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

DKA-hyperosmolar coma is a readily diagnosed and easily treated, potentially catastrophic emergency that regularly occurs in both Type I and Type II diabetics. This review emphasized that diabetic ketoacidosis and hyperosmolar coma can, and very frequently do, occur concurrently, but it is the hyperosmolar state rather than the DKA that is the primary cause of coma and death in this condition. One must therefore vigorously treat the hyperosmolarity and resulting dehydration, especially when total calculated osmolarity exceeds 230 to 240 mOsm/L. The major aim of treatment is to rapidly replace the major water loss that is responsible for this clinical condition and to stimulate glucose metabolism with insulin. The diagnosis of this dangerous condition is relatively simple. The therapy, in most regards, is equally apparent. There are good data demonstrating that the prompt recognition of DKA-hyperosmolar coma and the simple institution of rapid rehydration have continued to reduce the mortality and complications of this potentially disastrous complication of diabetes mellitus.
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PMID:Diabetic ketoacidosis and hyperosmolar coma. 161 73

We studied 13 children and adolescents during diabetic ketoacidosis; the duration of diabetes ranged from 1.4 to 6.0 years. A group of 13 diabetic sex, age and duration of disease-matched children served as control. Patients in ketoacidosis showed important abnormalities of T subset percentages (OKT3: 63.4 +/- 1.87% vs 72.1 +/- 3.4; p less than 0.001. OKT4: 37.18 +/- 1.85% vs 44.6 +/- 3.9; p less than 0.01. OKT8: 28.5 +/- 6.51% vs 28.1 +/- 1.9; p less than 0.04) and impaired neutrophil chemotaxis (53.10 +/- 3.3 vs 88.1 +/- 7.2; p less than 0.001). The patients showed normal levels of all classes of immunoglobulins. No correlation was observed between these abnormalities and the degree of ketoacidosis or glycaemia. When the patients were re-evaluated out of ketoacidosis, the values of the immunological parameters were normal and similar to those of the control group.
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PMID:[Immunologic changes in diabetic ketoacidosis]. 162 70

This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.
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PMID:The death of a child with diabetes from neglect. A case study. 162 64

During a 10-year period, 101 children with Type 1 (insulin-dependent) diabetes mellitus were admitted to the Department of Paediatrics of the University Hospital in Khartoum, Sudan. The age distribution of the patients showed a steady increase from age one to ten years followed by a sharper increase around puberty. A higher number of cases were diagnosed during the cooler compared to the warmer months of the year (p less than 0.05). Family history of Type 1 diabetes was reported in 14.9% of patients. Diabetic ketoacidosis was a presenting symptom in 82 patients (81.2%) and 93 patients (92.1%) have had at least two documented episodes of ketoacidosis during the follow-up period. Almost all patients were treated with bovine insulin given as a single dose per day. An initial remission period was not observed in any of the patients. Four years after diagnosis, the average daily dose of insulin used by the patients was greater than 2.0 U/kg body weight and the mean HbA1C was 13.4% (reference value 5.3-6.7%). Seventeen patients (16.8%) were known to have died during 399 person-years of observation resulting in a mortality rate of 42.6 per 1000 person-years of follow-up. Another 29 patients (28.7%) for no apparent reason did not attend a follow-up examination after discharge from hospital. Some of these patients might have died in other hospitals or at home. The study emphasizes the need for urgent measures to increase public awareness of diabetes and to improve methods of case-finding and management of diabetic patients.
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PMID:Clinical pattern of childhood type 1 (insulin-dependent) diabetes mellitus in the Sudan. 164 42

The influence of the acidotic state on the thyroxine (T4) peripheral metabolism was studied in two different forms of metabolic acidosis, ie infantile diarrhea and diabetic ketoacidosis. The serum concentrations of T4, free T4 (FT4), triiodothyronine (T3), reverse T3 (rT3), thyrotropin (TSH) and thyroxine-binding globulin (TBG) were measured and compared to healthy control groups. Lower T4 and T3 and higher rT3 serum concentrations were found in both tested groups of patients in relation to the control groups. In infants with severe metabolic acidosis FT4 values were lower than those observed in the control group. In addition, serum TBG levels were lower in diabetic patients as compared to control subjects. Despite the reduced serum T3 and T4 concentrations in both groups of patients, TSH concentrations, were within the normal range. Therefore, we concluded that acidosis caused either by diarrhea (not so far described) or by diabetes mellitus (well documented up to now) affects the thyroid hormones metabolism in a similar way, at least as far as the thyroid hormones blood levels are concerned.
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PMID:Thyroid hormones changes in infants and children with metabolic acidosis. 176 6

Diabetic ketoacidosis is frequently precipitated by infections. We report three cases in which ketoacidosis was induced by genital herpes infection. There is good evidence that early treatment with systemic Acyclovir is effective in patients with a first attack of genital herpes. Therefore genital examination should be considered in patients with diabetic ketoacidosis particularly when there are symptoms of genital herpes. During episodes of recurrence, diabetic patients need to monitor their blood sugars more frequently and adjust insulin requirements accordingly. We believe that this is the first description of ketoacidosis being associated with this increasingly common and recurrent infection.
Diabetes Res Clin Pract 1991 Aug
PMID:Diabetic ketoacidosis precipitated by genital herpes infection. 177 18

It has been suggested that screening all patients with diabetes diagnosed in later life for islet cell antibodies (ICA) would help predict insulin dependence. We have surveyed the case notes of 55 patients (22 male; ages 37-88 years) who were found to be ICA positive over a 9-year screening period to assess what contribution knowledge of ICA status made to their management. Forty-two patients had been put on insulin (half within 6 months of diagnosis and the rest after up to 6 years). Of the 13 patients not on insulin, six were on diet alone and seven on oral hypoglycaemic agents after a median follow-up of 3 years. In 37 of the 42 patients, insulin treatment was started for clinical rather than immunological reasons (diabetic ketoacidosis, ketonuria, weight loss and/or severe symptoms). Five patients were started on insulin because of ICA status when there was no compelling reason on clinical grounds. Knowledge that seven non-insulin-treated patients were ICA positive made doctors reluctant to discharge them from clinic. The data suggest that routine ICA estimation in this age group is unnecessary, as the decision to treat with insulin is best made on clinical grounds, and ICA estimation can lead to unwarranted insulin treatment, or anxiety in patients and doctors who are aware of a positive result.
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PMID:Does knowledge of islet cell antibody status help in managing diabetes presenting in middle and old age? 182 49

In Suleimania Children's Hospital, Riyadh, Saudi Arabia, 110 diabetic children were diagnosed and followed over a 5-year period (1985-1989). Seventy-five percent (82/110) were of Saudi origin and 54% (59/110) female. Their parents were often related, 31% (34/110) being first degree cousins, and 12% (13/110) second degree cousins. First degree family history was positive for Type 1 diabetes in 28% (31/110). Among these cases, siblings accounted for 26%, fathers 2%, and mothers none. Family history was also positive for Type 2 diabetes in 35% (38/110) and for both Type 1 diabetes and Type 2 diabetes in 14% (15/110). Mean age at onset was 5.9 years (7 months to 12 years). Thirty percent (33/110) of the patients were under 3 years of age on admission. The most common clinical presentation was diabetic ketoacidosis, seen in 67% of the patients (74/110).
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PMID:Childhood diabetes in Saudi Arabia. 182 6

The acute and chronic complications of diabetes account for the morbidity and mortality associated with this disease. Acute complications include diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia. Chronic hyperglycemia is central to the pathophysiology of chronic complications such as cardiovascular and peripheral vascular disease, retinopathy, nephropathy, and neuropathy. Pathophysiology and assessment of, and interventions for these complications are discussed.
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PMID:Complications of diabetes: acute and chronic. 184 Sep 72

Diabetes and eating disorders can be a deadly combination. Patients may omit or reduce their insulin dosages, which will induce glycosuria. Counseling and behavior modification are essential to prevent the development of complications such as DKA, frequent hypoglycemia, and the early onset of chronic complications. Diabetes education and insulin regulation must be combined with an interdisciplinary team approach to correct maladaptive coping mechanisms.
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PMID:Eating disorders as a special problem for persons with insulin-dependent diabetes mellitus. 189 3


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