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

A 21-year-old female patient complaining of frequent hypoglycemic attacks in the presence of a large amount of circulating insulin-binding antibodies without previous known immunization is described. In order to clarify the possible mechanism of the hypoglycemic attacks occurring in this new syndrome, changes in plasma glucose, plasma total and free immunoreactive insulin (IRI), and C peptide immunoreactivity (CPR) levels were investigated in the patient before, during, and after a three-hour glucose infusion. The character of her antibodies were also examined. An abrupt discontinuation of the glucose infusion caused a sharp decline in the plasma glucose level, reaching a nadir of 30 mg./100 nk, at 270 minutes; then she became unconscious. A huge amount of total IRI of 2,834 micron U./ml. was registered at 180 minutes, while the peak value of free IRI of 208 micronU./ml. was observed 45 minutes after the cessation of the glucose infusion. Plasma CPR was increased from high basal level, 19.6 ng./ml., to the maximum level of 29.2 ng./ml. The maximum insulin-binding capacity of IgG in the patient's serum was 6.25 mU./ml. The antibody-combining site was homogeneous, showing one high-affinity site (K: 1.1 X 10(9)M-1). Neither the prolonged fasting nor the administration of tolbutamide induced the hypoglycemic attack in the patient. The hypoglycemia may be explained by an unduly excessive amount of insulin liberated from a large pool of bound insulin irrespective of blood sugar level. The cause of the antibody production is also discussed.
Diabetes 1977 May
PMID:Mechanism of hypoglycemia observed in a patient with insulin autoimmune syndrome. 85 50

Fifty-nine patients with chronic pancreatitis were studied in retrospect. The incidence of overt diabetes was high, 36/59. Half of the diabetics were insulin-dependent, and among these labile diabetes with hyperglycemia and high amounts of glucose in the urine was not uncommon. Hypoglycemic episodes were noted in 14 of the 18 insulin-treated patients, and in 3 patients severe hypoglycemia was believed to be the cause of death. Mechanisms leading to such disastrous hypoglycemia are discussed, and a hypothesis regarding lack of glucagon as the cause of severe hypoglycemic attacks was experimentally tested by measuring pancreatic glucagon in plasma in two patients with pancreatic diabetes and severe brain damage following hypoglycemic coma. Low basal glucagon values were found, and the normal rise upon insulin-induced hypoglycemia was not seen. From these results it may be justified to suggest, firstly that glucagon should be used in the management of severe hypoglycemia in chronic pancreatitis, and secondly that a certain degree of hyperglycemia should be allowed in the treatment of diabetes in these patients.
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PMID:Diabetes and hypoglycemia in chronic pancreatitis. 86 1

An extracorporeal "closed-loop" system has been employed to maintain glycemia in the normal range during consumption of meals in nine insulin-treated diabetics. This artificial pancreas system incorporated continuous blood glucose monitoring (0.05 ml. per minute, delay time 90 seconds), a computer programed to respond to glycemia, and a hormone delivery system. Intravenous insulin delivery rates were determined by control parameters responsive to both glucose concentration and its rate of change. Because insulin-dependent diabetics often defend themselves poorly against hypoglycemia (in some cases due to inadequate glucagon responses), the instrument was also programed for exogenous glucagon delivery. A priori selection of ideal parameters for insulin and glucagon delivery for each individual is not yet possible. Consequently, when the parameters were used for the first time on each subject, they were varied over a reasonable range. This approach resulted in a corresponding variety of glycemic responses, the average of which characterized a set of initial parameters that is generally applicable. Appropriate control parameters are presented that successfully prevented hypoglycemia. Glucagon delivery directly related to glycemia appeared sufficient for this purpose, thus obviating the need for dextrose administration. This system provides a technique for complete normalization of blood glucose concentration in the types of diabetics tested, during both fed and interprandial periods. It has yielded insights essential to the development of more sophisticated future devices.
Diabetes 1977 Jul
PMID:Normalization of glycemia in diabetics during meals with insulin and glucagon delivery by the artificial pancreas. 87 73

Three patients experienced severe hypoglycemic encephalopathy during oral therapy of adult-onset diabetes mellitus. Disabling residual neurological deficits were observed in two of these patients. The insidious time course of drug-induced hypoglycemia appeared to prevent patient recognition of sustained hypoglycemia. These cases indicate the need for further caution in the administration of oral hypoglycemic agents.
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PMID:Encephalopathy induced by oral hypoglycemic drugs. 87 49

Hypoglycemia was diagnosed in 118 patients admitted to the University Children's Hospital Basel over 13 years, altogether 137 times. A definition of infantile and childhood hypoglycemia is discussed. Hypoglycemia was accepted as the correct diagnosis in 72 cases (group I), where 2 or more blood sugar values or at least one blood sugar value and one glucose value in the cerebrospinal fluid were below the limit for the age-group. In 46 cases only one abnormal blood sugar value vas documented (group II). In 19 cases no value was found to be definitely below the normal range. 58 patients were newborns up to 10 days of age. 34 patients (43 hospital admissions) were children in the agegroup after the newborn period. 65% of the newborns in group I and 58% of them in group II showed clinical symptoms concomitant with hypoglycemia. Convulsions (62%) were the most frequent feature. In more of the 76 patients was hypoglycemia documented as an isolated symptom. 75% of newborns were premature and/or of low birth weight. 50% had hypoglycemia and 20% verified central nervous system disease. 4 patients (5%) died in the hospital for reasons other than hypoglycemia. 15% (11 patients) had definite neurological symptoms when discharged from hospital. 30 of the 72 surviving neonates could be reexamined at a mean age of 26,5 months. 18% (13 patients) showed evidence of neurological disorders. 4 patients were readmitted with hypoglycemia at a later age, 3 were diagnosed as idiopathic and one as a ketotic hypoglycemia. One child developed diabetes mellitus at the age of 8 years.
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PMID:[On the syndrome of childhood-hypoglycemia. I. Definition of hypoglycemia in different age-groups and problems of neonatal hypoglycemia (author's transl)]. 89 34

Hypoglycemia (h.) in the postneonatal period was predominantly observed in male infants and children. The incidence was 0,51/1000 hospitalizations. The majority of cases was found in the agegroup around 2 years. Concomitant diseases (mostly infections of the upper respiratory tract or gastrointestinal tract) were found in 30 out of 43 hospitalizations. Convulsions and coma were the most frequent symptoms which were found in 43%. In 30% some degree of somnolence was obvious. Hypoglycemia was not considered in the differential diagnosis in any case by the physician treating first. Only 7 out of 34 cases a complicated biochemical work up resulted in an etiological diagnosis: one leucininduced h.; one ketotic h,; one h. in dystrophy and bronchopneumonia with septicemia; one h. in meningococcic septicemia; one h. in adrenal insufficiency; one h. in isolated ACTH-deficiency; one ethyl-induced h.; one h. in polynesy of pancreas; one h. in insulinoma; one h. in diabetes mellitus under insulintherapy.
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PMID:[On the syndrome of childhood-hypoglycemia. II. Hypoglycemia in the postneonatal period (author's transl)]. 89 35

Because of the differently selected groups of patients due to a narrow indication for pancreatic surgery, a direct comparison of the results of conservative and surgical therapy is not possible. A follow-up survey of 348 patients with proven chronic pancreatitis showed that patients suffering from uncomplicated pancreatitis should be treated conservatively as long as possible, for 70% (77 out of 109) will improve. In 2/3 of our patients with chronic pancreatitis, surgical treatment became necessary. As to the recurrence of pancreatitis and the lethality, resecting techniques were more successful (72%: 107 out of 148) than the non-resecting ones (61%: out of 91). The cooperation of the patient is crucial for the prognostic outcome regardless of the kind of treatment; especially the elimination of alcohol intake is essential. The most important accompanying or/and succeeding disease is diabetes mellitus, which impairs the long term prognosis especially because of the hazard of postoperative irreversible hypoglycemia. Optimal treatment of patients with chronic pancreatitis can only be accomplished on an individual basis and on the basis of a close cooperation of internists and surgeons.
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PMID:[Chronic pancreatitis--conservative versus surgical treatment under prognostic aspects]. 90 64

Changes in the myocardial contractile function were studied in 44 patients with diabetes mellitus by phasic analysis of the systole of the left ventricle, depending on the level and marked variations in glycemia in the course of 24 hours. The most pronounced phasic shifts by the 1 type of hypodynamia, pointing to reduction of the myocardial contractile function, were revealed in prolonged hyperglycemia, hypoglycemia, and a sharp fall of the blood sugar level at the period of marked 24-hour variations in glycemia. The results of investigations substantiated the fact that stable compensation of diabetes served as the active prophylactic measure of cardiovascular affections in this disease.
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PMID:[Role of alterations of carbohydrate metabolism in the mechanism of decreasing the contractile function of the myocardium in patients with diabetes mellitus]. 90 54

Pregnancy and delivery in 190 diabetic women are described. Obstetric, medical and neonatal guidelines for treatment are outlined and the following results are reported: 1. The delivery dates suggested by P. White were generally exceeded by 2 weeks. Group A was delivered at term, group B generally in the 38th week, group C between the 37th and 38th week and group D mostly in the 37th week of gestation. 2. Spontaneous delivery was achieved in 60% of the cases; Caesarean section was necessary in 33%, whilst the incidence of vacuum extraction was 5%. 3. The perinatal infant mortality rate in diabetic pregnancy decreased from 22.9% in 1970/71 to 2.7% in 1972/1976. 4. Perinatal mortality was related to the degree of severity of diabetes according to White's classification. 5. The percentage of PBSP cases was lowered from 32% to 24%. Perinatal mortality in the PBSP group decreased from 50% in 1970/71 to 19% in 1972/1976. 6. Hypoglycaemia occurred in 70% of 74 newborn infants submitted to intensive neonatal care. A true glucose value of less than 25 mg% was recorded in 30% of these cases. Hypocalcaemia was present in 16% cases, whilst 62% of the newborn infants suffered from respiratory distress syndrome. Cardiomegaly occurred in 28% of infants. 7. Development and prognosis are judged to be favourable in children of diabetic mothers.
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PMID:[Diabetes and pregnancy: treatment and results (author's transl)]. 90 20

Venous blood glucose concentration measured by Dextrostix-Eyetone Reflectance Meter method were compared with conventional enzymatic measurements of plasma glucose in the same 373 blood samples over the range of 0.55-22.2 mmol/l (10-400 mg/100 ml). Agreement between the two methods was good up to 5.5 mmol/l (100 mg/100 ml) but above 11.1 mmol/l (200 mg/100 ml) the Dextrostix-Eyetone method gave higher results for glucose concentration. The Dextrostix-Eyetone method is a reliable means of confirming or refuting the clinical diagnosis of hypoglycaemia and is useful in the day-to-day management of diabetes mellitus in situations where insulin dosage requirements are varying and where access to clinical laboratory facilities are not readily available.
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PMID:Evaluation in clinical practice of Dextrostix and the Eyetone Reflectance Meter. 91 48


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