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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Controlled respiration should have a place not only in cases of hypoventilation but also in the treatment of comatose and hyperventilating persons. Hyperventilation is liable severely to interfere with the blood supply to the brain, and this disturbance, in conjunction with the primary disease responsible for the comatose condition, such as hyperglycaemia, diabetes or cerebral trauma, may be a contributing factor to the lethal outcome. Controlled respiration helps towards regulation of the cerebral circulation and of the acid-base balance and provides improved conditions for normalization of the disturbed metabolism and thus greatly improves the prognosis of these cases.
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PMID:[Enlarge indications for controlled respiration (author's transl)]. 9 35

The authors analyzed the effects of obesity/non-obesity in 162 epidoses of severe metabolic disturbances. Ketoacidosis and hypoglycaemics comas were more frequent in the non-obese group of diabetics, who were often insulin treated; whereas hyperosmolar coma and lactic acidosis were frequent in the obese group of diabetics, usually not treated with insulin. In the obese group both advanced age as well as a higher frequency of degenerative complications impaired the prognosis of these metabolic accidents. However the mortality rate was not significantly different in the two groups of patients. Despite the importance of the weight balance in the natural history of diabetes mellitus, it did not seem to influence the clinical aspects nor did it modify the therapeutic management of the major metabolic disturbances which occur in diabetes.
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PMID:[Major metabolic disturbances occur in diabetic patients whether they are obese or not (author's transl)]. 11 Dec 20

Plasma renin activity (PRA) in 40 diabetic patients and 42 healthy controls was investigated using the method of Pickens in modification of Serebrovskaja et al. (1967). PRA was slightly lower in the whole group of diabetes but the difference was not significant. The subgroup of 20 maturity-onset diabetics had significantly lower PRA in comparison with 22 controls of similar age, while PRA in juvenile diabetics did not differ significantly from matched controls. In patients without clinical signs and symptoms of microangiopathy PRA was as high as in the controls. In diabetics with microangiopathy PRA was significantly lower. PRA was also lower in patients with longer duration of the disease. The stimulation of juxtaglomerular apparatus with sodium free diet and diuretic drugs resulted in an increase of PRA both in controls and diabetics. This suggests a functional depression of PRA in diabetic patients. In diabetics with ketoacidosis PRA was higher than in control subjects and decreased after disappearance of ketoacidosis. A high level was recorded in a patient with hyperosmolar coma and a very low level in a patient with polyneuropathy and severe orthostatic hypotension. The possible mechanisms involved in the changes of PRA in diabetic patients are discussed.
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PMID:Plasma renin activity in diabetic patients. 11 36

The typical patient with diabetes mellitus seen at major hospitals in Papua New Guinea between 1974 and 1977 had florid symptoms, a very high blood glucose, was non-obese and non-ketotic and, frequently had neuropathy and proteinuria. In 25% hypertension was present which was significantly more common in the presence of proteinuria. Diagnosis was often delayed by failure to test urine for glucose and treatment was usually ineffective so that coma, usually non-ketotic, severe infections and gangrene occurred frequently. Although not as common as in other South Pacific countries, diabetes is increasing in Papua New Guinea. The provision of simple adequate facilities to test urine for glucose in all hospitals and the establishment of diabetic out-patient clinics in major centres to instruct both patients and other health workers are essential to improve treatment and reduce mortality and morbidity.
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PMID:The clinical characteristics of diabetes mellitus in Papua New Guinea. 29 6

During the past decades insulin has been given in relatively high doses when treating diabetic coma. Recently low-dose insulin treatment has been proposed by several groups. In the reported investigation insulin was initially given in moderate to high doses (12-200 U/h) with a steady reduction in dose during the course of treatment. Insulin infusion was regulated either manually with an adjustable infusion pump (7 patients) or automatically with an artificial endocrine pancreas (glucose-controlled insulin infusion system; 11 patients). Thus 18 patients with decompensated diabetes mellitus (coma or precoma) were treated. In 14 patients with ketoacidotic decompensation laboratory data on hospital admission were: blood glucose 7.35 +/- 0.61 g/l, serum potassium 4.7 +/- 0.4 mmol/l, pH 7.1 +/- 0.04, base excess - 19,7 +/- 2.2 mmol/l (x +/- SEM). The other patients had hyperglycaemic or hyperosmolar non-ketotic decompensation. In all patients controlled reduction of blood glucose levels was achieved within 2.3 to 18 hours. The amounts of insulin infused during this ranged from 17 to 320 units, but in one instance was 1950 units. There were no complications.
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PMID:[Insulin treatment of decompensated diabetes mellitus with a new artificial endocrine pancreas (author's transl)]. 33 2

It is today's general medical opinion that children's diabetes mellitus was uncommon in the past. It was generally admitted at that time the initail stages were so sudden as to make difficut its early diagnosis. It's increased incidence is at present an alarming truth; however, a parallel increase of diabetic coma or of mulminant types has rather dropped. Diabetes may be diagnosed by just considering the main symptoms at the onset which are polydipsia, polyuria and weight loss. If an early diagnosis is not made, acidosis (abdominal pain, nausea, vomiting) may appear within a few days or weeks followed by coma (Kussamul's acidotic respiration and dehydration). Coma may be avoided by an early diagnosis and a life may be saved. It must be stressed that an important percentage of children and adolescents show a slow and gradual evolution (week or months) of their diabetes: gradual weight loss, sometimes with noticeable polyphagia, occasional enuresis, but without other associated symptoms. Asymptomatic, intermittent glucosurias are also frequent; they vary in magnitude an almost always they appear without ketonuria and with fasting normal glycemia. According to our experience they may precede in weeks or months the clinical manifestations of the disease. Postprandial glycemia is a sure diagnostic resource; it is of greater trustworthines than fasting glycemia; therefore we advise it as a routine diagnostic procedure which we recommend widely. In uncertain situations, the oral glucose tolerance test is advisable.
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PMID:[Diabetes mellitus in childhood and adolescence. Clinical types]. 48 58

A study has been carried out on 262 children with juvenile diabetes and their parents, treated up to 10 yr on an ambulatory basis by a multidisciplinary team composed of pediatric endocrinologist, nurse, dietitian, psychologist, and social worker. Comparison of the findings with those of a study performed before inception of the Counselling Center for Juvenile Diabetics revealed the following positive influences: the degree of control attained was both higher and sustained with greater regularity; there were fewer complications with no episodes of coma, brittle diabetes, or severe ketoacidosis and almost no need for hospitalization; the attitude of the affected child, his parents, and his teachers was found to be considerably improved; there was better understanding of the nature of the disease and its requirements; the child's motivation to maintain the diabetic regimen was greater and conflicts within the family circle were markedly reduced; the child's self-concept was much higher; and both scholastic achievements and social adjustment were greater. We concluded that psychological stability is a basic factor in the control of diabetes, and the value of the multidisciplinary approach in the treatment of this chronic disease is indicated.
Diabetes Care
PMID:A multidisciplinary, comprehensive, ambulatory treatment scheme for diabetes mellitus in children. 51 Jan 29

The diagnosis of occlusion of the intradural vertebrobasilar artery (OIDVBA) was made by means of cerebral angiography in 22 patients. The clinical presentation, course and followup were studied in conjunction with the angiographic findings in each case and the following conclusions made. OIDVBA is not rare. It occurs one-fourth as often as occlusion of the carotid artery. The correct diagnosis is not made clinically before angiography in the majority of patients. Complete visualization of the neck and intracranial vasculature is necessary to document the occlusion. Atherosclerotic thrombosis is the most common type of occlusive lesion. The most common predisposing factors are atherosclerosis, hypertensive cardiovascular disease, diabetes mellitus, and developmental vertebrobasilar hypoplasia. Most patients with occlusion are in the 7th and 8th decades of life and transient attacks of vertebrobasilar ischemia precede the occlusion in one-half of the cases. Emboli usually lodge in the terminal portion of the basilar artery whereas thrombotic occlusions tend not to be located in a characteristic segment. A majority of patients diagnosed angiographically survive their OIDVBA, but most distal occlusions result in death, often following several weeks of coma. In the surviving majority, disturbance of gait, impairment of vision, and symptoms of transient vertebrobasilar ischemia are the most common sequelae.
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PMID:Occlusion of the intradural vertebrobasilar artery. 63 67

Using the life table method, 962 cases of infarction, 279 cases of hemorrhage, and 243 cases of undetermined type of stroke, occurring in Manitoba between Jan 1, 1970, and June 30, 1971, were analyzed for factors affecting survival. Survival until Dec 31, 1973, was found to be adversely affected by the presence of coma or unconsciousness and the absence of localizing signs and symptoms. Also, the prognosis was poor if the heart was enlarged on the x-ray film or the ECG was abnormal. On the other hand, the presence of individual clinical entities such as hypertension, hypertensive heart disease, myocardial infarction, atrial fibrillation, or diabetes did not affect the survival significantly. These findings will help in predicting the prognosis and in planning for management of stroke cases.
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PMID:Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. II. Clinical variables and laboratory measurements. 63 54

We report the case of a boy aged 9 1/2 years with hyperosmolar, nonketotic diabetic coma. He was not known to be diabetic prior to the onset of coma. Pathogenetic aspects of this rare manifestation of juvenile diabetes are discussed. It is dangerous to decrease osmolarity too rapidly during infusion of very hypotonic solutions. Treatment with continuous low-dose insulin infusion may cautiously be tried.
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PMID:[Hyperosmolar nonketotic diabetic coma. Treatment with continuous low-dose insulin infusion (author's transl)]. 73 22


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