>er8ity School of Medicine
EPHRAIM KATCHALSKI-KATZIR, The Weizmann IR8titute of Science
DAVID KRITCHEVSKY, Wi8tar In8titute
ABEL LAJTHA, New Yark State Ruearch IR8titute for Neurochemi8try and Drug Addiction
RODOLFO PAOLETTI, Univerrity of Milan
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THE ENDOCRINE PANCREAS AND JUVENILE DIABETES
Edited by David M. Klachko, Ralph R. Anderson, Thomas W. Burns, and
Harold V. Werner
THE ENDOCRINE
PANCREAS AND
JUVENILE DIABETES
Edited by
David M. Klachko
Ralph R. Anderson
Thomas W. Burns
and
v.
Harold Werner
University of Missouri· Columbia
Columbia, Missouri
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Midwest Conference on Endocrinology and Metabolism, 13th, University of Missouri,
Columbia, 1977.
The endocrine pancreas and juvenile diabetes.
(Advances in experimental medicine and biology; v. 124)
"Proceedings of the Thirteenth Midwest Conference on Endocrinology and Metabolism,
held at the University of Missouri, Columbia, Missouri, September 28-30, 1977 and spon
sored by the University of Missouri - Columbia, College of Agriculture ... ret al.]"
Includes bibliographical references and index.
1. Diabetes - Congresses. 2. Pancreas - Secretions - Congresses. 3. Diabetes in chil
dren - Congresses. 4. Diabetic angiopathies - Congresses. I. Klachko, David M. II. University
of Missouri - Columbia, College of Agriculture. III. Title. IV. Series.
RC660.M531977 616.4'62 79-21998
ISBN-13:978-1-4684-8510-3 e-ISBN-13 :978-1-4684-8508-0
DOl: 10.1007/978-1-4684-8508-0
Proceedings of the Thirteenth Midwest Conference on Endocrinology and
Metabolism, held at the University of Missouri, Columbia, Missouri,
September 28-30,1977 and sponsored by:
University of Missouri - Columbia
College of Agriculture
Dalton Research Center
Department of Biochemistry
Department of Child Health
Department of Family & Community Medicine
Department of Medicine
Department of Pharmacology
Department of Physiology
Department of Radiology
Department of Surgery
Department of Veterinary Anatomy & Physiology
Department of Veterinary Medicine & Surgery
Department of Veterinary Pathology
Division of Biological Sciences
Extension Division
Graduate School
School of Medicine
Sinclair Research Farm
University Assembly Lecture Committee
Veterinary Medicine Diagnostic Laboratory
Eli Lilly and Company
Mead Johnson Research Center
Ross Laboratories
Upjohn Company
Wyeth Laboratories
© 1979 Plenum Press, New York
Softcover reprint of the hardcover 1s t edition 1979
A Division of Plenum Publishing Corporation
227 West 17th Street, New York, N.Y. 10011
All rights 'reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Conference Chairmen
RALPH R. ANDERSON, Ph.D., Associate Professor of Dairy Husbandry, UMC
DA VID M. KLACHKO, M.D., Associate Professor of Medicine, UMC
Planning Committee
JOHN D. DAVID, Ph.D., Assistant Professor of Biological Sciences, UMC
C. W. FOLEY, Ph.D., Professor of Veterinary Anatomy-Physiology, UMC
LEONARD R. FORTE, Ph.D., Associate Professor of Pharmacology, UMC
JOHN M. FRANZ, Ph.D., Associate Professor of Biocnemistry, UMC
JAMES A. GREEN, Ph.D., rrofessor of Anatomy, UMC
LAURENCE W. HEDLUND, Ph.D., Assistant Professor of Dairy Husbandry, UMC
MURRA Y HEIMBERG, M.D., Ph.D., Professor of Pharmacology and Medicine, UMC
J. ALAN JOHNSON, Ph.D., Assistant Professor of Physiology, UMC
CALVIN W. WOODRUFF, Professor of Child Health, UMC
WARREN L. ZAHLER, Ph.D., Assistant Professor of Biochemistry, UMC
Speakers
ROBERT S. BAR, M.D., Assistant Professor of Medicine, Division of Endocrinology and Metabolism,
University of Iowa College of Medicine, Iowa City, Iowa
BURlS R. BOSHELL, M.D., Ruth Lawson Hanson Professor of Medicine; Medical Director, Diabetes
Research and Education Hospital, University of Alabama School of Medicine, Birmingham,
Alabama
MICHAEL BROWNLEE, M.D., Chief Fellow, Joslin Clinic, Boston, Massachusetts
REX S. CLEMENTS, JR., M.D., Associate Professor of Medicine; Director, Clinical Research Center
and Metabolic Research Laboratories, University of Alabama, Birmingham, Alabama
JOHN E. GERICH, M.D., Associate Professor of Medicine and Physiology; Director of Diabetes and
Metabolism Research Laboratory, Mayo Medical School, Rochester, Minnesota
RACHMIEL LEVINE, M.D., Executive Medical Director, City of Hope Medical Center, Duarte,
California
CHARLES R. PARK, M.D., Professor and Chairman, Department of Physiology, Vanderbilt Uni
versity School of Medicine, Nashville, Tennessee
ARTHUR H. RUBENSTEIN, M.D., Professor and Associate Chairman, Department of Medicine,
University of Chicago, Chicago, Illinois
MARK A. SPERLING, M.D., Associate Professor of Pediatrics; Chief, Pediatric Endocrinology and
Metabolism, U.C.L.A. School of Medicine, Harbor General Hospital, Torrance, California
MICHAEL W. STEFFES, M.D., Ph.D., Associate Professor, Department of Laboratory Medicine
and Pathology; Medical Director of Clinical Chemistry Laboratory, University of Minnesota
Medical School, Minneapolis, Minnesota
JOSEPH R. WILLIAMSON, M.D., Professor of Pathology, Washington University School of Med
icine, St. Louis, Missouri
Moderators
THOMAS W. BURNS, M.D., Professor of Medicine and Director, Division of Endocrinology and
Metabolism, UMC
RICHARD A. GUTHRIE, M.D., Professor and Chairman, Department of Pediatrics, University of
Kansas School of Medicine, Wichita, KaD8Il8
ROBERT C. HARDIN, M.D., Professor of Medicine, University of Iowa, Iowa City, Iowa
MURRAY HEIMBERG, M.D., Ph.D., Professor and Chairman, Department of Pharmacology, UMC
ROBERT L. JACKSON, M.D., Professor of Child Health, UMC
HAROLD V. WERNER, Assistant Professor of Medicine, UMC
Discussants
BREITENBACH, R.P., Division of Biological Sciences, University of Missouri-Columbia
BURNS, T. W., Deparbnent of Medicine, University of Missouri-Columbia
DAVIS, J. W.,·Department of Biochemistry, Saint Louis University, Saint Louis, Missouri
FRANZ, J. M., Department of Biochemistry, University of Missouri-Columbia
GUTHRIE, R., Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
HAmACH, H., Deparbnent of Radiology, University of Missouri-Columbia
HEIMBERG, M., Department of Pharmacology, University of Missouri-Columbia
IVEY, K. J., Department of Medicine, University of Missouri-Columbia
JACKSON, R. L., Department of Child Health, University of Missouri-Columbia
KILO, C., West County Internal Medicine Inc., Saint Louis, Missouri
KLACHKO, D. M., Department of Medicine, University of Missouri-Columbia
PETERSON, C. M., Department of Medical Biochemistry, The Rockefeller University, New York,
New York
SANNY, C. G., Department of Biochemistry, College of Osteopathic Medicine and Surgery,
Des Moines, Iowa
SHEAR, D. B., Department of Biochemistry, University of Missouri-Columbia
TOWNSEND, J. F., Department of Pathology, University of Missouri-Columbia
VORBECK, M. L., Deparbnent of Pathology, University of Missouri-Columbia
WEINSTEIN, I., Department of Pharmacology, University of Missouri-Columbia
WERNER, H. V., Department of Medicine, University of Missouri-Colurnbia
Preface
Dr. Robert L. Jackson, Professor of Child Health at the Uni
versity of Missouri-Columbia, decided to retire from clinical
practice in 1977 and the Department of Child Health planned a con
ference in his honor. The Thirteenth Annual MidweSt Conference on
Endocrinology and Metabolism also was in the planning stages and
scheduled for two days in the fall. It seemed appropriate to com
bine the two into an expanded three-day conference. In view of
Dr. Jackson's international reputation in the study and care of
children with diabetes mellitus, the conference topic was not dif
ficult to find. Experts in this field were delighted to be asked
to speak at a conference in Dr. Jackson's honor. We selected a
number of excellent speakers to survey the physiology and pathophy
siology of pancreatic hormones and their effects in diabetes mel
litus, to discuss current knowledge of the microvascular complica
tions of the disease, and to put it all into the proper historical
perspective of where we have been and where we are going. We
think the conference achieved its objective to pay meaningful trib
ute to a distinguished member of the scientific community.
As with any conference, the conversion of the presentations
and discussions to the printed page is a long and arduous process.
Many manuscripts were completed well after the conference and
references often are more recent than the date of the conference.
We wish to express our appreciation to all participants in the
conference, to the planning committee, to Mrs. Linda Bennett who
typed the copy, to Plenum Press for their assistance and, espe
cially, to the sponsors without whom the conference could not
have taken place.
Ralph R. Anderson
Thomas W. Burns
David M. Klachko
Harold V. Werner
vii
Robert L. Jackson, M.D.
ROBERT LAWRENCE JACKSON
Robert Jackson is a native of Michigan and was born in the
town of Clare in the central part of the lower peninsula where he
attended the public schools. He received the Bachelor of Science
degree from Notre Dame University in 1930. Subsequently, he
studied at the University of Michigan and was awarded the M.D. de
gree. From 1934 to 1937 he was first a rotating intern and then
a resident in Pediatrics at the University of Iowa Hospitals, in
cluding an exchange residency at the University of Rochester. In
the years 1937 to 1954 he remained at the University of Iowa in
advancing ranks from Instructor to Professor of Pediatrics. In
1954 he accepted the Chair of Pediatrics at the University of Mis
souri-Columbia in which capacity he served until 1973. Since then
he has remained active as Professor of Pediatrics.
These are but milestones which tell us little about the per
son whose journey they mark. He is, and was always, a talented
physician, teacher, and research scientist whose energy was spent
in making better the lives of children, both sick and well. The
interesting questions are: What led him to these endeavors? What
did he accomplish? Why did he devote himself to these tasks?
The last question, "Why," cannot be answered with certainty
because individuals rarely understand themselves so completely and
observers never do. Probably what one does in life is a product
of opportunity and personality. As will be recounted, Dr. Jackson
had an early introduction to biological research and this, judging
subsequent events, caught his interest.
An even temperament which has enabled him to succeed arises
in part, at least, from certain facets of his character of which
four come to mind. First, he has a deep religious faith which is
a natural part of his everyday life.
Second, he is truly a "family man." He and Mrs. Jackson have
enjoyed many years together and have raised a family which is a
constant source of pleasure and support.
ix
x ROBERT L. JACKSON
Third, he has but one approach to all people. He is a superb
clinical scientist and a demanding teacher, but with students, pa
tients, patients' parents, and colleagues, the only interpersonal
relationship he understands is friendship. A warm regard for him
as a person persists in patients and students for years after
their initial contact.
The fourth characteristic is a true love for children --his
own, his patient, or, for that matter, any child. This is the
solid base for all his work and is, perhaps, as close as one can
come to "why."
How he proceeded into his life work is a bit easier to ascer
tain. As an undergraduate at Notre Dame he majored in chemistry
and as a senior was a laboratory assistant in organic chemistry.
It was then that he did his first research which concerned the
chemistry of pyridine. While a medical student at Michigan he
worked at a community hospital in Ann Arbor, St. Joseph Mercy
Hospital, and became involved in investigation into cystinuria
and the pharmacological properties of caffeine. Research became
a daily part of life as a house officer and soon after he began
to focus on two fields in particular --diabetes and nutrition. In
many ways these studies were related, particularly those concern
ed with the nutritional needs and the growth and development of
diabetic children. Dr. Jackson made important contributions in
the field of rheumatic heart disease and the prophylaxis of rheu
matic fever and in renal disease. However, the major thrust for
40 years has been the management of the juvenile diabetic.
Since the discovery of insulin, the treatment of the child
with diabetes has been revolutionized. In the beginning, abso
lutely nothing was known about what would happen to a diabetic
child whose life was prolonged by insulin. Since then, much has
been learned and each step of the way has been illuminated by Dr.
Jackson. He was influenced by Dr. Julian Boyd who postulated
very early that the goal of treatment should be a return to normal
physiology, including normal growth and development. Dr. Jackson
played a major role in the establishment of norms of growth of
well children and demonstrated that these could and should apply
to diabetic children. To this end, he conducted nutritional
studies and research into the effects of various types of insulin,
their combinations, and timing of their use. With his coworkers
he demonstrated fully that the diabetic child could achieve a
normal life.
Finally, he turned his attention to the question of whether
the specific vascular disease of diabetes could be prevented by
treatment. This last work has continued to the present day and
there is now a widening acceptance of the necessity for careful
control of the juvenile diabetic. These would seem to be the out-