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

Thirteen patients with pancreatic diabetes caused by calcifying pancreatitis were divided into 2 groups; 5 with diabetic autonomic neuropathy [AN(+) group] and 8 without [AN(-) group]. They were subjected to an insulin-induced hypoglycemic stress test to evaluate their blood pancreatic glucagon, adrenalin, and cortisol responses. When a blood glucose level below 45 mg/100 ml was defined to be hypoglycemia, all the patients in the AN(-) group exhibited peripheral adrenalin responses, with a significant increase (mean, 19.0 times the basal level) in the blood adrenalin level. Among the AN(+) group, on the other hand, central nervous symptoms became evident rather than the peripheral adrenalin response (the blood adrenalin level hardly exceeded the basal level). With the exception of a single patient, none exhibited responses in the blood pancreatic glucagon levels. Only one patient showed a minimal cortisol response but the remaining 12 reacted normally in the cortisol release. The findings are summarized as follows: in pancreatic diabetes, insulin-induced hypoglycemia causes little change in pancreatic glucagon secretion; when the condition is complicated with autonomic neuropathy, central nervous symptoms develop while the blood adrenalin level hardly increases. These findings indicated that patients with pancreatic diabetes complicated with diabetic autonomic neuropathy have a risk of lapsing into an acute hypoglycemic coma and difficulty in recovering from the hypoglycemic state.
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PMID:Decreased counterregulatory hormone responses to insulin-induced hypoglycemia in patients with pancreatic diabetes having autonomic neuropathy. 773 13

The annual economic impact of diabetes mellitus in the United States is an estimated $92 billion, primarily reflecting the treatment of both acute (e.g., diabetic ketoacidosis and hypoglycemic coma) and chronic (e.g., atherosclerotic cardiovascular disease, blindness, renal failure, neuropathy, and amputation of extremities) complications. The complications of diabetes may be prevented or delayed through intensive treatment and through early detection and treatment of complications. To characterize continuing care of diabetes in Rhode Island in 1991, the Rhode Island Department of Health initiated a Diabetes Care Survey (DCS) in conjunction with its statewide Health Interview Survey (HIS) in 1990. This report summarizes the results of that survey.
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PMID:Continuing diabetes care--Rhode Island, 1991. 793 16

We report the sudden and dramatic reversal of maturity onset diabetes in a 57-year-old woman in association with relapse of IgA myeloma diagnosed 3 years earlier. Prior to the relapse of the myeloma, twice daily insulin had been administered at a dose which had been stable for 3 years. However, the same dose produced hypoglycaemic coma at the time of relapse and, subsequently, blood glucose was controlled by diet alone. There had been no significant change in weight or renal function prior to the hypoglycaemic episode. Investigations showed a suppressed fasting serum insulin level in association with an inappropriately high serum level of IGF-II compared with IGF-I and a 'big' IGF-II concentration at the upper end of the normal range. Pituitary, adrenal and liver disease, as well as the autoimmune insulin syndrome, were excluded. The findings are consistent with the hypothesis that the plasma cell tumour was associated with excessive production of insulin-like peptides with consequent reduction in the blood glucose level.
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PMID:Reversal of diabetes associated with escape of myeloma: evidence for inappropriate IGF-II secretion. 794 48

A patient with an 8 year history of insulin-dependent diabetes mellitus was admitted to the emergency ward for hypoglycaemic coma (blood glucose 1.11 mmol/l). The initial electrocardiogram revealed a junctional rhythm and major ischaemia with an ST depression of 6-7 mm. Sinus rhythm and normal repolarization were recovered 15 minutes after administration of 50% glucose. No evidence of myocardial infarction appeared during follow-up. Such hypoglycaemia-induced ECG changes have rarely been documented and no conclusive explanation has been put forward although altered balance between energy supply and demand in myocardial tissue has been suggested. Special care should be taken when administering hypoglycaemic agents to patients at risk for myocardial ischaemia.
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PMID:Hypoglycaemia-induced ischaemic ECG changes. 814 76

A 38-year-old woman was brought to hospital in an unconscious condition due to hypoglycemic coma. At 23 years of age she was diagnosed as having insulin-dependent diabetes mellitus. She had been treated with insulin but the control of her blood sugar was inadequate. Emergency endotracheal intubation was performed and she began to breathe spontaneously. Two days later, sore throat, swelling of the neck and fever appeared. She was therefore transferred to our hospital. CT showed a continuous abscess with multiple air bubble from the pharynx to the mediastinum. Cervical incision was performed and treatment with ampicillin, cefmetazole, and clyndamicin was started. Culture of the pus revealed alpha-streptococcus. The abscess decreased in size and her blood sugar was controlled by insulin and diet. She was discharged after 11 weeks of hospitalization. At that time CT showed only emphysematous change.
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PMID:[Mediastinal abscess due to endotracheal intubation]. 825 33

Insulin has been in therapeutic use for around 70 years, and the range of adverse effects associated with its use is very limited. Insulin allergy and other local cutaneous reactions, which were common with the early insulins, are now rarely seen with highly purified and biosynthetic preparations. By far the most important complication of exogenous insulin is hypoglycaemia, which affects almost all insulin-treated patients and is largely a manifestation of nonphysiological insulin regimens and routes of administration. The problem of hypoglycaemia unawareness is now being increasingly recognised, with onset of severe neuroglycopenia and coma which is not preceded by the characteristic warning symptoms associated with autonomic activation. This can occur with excessively tight glycaemic control, and this situation is usually reversible. More commonly, however, hypoglycaemia unawareness is a chronic problem which is predominantly a feature of long duration of diabetes. Although individual episodes of hypoglycaemic coma can usually be effectively treated with parenteral dextrose or glucagon, management of patients with chronic hypoglycaemia unawareness is a difficult clinical challenge, with limited therapeutic options. In the past few years, there has been concern that the use of human insulin preparations may predispose to hypoglycaemia unawareness. The evidence for and against this is discussed, although at present it is difficult to draw any absolutely firm conclusions.
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PMID:Adverse effects of exogenous insulin. Clinical features, management and prevention. 832 48

Mendenhall's syndrome, characterized by familial insulin resistant diabetes, pineal hyperplasia and multiple somatic abnormalities, is associated with defects involving the alpha-subunit of the insulin receptor. The associated insulin-resistant diabetes is extremely difficult to treat; insulin is required in very large doses to control hyperglycaemia and oral hypoglycaemic agents are ineffective. We report a case of severe, prolonged hypoglycaemia that occurred in a 24-year-old patient with Mendenhall's syndrome following therapy with glibenclamide. He had glibenclamide 10 mg daily for 1 week following which he was admitted to hospital in hypoglycaemic coma with blood glucose levels < 1.0 mmol/l. This subject had undergone hypophysectomy at the age of 11 years. Prior to pituitary ablation, oral hypoglycaemic agents did not improve glycaemic control. Thus, previous hypophysectomy in this patient appears to have made it possible for glibenclamide to exert its hypoglycaemic effect. The occurrence of hypoglycaemia in this patient suggests alternative mechanisms for insulin action in conditions characterized by severe insulin resistance due to insulin receptor defects.
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PMID:Serious, prolonged hypoglycaemia with glibenclamide in a patient with Mendenhall's syndrome. 834 1

The study was performed to investigate subclinical abnormalities in regional cerebral blood flow (rCBF) in patients with insulin-dependent diabetes mellitus (IDDM) and to correlate them with patients characteristics. After intravenous injection of technetium-99m hexamethylpropylene amine oxime (HMPAO), tracer uptake of the prefrontal, frontal and parieto-occipital zones was measured with a triple-head single-photon emission tomography (SPET) camera system in 35 IDDM patients outside an episode of hypoglycaemia. Tracer uptake values in 16 age- and sex-matched healthy volunteers served as reference values. Compared with healthy subjects, increased tracer uptake of both prefrontal regions and the left frontal region could be shown in diabetes. Tracer uptake was negatively correlated with the duration of diabetes in all investigated regions. In diabetic patients with a disease duration of more than 5 years (n=26), stepwise regression analysis revealed a significant positive correlation between their HbA1c levels and tracer uptake. Long-term diabetic patients with reduced (pre)frontal tracer uptake (n=8) had lower HbA1c levels than those without (8.4%+/-0.2% vs 9.3%+/-0.3%, P<0.05) and tended to have more frequently a history of hypoglycaemic coma (6/8 vs 6/18, P=0.06). It can be concluded that duration of diabetes contributes to subclinical changes in basal rCBF in IDDM as detected with HMPAO SPET of the brain. The positive correlation between the presence of regional hypoperfusion and lower HbA1c levels in long-term diabetic patients may be interpreted in the light of a presumed higher incidence of hypoglycaemia as metabolic control improves.
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PMID:Technetium-99m hexamethylpropylene amine oxime single-photon emission tomography of regional cerebral blood flow in insulin-dependent diabetes. 892 51

We examined at autopsy 47 cases (22 males and 25 females) of insulin-dependent diabetes mellitus (IDDM) from 21 hospitals in Japan to clarify the pathological changes that occur in the pancreas vs. those in control patients. The mean age was 39.7 +/- 13.9 (mean +/- SD) years, and the duration of IDDM from clinical onset was 13.1 +/- 6.5 years. Causes of death included renal complications, infections, acute diabetic complications such as ketoacidosis or hyper- or hypoglycemic coma, and atherosclerotic disease. This study revealed noticeable decreases in the islet area and beta cell area, and a slight decreases in the alpha cell area and preservation of the number of islets. Insulitis was found in only 1 case, representing 25% of the cases with a duration of IDDM of one year or less. Lymphocytic infiltration of the exocrine gland was seen in 22 cases (46.8%). Predominant phenotypes of the lymphocytes were T lymphocytes and macrophages. Fibrosis, fatty change and atrophy were also found. Although this is not a strictly age- and sex-matched study, the high incidence of lymphocytic infiltration of the exocrine pancreas indicates that the exocrine tissue as well as beta cells is the target of immune reactions in Japanese patients with IDDM.
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PMID:Histopathologic study of the pancreas shows a characteristic lymphocytic infiltration in Japanese patients with IDDM. 915 11

The objective of the study was to assess the safety of changing ambulatory patients from animal insulin produced in the Czech Republic administered by classical insulin syringes to human insulins of the Danish firm Novo Nordisk, using a NovoPen 3 applicator. Furthermore antibody levels against hog, bovine and human insulin were assessed. Forty-seven patients with diabetes type I stabilized on an intensified insulin regime were after a four-day preparatory period divided at random into two groups. Patients in group A (n = 22) were after randomization changed to human insulin, patients in group B (n = 25) eight weeks later. From the onset of treatment with human insulins up to the end of the study the mean daily dose of insulin in both groups increased (in group A by 1.51 IU/day, in group 1.35 IU/day). This is not statistically or clinically significant. During the same period a statistically significant decline of the mean value of the daily 8-point glycaemic profile was recorded (in group A by 0.85 mmol/l, in group B by 0.51 mmol/l). Glycosylated haemoglobin declined also significantly in the course of the study (in group A by 1.64%, p = 0.00004, in group B by 1.02%, p = 0.0077). The greatest drop occurred during the preparatory period. Despite the increased daily insulin dose and improved compensation the number of hypoglycaemic events declined significantly in both groups (in group A by 0.78%, p = 0.0102, in group B by 0.74%, p = 0.0134). Hypoglycaemic coma was not recorded in either group. A significant drop of insulin antibodies was found in both group after the onset of treatment with human insulins. From the results of the study ensues that metabolically compensated type I diabetics with a mean daily insulin dose of 0.6 IU/kg body weight can be changed without any complications, in the ambulatory department, to human insulins with the same dosage. Concurrently a gradual decline of antibodies can be expected.
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PMID:[Clinical experience with changing type I diabetics from animal to human insulin administered by the NovoPen 3 applicator]. 922 71


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