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Query: UMLS:C0011849 (diabetes)
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Hypoglycemia is a serious problem in insulin-treated diabetic patients. In this study the efficacy of intravenous glucagon (1 mg) was compared with that of intravenous dextrose (25 g) in the treatment of hypoglycemia in insulin-treated patients attending an accident and emergency department. In addition, the prevailing glycemic control of these patients was compared with patients routinely attending a diabetic outpatient clinic. Both intravenous glucagon and dextrose were effective in the treatment of hypoglycemic coma. There was a difference in the glycemic profile after intravenous glucagon compared with intravenous dextrose, and recovery of a normal level of consciousness after glucagon was slower than after dextrose (6.5 vs. 4.0 min, respectively; P less than .001), although the average duration of hypoglycemic coma was 1.4 h. The glucagon- and dextrose-treated groups had significantly lower HbA1 than comparable patients routinely attending the clinic (9.5 +/- 0.8 vs. 12.0 +/- 3.8%, respectively; P less than .001). In view of the ease of administration and the small risk of vascular and extravascular complications, intravenous glucagon appears to be a useful alternative to intravenous dextrose in the treatment of severe hypoglycemia.
Diabetes Care
PMID:Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in an accident and emergency department. 342 48

Continuous subcutaneous insulin infusion (CSII) with a portable pump was compared to unchanged conventional treatment (UCT) in long-term treated patients with IDDM in order to evaluate changes in glucose homeostasis, metabolites, hormones and quality of life. We found that the mean blood glucose values, measured at home, and the HbA1c values were significantly lower in the CSII group compared to the UCT group. The improved control during CSII was followed by a nearly normalization of the diurnal pattern of FFA and ketone bodies in plasma. Plasma free insulin values were significantly higher in the morning (fasting) during CSII compared to UCT, whereas the mean diurnal concentrations and the diurnal pattern were identical in the 2 groups. Both peak values of growth hormone during the day and the fasting values were significantly lower in the CSII group compared to the UCT group. In patients treated with the insulin pump (CSII) the wellbeing (quality of life) was estimated to be significantly improved. Two patients developed ketoacidosis during CSII, whereas 2 controls (UCT) were hospitalized with hypoglycemic coma. We conclude that insulin pump treatment for 6 months results in a near normalization of glucose and FFA metabolism, resulting in an improved quality of life. The improved control seems not to be explained by a change of the diurnal pattern of plasma insulin. However, the higher morning values may be of significant importance.
Diabetes Res 1985 Jan
PMID:Insulin pump treatment: effect on glucose homeostasis, metabolites, hormones, insulin antibodies and quality of life. 388 95

The frequency of diabetic ketoacidosis and hypoglycemic coma in a large series of patients with insulin-dependent diabetes treated by long-term continuous subcutaneous insulin infusion was compared with the frequency of these events in a matched group of patients treated by conventional insulin injections at the same hospital over the same period of time. Ketoacidosis and hypoglycemic coma occurred no more frequently in continuous subcutaneous insulin infusion-treated patients. Therefore, intensified insulin therapy achieved by continuous subcutaneous insulin infusion does not appear to be associated with a greater risk of ketoacidosis or hypoglycemic coma than does conventional insulin therapy.
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PMID:Frequency of diabetic ketoacidosis and hypoglycemic coma during treatment with continuous subcutaneous insulin infusion. Audit of medical care. 393 67

We have studied memory (Wechsler Memory Scale) and mood states in 20 insulin dependent diabetics under maximized metabolic control (treated with multiple insulin injections daily or insulin pumps) and 12 patients under standard control (treated with one or more injections of insulin daily). Both groups of patients have been enrolled in the Minnesota Diabetes Complications Clinical Trial for two years or longer. The patients in the maximized control group (mean +/- SD) blood glucose 130 +/- 9 mg/dl) had hypoglycemic episodes much more frequently than the patients in the standard control group (mean +/- SD blood glucose 242 +/- 22 mg/dl). Both groups of patients had normal cognitive functions, including a few patients with numerous hypoglycemic episodes. Only one patient who developed a hypoglycemic coma for several weeks has had lasting abnormal cognitive functions including a few patients with numerous hypoglycemic episodes. We conclude that long-term maximized diabetic control (at least 2 years), although not devoid of danger, does not seem to affect cognitive functions in the patients tested according to the parameters used.
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PMID:The Minnesota Diabetes Complications Clinical Trial cognitive functions under long-term maximized and standard metabolic controls. 637 26

We determined the frequency of acute complications associated with insulin pump therapy in 161 insulin-dependent patients followed up for a total of 2,978 patient-months. Diabetes control improved substantively with pump therapy, but 42% of the patients experienced one or more acute complications while using insulin pumps. Infected infusion sites, ketoacidosis, and hypoglycemic coma occurred once in every 27, 78, and 175 patient-months, respectively. More patients experienced ketoacidosis after the onset of pump therapy than in an equivalent interval immediately before the onset of pump therapy. Ketoacidosis also occurred in more patients using pump therapy than in a comparison group of 165 patients receiving conventional insulin injections surveyed during an equivalent period. The frequency of hypoglycemic coma was not significantly changed by pump therapy.
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PMID:Acute complications associated with insulin infusion pump therapy. Report of experience with 161 patients. 643 96

Disopyramide (Norpace) is a widely used, generally well tolerated antiarrhythmic agent. We have described an 82-year-old patient with non-insulin-dependent diabetes mellitus and renal insufficiency who had hypoglycemic coma and obstructive uropathy due to disopyramide therapy.
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PMID:Hypoglycemic coma due to disopyramide toxicity. 663 45

Severely brittle diabetes is defined as a rare subtype of insulin-dependent diabetes with wide, fast, unpredictable, and inexplicable swings in blood glucose concentration, often culminating in ketoacidosis or hypoglycaemic coma. To assess the role of inappropriate type, amount, or timing of insulin treatment and the route of administration as a cause of severe brittleness six patients with continuous subcutaneous insulin infusion, which provides a high degree of optimisation of dosage with exogenous insulin in stable diabetics. The glycaemic control achieved during continuous subcutaneous insulin infusion was compared with that during continuous intramuscular insulin infusion. Six patients with non-brittle diabetes were also treated by continuous subcutaneous insulin infusion. These patients achieved the expected improvement in glycaemic control (mean +/- SD plasma glucose concentration 5.1 +/- 2.3 mmol/l (92 +/- 41 mg/100 ml)), but not the patients with brittle diabetes remained uncontrolled with continuous subcutaneous infusion (13.6 +/- 5.8 mmol/1 (245 +/- 105 mg/100 ml) compared with 10.3 +/- 4.1 mmol/l (186 +/- 74 mg/100 ml) during treatment with optimised conventional subcutaneous injections). During continuous intramuscular infusion, however, glycaemic control in five of the patients with brittle diabetes was significantly improved (7.7 +/- 2.6 mmol/l (139 +/- 47 mg/100 ml). The remaining patient with brittle diabetes, previously safely controlled only with continuous intravenous insulin, did not respond to continuous intramuscular infusion. It is concluded that in five of the six patients with brittle diabetes studied here impaired or irregular absorption of insulin from the subcutaneous site played a more important part in their hyperlability than inappropriate injection strategies. This absorption defect was presumably bypassed by the intramuscular route.
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PMID:Management of severely brittle diabetes by continuous subcutaneous and intramuscular insulin infusions: evidence for a defect in subcutaneous insulin absorption. 678 19

A 62-year-old Indian with diabetic nephropathy controlled with metformin, developed miliary tuberculosis for which he was treated with rifampicin, isoniazid and ethambutol. Soon afterwards he developed cholestatic hepatitis and visual disturbance. Rifampicin and ethambutol were stopped. Streptomycin caused vertigo and had to be stopped. The introduction of para-aminosalicylic acid (PAS) led to hypoglycaemic coma. Metformin was stopped. Hypoglycaemic coma recurred. PAS was stopped and the patient's blood glucose concentrations became normal. Treatment with isoniazid and ethambutol led to total recovery from pulmonary tuberculosis. The induction of hypoglycaemia with PAS in this patient suggests a potential role for PAS in the treatment of diabetes mellitus.
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PMID:Para-aminosalicylic acid-induced hypoglycaemia in a patient with diabetic nephropathy. 739 95

Five weeks following the initiation of chlorpropamide therapy for diabetes mellitus, hypoglycemic coma, cholestatic jaundice, and RBC aplasia developed in a 41-year-old woman. Within 40 days of stopping the drug, she had made a complete recovery. To our knowledge, this is the first case in which these three complications of chlorpropamide have occurred simultaneously.
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PMID:Hypoglycemic coma, jaundice, and pure RBC aplasia following chlorpropamide therapy. 739 1

Regional distribution of cerebral blood flow was determined semi-quantitatively with 99Tcm-HMPAO brain SPET under basal conditions in Type 1 (insulin-dependent) diabetic patients of recent onset and longer disease duration, and related to metabolic control and history of hypoglycaemic events. Long-term diabetic patients showed significantly more alterations in regional cerebral blood flow than diabetics of recent onset and healthy controls. Regional hypoperfusion, predominantly localized in the fronto-temporal cortex, was almost exclusively observed in patients with long-term diabetes. The latter finding was related to lower HbA1c levels (i.e. better metabolic control) and to the frequency of impending hypoglycaemia, but not to age of the patient, duration of diabetes or to chronic diabetes complications. The incidence of hypoperfusion was comparable in patient groups with or without a medical history of hypoglycaemic coma. However, regions of hypoperfusion were larger in the patients who had experienced hypoglycaemic coma. It is concluded that regional cerebral hypoperfusion in long-term Type 1 (insulin-dependent) diabetics, as evidenced by HMPAO-SPET can be related to the frequency and degree of hypoglycaemic events and to tight metabolic control, which is however at the expense of an increased risk of recurrent hypoglycaemia.
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PMID:Regional cerebral hypoperfusion in long-term type 1 (insulin-dependent) diabetic patients: relation to hypoglycaemic events. 760 29


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