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

Diabetic ketoacidosis remains a significant cause of death in cases of insulin-dependent diabetes mellitus (IDDM). Among patients hospitalised for diabetic ketoacidosis, the death rate is 5-10 per cent, cardiovascular disease, infection, and ARDS (adult respiratory distress syndrome) being major contributory factors, whereas the degree of acidosis does not differ from that among survivors. Ketoacidosis is a major determinant of the two-fold higher mortality among the youngest age-groups of IDDM patients. The age-specific incidence of ketoacidosis among patients under 20 years of age is several time higher than that among patients over 50. Intensified insulin treatment, using multiple injections or insulin pumps, probably results in an increased risk of insulin deficiency owing to the smaller insulin depots. Thus, there is a need of intensified testing for ketonuria and improved education of patients, physicians and other health care personnel, in order to promote the prevention or rapid, effective treatment of diabetic ketoacidosis.
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PMID:[Diabetic coma--an unnecessary death]. 140 26

IDDM and eating disorders are common conditions in young women. Whether a specific association exists between these two disorders remains controversial. Some studies have suggested an increased incidence of eating disorders in young women with IDDM, whereas others have not detected such an increase. These differences may be attributable, at least in part, to methodological issues in study design, measurement tools, and relatively small sample sizes. Whether the prevalence of eating disorders in IDDM is increased will be resolved only by larger studies that use standardized diagnostic interviews. We suspect that certain aspects of IDDM and its management may trigger the expression of an eating disorder in susceptible individuals. Required dietary restraint and weight gain related to diabetes management are the factors most likely to be implicated. Eating disorders are relatively common in young women with IDDM and may contribute to impaired metabolic control with hypoglycemia and DKA, and to long-term microvascular complications of diabetes. Omission or reduction of required insulin, an extremely common means of weight control in these young women, is likely an important factor in this regard. Further research is required to determine more precisely the relationship between IDDM and eating disorders, and the effects of eating disorders on metabolic control and chronic complications of IDDM.
Diabetes Care 1992 Oct
PMID:Eating disorders and IDDM. A problematic association. 142 9

Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes mellitus that can be life threatening. Although DKA is often preventable, approximately 84,000 DKA-associated hospitalizations and 1800 DKA-associated deaths occurred in the United States during 1988. The Washington Department of Health (WDH) monitors DKA-associated hospitalizations to assist its chronic disease programs in preventing DKA-associated hospitalizations and deaths. This report summarizes surveillance of DKA hospitalizations among Washington state residents from 1987 through 1989.
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PMID:Hospitalizations for diabetic ketoacidosis--Washington State, 1987-1989. 143 70

The following is a case of a family with a pair of identical twins and a family history of insulin-dependent diabetes mellitus (IDDM). A 2 year old identical twin was first admitted to our hospital and diagnosed as IDDM based on diabetic ketoacidosis. His father has been treated with insulin since the diagnosis of IDDM at the age of 17. All family members had the HLA-DR4 and DQA1*0301 alleles, which are strongly associated with IDDM. The DR-DQ haplotypes of the father and both twins were DR4-DQW8 (DQB1*0302), which increases susceptibility to IDDM. Islet cell antibodies were positive only in the index twin at the time of diagnosis. The co-twin was considered to have beta-cell dysfunction based on the result of an intravenous glucose tolerance test.
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PMID:Case report of an insulin-dependent diabetes multiplex family with a pair of identical twins. 144 31

Analysis of the causes of development, clinical features of and treatment strategy in diabetic ketoacidosis (DKA) in 457 diabetics of various age groups (16-39, 40-60, over 60) has revealed a more grave course of this condition in old patients. This may be explained largely by a combination of diabetes mellitus with coronary disease or brain ischemia, that impede timely detection of DKA, this resulting in delayed hospitalization and deterioration of the vital prognosis.
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PMID:[Age-related features of the development and course of diabetic ketoacidosis]. 148 May 88

Urine glucose testing has been deemed by some to be nonessential in the management of diabetes mellitus since the technique and equipment for self-monitoring of blood glucose has become available. However, most physicians have experienced pitfalls in the management of diabetes mellitus when insulin dosage is adjusted daily based solely on the patient's monitoring of blood glucose. There have also been recent reports suggesting the use of urine glucose testing as a reliable and a reasonable alternative to monitoring of blood glucose in the management of diabetic subjects, including those using insulin as the mode of therapy. In this report, we describe a patient in whom diabetic ketoacidosis occurred during hospitalization as a result of inadequate insulin administration due to inaccurate capillary blood glucose test results. Furthermore, urine glucose and ketone values obtained simultaneously had been disregarded. If insulin therapy had been adjusted according to urine glucose results rather than blood glucose readings, diabetic ketoacidosis could have been averted in this patient. Urine glucose testing may provide a reliable backup for suspect whole blood glucose values and may prevent catastrophic events requiring expensive hospitalization. This report also delineates several potential procedural problems that exist in the technique of whole blood glucose monitoring and provides recommendations to overcome these deficiencies.
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PMID:Urine glucose testing: reliable backup for whole blood glucose monitoring. 155 42

Hyperglycemic emergencies are the most common endocrinopathies that require intensive care. It is estimated that between 10% and 15% of patients admitted to intensive care units experience complications of acute hyperglycemia. The common denominator of hyperglycemic emergencies is diabetes mellitus, a group of diseases in which, either because of beta-cell destruction of the pancreas or insulin receptor-site defects, there is a relative or absolute deficiency of insulin that results in hyperglycemia. In response to various precipitating factors, staggering hyperglycemia may develop in the form of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNK). The existence of DKA has been known since ancient times, and critical care nurses are familiar with the diagnosis. The more lethal disorder of HHNK was "rediscovered" in the 1950s and is occurring with greater frequency as clinical awareness of the condition grows and the elderly (who are at greatest risk for the disorder) populate critical care units in increasing numbers. Prevention is instrumental in abating deadly hyperglycemic emergencies. A positive outcome can be realized but only with timely diagnosis and prompt hormonal and fluid replacement.
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PMID:Hyperglycemic emergencies. 157 33

To study the relations between renal tubular disorder and glomerular dysfunction in the early phase of insulin-dependent diabetes mellitus (IDDM), we performed concomitant measurements of urinary beta-D-N-acetyl glucosaminidase (NAG), beta 2-microglobulin (BMG), and microalbumin in 29 of pediatric patients with IDDM, 15 normal controls, and 83 patients with non-diabetic ketoacidosis. Urinary NAG levels were significantly elevated in the IDDM patients compared with controls. Urinary BMG levels were also elevated in IDDM, however, they were not as prominent as NAG levels. Although urinary microalbumin levels were elevated in the IDDM patients, statistical analysis did not show any significant difference between the IDDM patients and controls. Urinary NAG and BMG concentrations were also increased in patients with non-diabetic ketoacidosis, suggesting a toxic effect of ketone bodies to renal tubular cells. Statistically significant correlations were noted both between urinary NAG and microalbumin and between urinary BMG and microalbumin. These results suggest that, in early phase of IDDM, microalbuminuria is preceded by elevations in urinary NAG and BMG levels, and that keton bodies have deleterious effects on renal tubular cells.
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PMID:Study on the relation between renal tubular disorders and glomerular dysfunction in the early phase of insulin-dependent diabetes mellitus in children. 159 97

Cytoplasmic islet-cell antibodies (ICA) and endogenous insulin secretion were studied in 46 Sudanese children (mean age 11.6 years) with newly diagnosed insulin-dependent diabetes mellitus (IDDM). Islet-cell antibodies were detected both by the indirect immunofluorescence (IF) and complement fixation (CF) methods. Endogenous insulin levels were measured as C-peptide concentration using radio-immunoassays. The degree of metabolic control of diabetics was judged by the presence of diabetic ketoacidosis (DKA) at onset, glycated haemoglobin (HbA1c) level and insulin requirement, expressed as dose per kg body weight per day, at the time of presentation. Twenty-nine patients (63%) had either IF-ICA or CF-ICA or both in their sera. These figures are significantly higher than those reported for African populations. Islet-cell antibody positive patients had significantly lower C-peptide concentration, higher HbA1c level, higher insulin requirement and higher prevalence of ketoacidosis at presentation. Furthermore, the C-peptide levels were higher in CF-ICA positive patients than in subjects who showed only IF-ICA positivity. Our findings show a clear association between ICA and severity of diabetes at clinical onset and also suggest that the presence of CF-ICA at or shortly after diagnosis of IDDM is indicative of preservation of some functioning beta-cell mass.
Diabetes Res Clin Pract 1992 May
PMID:Islet-cell antibodies and endogenous insulin secretion in Sudanese diabetic children. 160 Aug 56

A critical analysis of the evolution during the first 24 hours was undertaken in 41 children and adolescents (age: 10.1 +/- 4.6 years) treated for diabetic ketoacidosis. Three of 4 children presented with ketoacidosis revealing diabetes. One of 4 was less than 6 years of age. Severe ketoacidosis (pH less than 7.15) concerned one third of children and were more frequent in the group of adolescents with already known diabetes. In these patients, ketoacidotic decompensation was attributed to psychosocial factors in most cases. Evolution was favorable in all cases, without complication. Blood glucose levels decreased from 28.7 mmol/l on arrival to 16.2 mmol/l after 2 hours of treatment and became stable at 10 mmol/l from the 12th to the 24th hours. The corrected blood sodium levels were stable, showing the adequacy of infusion solute osmolarities. Blood potassium was maintained at a normal level owing to early potassium supplementation. Ketoacidosis was corrected after about 12 hours, without bicarbonate administration when pH was greater than 7.15. Average perfused volumes were 3 l/m2/24 hours. Insulin doses were 2 UI/kg/24 hours and were inversely correlated with the admission pH (r = -0.6; p = 0.0001). This study shows the efficacy of a treatment taking into account the pathophysiology of diabetic ketoacidosis and the knowledge of the complication risk factors, by foreseeing the adjustments to be done with respect to individual and/or at risk situations. These precise descriptive data, collected on a large group of patients, establish a reference basis to follow evolution in the course of the treatment of diabetic ketoacidosis in children.
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PMID:[Critical study of diabetic ketoacidosis in children. Initial description and course during the first 24 hours of treatment]. 161 Feb 73


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