Some studies in the metabolic consequences of diabetes and the management of chronic pain.

This submission details work published between 1979 and 1989 into some of the metabolic consequences of diabetes and the management of chronic pain. The results of these studies are to be found in the 26 published research papers appended. 1. The metabolic consequences of diabetes: studies in this area are various but fall into several distinct sections, a) the use of cortisol creatinine ratio as a marker for nocturnal hypoglycaemic episodes, these studies looked at the possibility that the stress response to hypoglycaemia could be used to identify episodes of nocturnal hypoglycaemia in insulin treated diabetics, b) investigations of the phenomenon of chlorpropamide alcohol flushing. These studies were designed to investigate the possibility that the tendency of some noninsulin dependent diabetic patients to flush when taking alcohol concurrently with chlorpropamide was important as a marker of their susceptibility to the long term complications of the disease, c) other studies involving the metabolic aspects of diabetic complications. The role of magnesium in glucose disposal; urinary albumin as a marker of renal disease; haemoglobin glycosylation and retinopathy; hormones in pregnancy. 2. The management of chronic pain: this work arose as a natural continuation of the work with cortisol as a marker for hypoglycaemic stress and looked at the stress response to other clinical interventions such as surgery and in subjects who experienced chronic pain and sought to discover how this might affect recovery from surgery and general patient well being. As a consequence of these studies a more general assessment was made of pituitary function before and after alcohol destruction of the pituitary as a treatment for the relief of chronic pain. Much of the work required the development of new analytical rests for various analytes e.g. chlorpropamide, free insulin, insulin antibodies, plasma acetate and urinary albumin.