Acute hypoxia improves insulin sensitivity (SI2*) and β cell function in individuals with Type 2 Diabetes

Type 2 diabetes is a multifactorial metabolic disease characterized by defects in β-cells function, insulin sensitivity, glucose effectiveness and endogenous glucose production (1). It is widely accepted that insulin and exercise are potent stimuli for glucose transport (2). Acute exercise is known to promote glucose uptake in skeletal muscle via an intact contraction stimulated mechanism (3), while post-exercise improvements in glucose control are due to insulin-dependant mechanisms (2). Hypoxia is also known to promote glucose uptake in skeletal muscle using the contraction stimulated pathway. This has been shown to occur in vitro via an increase in β-cell function, however data in vivo is lacking. The aim of this study was to examine the effects of acute hypoxia with and without exercise on insulin sensitivity (SI2*), glucose effectiveness (SG2*) and β-cell function in individuals with type 2 diabetes. Following an overnight fast, six type 2 diabetics, afer giving informed written consent, completed 60 min of the following: 1) normoxic rest (Nor Rest); 2) hypoxic rest [Hy Rest; O2 = 14.6 (0.4)%]; 3) normoxic exercise (Nor Ex); 4) hypoxic exercise [Hy Ex; O2 = 14.6 (0.4)%]. Exercise trails were set at 90% of lactate threshold. Each condition was followed by a labelled intravenous glucose tolerance test (IVGTT) to provide estimations of SI2*, SG2* and β-cell function. Values are presented as means (SEM). Two-compartmental minimal model analysis showed SI2* to be higher following Hy Rest when comparisons were made with Nor Rest (P = 0.047). SI2* was also higher following Hy Ex [4.37 (0.48) x10-4 . min-1 (μU/ml)] compared to Nor Ex [3.24 (0.51) x10-4 . min-1 (μU/ml)] (P = 0.048). Acute insulin response to glucose (AIRg) was reduced following Hy Rest vs. Nor Rest (P = 0.014 - Table 1). This study demonstrated that 1) hypoxia has the ability to increase glucose disposal; 2) hypoxic-induced improvements in glucose tolerance in the 4 hr following exposure can be attributed to improvements in peripheral SI2*; 3) resting hypoxic exposure improves β-cell function and 4) exercise and hypoxia have an additive effect on SG2* in type 2 diabetics. These findings suggest a possible use for hypoxia both with and without exercise in the clinical treatment of type 2 diabetes.

Sensory imagery in individuals who are blind and sighted: examining unimodal and multimodal forms

Introduction: Previous research has suggested that visual images are more easily generated, more vivid and more memorable than other sensory modalities. This research examined whether or not imagery is experienced in similar ways by people with and without sight. Specifically, the imabeability of visual, auditory and tactile cue words was compared. The degree to which images were multimodal or unimodal was also examined. Method: Twelve participants totally blind from early infancy and 12 sighted participants generated images in response to 53 sensory and non sensory words, rating imageability and the sensory modality, and describing images. From these 53 items, 4 subgroups of words, which stimulated images that were predominantly visual, tactile, auditory and low-imagery, respectively, were created. Results: T-tests comparing imageability ratings from blind and sighted participants found no differences for auditory and tactile words (both p>.1). Nevertheless, whilst participants without sight found auditory and tactile images equally imageable, sighted participants found images in response to tactile cue words harder to generate than visual cue words (mean difference: -0.51, p=.025). Participants with sight were also more likely to develop multisensory images than were participants without sight (both U≥15.0, N1=12, N2=12, p≤.008). Discussion: For both the blind and sighted, auditory and tactile images were rich and varied and similar language was used. Sighted participants were more likely to generate multimodal images. This was particularly the case for tactile words. Nevertheless, cue words that resulted in multisensory images were not necessarily rated as more imageable. The discussion considers whether or not multimodal imagery represent a method of compensating for impoverished unimodal imagery. Implications for Practitioners: Imagery is important not only as a mnemonic in memory rehabilitation, but also everyday uses for things such as autobiographical memory. This research emphasises both the importance of not only auditory and tactile sensory imagery, but also spatial imagery for people without sight.

A voice for change? Trust relationships between ombudsmen, individuals and public service providers

There has been a debate for years about what the role of the ombudsman is. This article examines a key component of the role, to promote trust in public services and government. To be able to do this, however, an ombudsman needs to be perceived as legitimate and be trusted by a range of stakeholders, including the user. This article argues that three key relationships in a person’s complaint journey can build trust in an institution, and must therefore be understood as a system. The restorative justice framework is adapted to conceptualize this trust model as a novel approach to understanding the institution from the perspective of its users. Taking two public sector ombudsmen as examples, the article finds that voice and trust need to be reinforced through the relationships in a consumer journey to manage individual expectations, prevent disengagement, and thereby promote trust in the institution, in public service providers, and in government.