Introduction: Patients with diabetes mellitus are prone to wide variation of blood glucose. Early postprandial hyperglycemia, and delayed postprandial hypoglycemia remain a major challenge, especially in insulin treated diabetic patients. Soluble fibers, by delaying glucose absorption, may prevent both early hyper and late hypoglycemia. Psyllium, a known soluble fiber, has been recommended to diabetic patients by many experts. To prevent wide variations in the blood glucose levels in diabetic patients, we tried to formulate, produce and test psyllium biscuits as an inter-diet or midnight snack. 
Methods: At the first phase of this study, different combinations of psyllium and other constituents of biscuits were evaluated to produce a brickle, non-bloating biscuit with acceptable taste, size, and weight. After primary production of three formulations, a group of medical students selected a formulation as the most palatable and acceptable one. At the third phase, in a randomized, double blind study on diet controlled diabetic patients, this biscuit was compared with placebo, regarding changes of hourly blood glucose level during four hours after ingestion. 
Results: Sixty diabetic patients (33 women and 27 men) participated in the study. Age and BMI were similar between groups (p=0.37 and 0.41 respectively). Fasting (hour 0) and blood glucose at hour 4 were not different, but at hours 1, 2 and 3 were significantly lower in the psyllium biscuit group (p=0.001, 0.001, and 0.012 respectively). Changes in blood glucose during 4 hours after eating biscuits were more sluggish in the psyllium biscuit group. In the control group peak serum glucose occurred one hour after eating but in the psullium biscuit group it occurred between hours one to three.
Conclusion: Psyllium biscuit may be considered as a suitable snack in diabetic patients. Larger studies focusing rate of early postprandial hyperglycemia, delayed postprandial hypoglycemia and HbA1c may help to determine its role in different diabetic patients.

Background and aims: Atherosclerosis is a chronic disease involving cholesterol deposition within the arterial wall. LDL oxidation is a major step in atherosclerosis. Cholesterol returning to the liver and the scavenging of oxidants by HDL can provide an important first line defense against atherosclerosis. Elevation of HDL is considered an anti-risk factor for atherosclerosis. 
The purpose of the present study was assessment of the effects of Vitamin C, gemfibrozil, and their combination on serum HDL and other lipids in type 2 diabetic patients.
Methods:This was a randomized single blind clinical trial. Type 2 diabetic patients were divided in 3 groups after 1 month of lifestyle and diet modification. Oral vitamin C (1000 mg) and gemfibrozil (600mg) or their combination was prescribed for groups A, B and C respectively. After twelve weeks, lipid profile of participants were determined and compared to the baseline values. Mean lipid changes were also compared between groups.
Results: 67 participants entered to the present study. Forty-six patients finished the study protocol (18, 14 and 14 in the A, B and C groups respectively).
The mean HDL elevation in groups A, B and C was 6.3, 4.4 and 5.0 mg/dl respectively (p=0.02, 0.01 and 0.03 respectively).
Significant decrease of TG, cholesterol and LDL was observed in groups B and C, but not group A.
Conclusion: The present study reveals that vitamin C can effectively elevate serum HDL levels in diabetic patients, but in the presence of additional lipid disorders, other choices like gemfibrozil are more effective.

Background: Multiple cases of severe exogenous Cushing syndrome have been observed at broad geographic areas of Iran in a group of IV drug abusers due to illicit abuse of a narcotic drug named Norjizak. It composes variable combinations of opiates and dexamethasone. Here we present variable endocrine manifestations in a case series of 23 patients.
Methods: Patients were first evaluated and managed based on the present illness, and then entered a detoxification program by a medical team. Clinical data were collected by interview and the patient's files. Biochemical analyses of the norjizak were conducted by HPLC. 
Results: Twenty-three patients (2 women and 21 men) enrolled in the present study. The major complaints beyond withdrawal symptoms included severe edema, cushingoid features, osteoporotic fracture, impairment in glucose tolerance, decreased libido, amenorrhea, and sepsis. Most patients had started with 2 or 3 vials/day, and then had increased the dose compulsively to maximum of about 15-25 vials per day.
Conclusion: Norjizak syndrome will probably soon become a medical catastrophe due to multiple complications and extensive acceptance between addicts.

Introduction: Opium is commonly advertised as an anti-diabetic agent. This misconception is prevalent even between some physicians. We customarily observe frequent cases of chronic diabetic complications in diabetic addicts. This study was performed to test whether opium can affect glucose homeostasis by evaluation of insulin resistance in non-diabetic opium addicts.
Materials and methods: this was a two-phase study on addicted patients referring for opium cessation to the Substance Control Unit of Khorshid hospital, Isfahan, Iran.
In the first phase, insulin resistance was compared between the patients and matched controls by using HOMA-IR formula (fasting plasma insulin*fasting plasma glucose/22.5). In the second phase, insulin resistance was compared between three steps of opium cessation in the patients:
1-	At the entrance of the study, before any Intervention
2-	One week after methadone cessation
3-	One week after successful naltrexone cessation
Basal data of the participants and also mean fasting plasma glucose, fasting insulin and HOMA-IR were compared between two groups (case and control) by t-test. These variables were compared in three steps of opium cessation in patients, by repeated measure ANOVA.
Results: At the first phase142 cases entered to the study, 60 in the control and 82 in the case group. Thirteen patients and equal number of matched controls finished the study. Fasting glucose was significantly higher in addicts compared to the normal controls (90.6 versus 80.9, p<0.001). There was no significant difference in fasting insulin and HOMA-IR between patients and the control group (10.57 versus11.84, p=0.67 and 2.44 versus2.39, p=0.94 respectively). 
Fasting insulin, fasting glucose, and HOMA-IR did not changed significantly at three steps of opium cessation in opium addicts.
Conclusion: the present study shows opium addiction predisposes to higher fasting plasma glucose and higher insulin resistance. It may also be associated with lower beta cell function.

Background: Despite long-standing iodine supplementation in Iran, the prevalence of goiter remains high in some areas. This suggests other nutritional deficiencies may be considered as responsible factors of goiter persistence. Therefore, we assessed the prevalence of vitamin A deficiency in children living in a mountainous area in Iran to evaluate its correlation with goiter. 
Methods: In this cross-sectional study, 1828 students from the 108 primary schools of urban and rural areas of Semirom in central Iran were selected by multistage random cluster sampling. After obtaining written consent from their parents, the children were examined for goiter grading. Grade 2 goitrous children (108 cases) were compared with non-goitrous children (111 children) as control group for serum Retinol concentration.
Results: Overall, 36.7% of 1828 students had goiter. The mean and median urinary iodine excretion level was 19.3 and 18.55µg/dl respectively. This was within normal limits. Twenty-four of 214 studied students (11.2%) had vitamin A deficiency. Of these, sixteen children were goitrous. There was significant difference in goiter prevalence between vitamin A deficient and sufficient participants (66.7% versus 47.4%, p=0.037, odds Ratio=2.222). After adjustment for TSH, T4, puberty status, BMI and sex by logistic regression model, vitamin A deficiency was associated with a relative risk of 2.71 for the development of goiter(p=0.038).  
Conclusion: Vitamin A deficiency is a risk factor for goiter persistence in iodine-replenished areas. It should be considered in programs against iodine deficiency disorders.

Introduction:
Lower limb ulcer is one of the most important complications of diabetes mellitus.
Most diabetic foot ulcers do not heal completely, or heal with a very slow rate.
Growth factors are promising, but expensive and still experimental. 
Insulin role in cell growth and differentiation, and its cross reaction with IGF receptors, suggest important roles for this hormone in topical treatments of diabetic ulcers. If prove effective, because of accessibility, safety and appropriate price, it may become a popular agent in topical treatment of diabetic foot ulcers.
Material and Methods:
This study is a non-blind, prospective clinical trial. After obtaining written consent, patients with non-healing diabetic foot ulcers (duration of ulcers more than 6 months without healing) were enrolled to the present study.
Diabetic foot ulcers were treated with standard measures plus topical insulin.
Debridment as a major part of standard treatment was considered twice a week. Every day, ulcers were washed and cleaned with sterile saline and then, topical insulin was applied on the ulcers. 
First, 40 IU of NPH insulin was pushed directly on the ulcer and then ulcer was covered or filled with a water-based gel containing 40 IU of NPH insulin per ml in sterile conditions. Ulcers were followed clinically until complete healing. Mean of ulcer duration before and after topical insulin were compared by t test. Percent of healed ulcers were also evaluated.
Result:
Twelve patients with non-healing diabetic foot ulcers entered to this study. All ulcers were healed by topical insulin, although treatment duration was different. 
Mean of treatment duration for ulcers with routine standard measures, without healing was 10.73 months (Mean ±SD: 10.73±4.94).
Mean of treatment duration until ulcer healing was 1.95 months with topical insulin (Mean ±SD: 1.95±0.78). These were significantly different (P-value<0.0001). No cases of hypoglycemia or any other complication of treatment was observed.
Conclusion: Topical insulin is a safe and effective adjuvant therapy for non-healing neuropathic diabetic foot ulcers.