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

Current information on the nature, pathogenesis and treatment of diabetic glomerulosclerosis is reviewed. The fundamental lesion is one of the glomerular basement membrane, a complex layer of collage-like and other peptides; thickening of this membrane, seen microscopically, is due to the presence of an increased amount of membrane material of normal composition. There is little reliable evidence relating the frequency of glomerulosclerosis to the quality of control of the diabetic state, but indirect evidence from patients with secondary diabetes and from a variety of studies in animals indicates strongly that the glomerular lesion is a consequence of the abnormal metabolic state and can be prevented by adequate treatment of the diabetes. A concept of the pathogenesis of the glomerular lesions and renal failure is presented, but there remain large gaps in knowledge of the mechanisms involved. Treatment of chronic renal failure by maintenance renal dialysis and renal transplantation is not as successful in persons with diabetes as in those without this condition; however, the results appear to be improving, and transplantation particularly holds much promise.
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PMID:Diabetic glomerulosclerosis: current status. 35 65

Bullous eruption of diabetes is a cutaneous sign of diabetes mellitus. Patients with this disorder manifest a sudden onset of intraepidermal or subepidermal bullae, which are primarily confined to the extremities and heal within several weeks without scarring. Our patient had severe diabetes and experienced two episodes of bullae associated with intense, ultraviolet light exposure. Negative immunofluorescence, early disappearance of anchoring filaments and half-desmosomes between cell membrane and basal lamina, and the absence of urinary uroporphyrins separate this entity from certain similar-appearing conditions. Cation imbalance, precipitated by renal failure, could be a possible causal factor.
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PMID:Bullous eruption of diabetes mellitus. 37 35

This review attempts to outline the present understanding of diabetic autonomic neuropathy. The clinical features have been increasinly recognised but knowledge of the localization and morphology of the lesions and their pathogenesis remains fragmentary. A metabolic causation as postulated in somatic nerves accords best with clinical observations. Most bodily systems, particularly the cardiovascular, gastrointestinal and urogenital, are involved with added disturbances of thermoregulatory function and pupillary reflexes. Possible effects on neuroendocrine and peptidergic secretion and respiratory control await definition. Current interest centres around the development of a new generation of tests of autonomic nerve function that are simple, non-invasive, reproducible and allow precision in diagnosis and accurate quantitation. Most are based on cardiovascular reflexes and abnormality in them is assumed to reflect autonomic damage elsewhere. Probably no single test suffices and a battery of tests reflecting both parasympathetic and sympathetic function is preferable. Little is known of the natural history. The prevalence may be greater than previously suspected and although symptoms are mild in the majority, a few develop florid features. The relation of control and duration of diabetes to the onset and progression of autonomic neuropathy is not clearly established. Once tests of autonomic function become abnormal they usually remain abnormal. Symptomatic autonomic neuropathy carries a greatly increased mortality rate possibly due to indirect mechanisms such as renal failure and direct mechanisms such as cardio-resiratory arrest. Improved treatment of some of the more disabling symptoms has been possible in recent years.
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PMID:Diabetic autonomic neuropathy. 38 1

The glucose metabolism of diabetes mellitus during maintenance haemodialysis treatment was studied in four patients with endstage renal failure. There was a large day-to-day variation in the predialysis blood glucose levels, which it was difficult to control by adjusting the insulin dose. In spite of very high blood glucose levels, blood lactate and beta-hydroxybutyrate were not elevated. Triglycerides were markedly and constantly elevated, in no apparent association with the predialysis blood glucose level. The patients were shown to release moderate amounts of glucose, beta-hydroxybutyrate and lactate into the dialysate during the dialysis period. A technique of continuous blood glucose monitoring during the haemodialysis period was applied. With this technique blood sugar levels were accurately determined during the whole dialysis period. A rapid drop in the blood glucose level was found in apparent association with an aggravation of symptoms. A very marked tendency to hypoglycaemia was also revealed. It is concluded that the technique is a valuable aid in the proper management of diabetes in these cases.
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PMID:Continuous blood glucose monitoring and characteristics of diabetes in patients on maintenance haemodialysis treatment. 39 11

Coincidence of chronic renal failure and diabetes mellitus brings with it serious therapeutic problems, especially in dietetic treatment. It is not possible to wish to do justice to all the therapeutic principles of the text books to the same extent. The condition of renal failure with its demands takes precedence in all cases. But if the renal disease has not yet led to a perceptible retention of normal urinary constituents in the serum, no specific dietary measures are necessary. In these cases, the diabetic diet is proceded with in the usual manner.
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PMID:[Dietetic therapy of diabetes and renal insufficiency (author's transl)]. 40 67

Long-term dialysis treatment of diabetics with terminal renal failure is beset with severe complications. In 19 unselected diabetics in terminal renal failure (13 juvenile diabetics and 6 maturity-onset diabetics) the clinical course during long-term dialysis was observed. A total of 1377 dialyses during 167 months of treatment were performed. Diabetic angiopathy, hypertension, and hyperhydration were the most prominent complications. The interval between the onset of diabetes and the beginning of dialysis treatment was 21,5 years in the juvenile diabetics and 5,2 years in maturity-onset diabetes. The survival time during dialysis was on average 13,2 months for the juvenile diabetics and 0,6 months for maturity-onset diabetics. The patients died chiefly from cardiovascular complications.
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PMID:[Haemodialysis in diabetics with terminal renal failure]. 41 46

Early experience with the treatment of patients with insulin-dependent diabetes and renal failure by chronic hemodialysis indicated a high mortality and increased incidence of medical complications. Since 1972, a marked improvement in survival and reduction in incidence of complications has been attributed to more rigorous control of fluid overload, hypertension, and blood sugar levels by insulin therapy and careful dietary management. A diet has been developed which combines the diet used by dialysis patients with suitable modifications for the insulin-dependent patient with diabetes. The importance of patient education is stressed in an attempt to improve patient compliance.
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PMID:Dietary management of patients with diabetes treated by hemodialysis. 46 38

Out of 769 patients with arterial diseases, reconstructive surgery was performed on 100 limbs of 79 patients for arteriosclerosis. The overall patency rate was 59 per cent over a period of 3 to 8 years. Long-term patency was influenced by the condition of the run-off arteries, the site of the operation, and the method of surgery. No relation was found between patency rate and hypertension, cardiac insufficiency, total serum cholesterol, diabetes mellitus, or age. The survival rate was 62 per cent at 5 years and 48 per cent at 7 years. These rates were significantly poor (p less than 0.001), compared with those in the normal population. Mortality was related to the degree of hypertension, with cardiac and renal failure being responsible for 72 per cent of deaths. Aggressive reconstruction may be indicated in cases with hypertension of stage 2 or below based on the WHO classification. However, especially in patients with associated diabetes mellitus close long-term observation of the cardiovascular system is necessary.
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PMID:Long-term prognosis for reconstruction of arterial lesions due to arteriosclerosis. 47 Feb 53

Twenty-two of 29 (76 per cent) diabetic patients with a creatinine level of more than 2 mg/100 ml had exacerbation of renal failure following intravenous pyelography. In nine patients this was irreversible. Particularly at risk seem to be patients with early onset diabetes (less than 40 years), and those patients with severe renal failure (creatine over 5 mg/100 ml). No less that 15 of 16 (93 per cent) such patients had problems after intravenous pyelography; of these, nine (56 per cent) had irreversible deterioration. This report, in context with the increasing number of case reports of similar findin.gs, indicates that intravenous pyelography is dangerous in patients with juvenile onset diabetes who have a creatinine level of more than 5 mg/100 ml.
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PMID:Exacerbation of diabetic renal failure following intravenous pyelography. 60 16

Seven patients had acute oliguric renal failure after intravenous urography (2), celiac arteriography (2), or cardiac angiography (3). Diatrizoate meglumine was the contrast media used in all of the cases. These patients had an average age of 63 years and six were 55 years of age or older. Diabetes mellitus, negative fluid balance before the procedure, underlying renal insufficiency, and hypertension were common, being present in three, four, five, and six of the patients respectively . Anuria or oliguria occurred within 24 hours of the procedure and persisted from 36 to 96 hours (72 hours average). The serum creatinine level rose significantly in all of the patients and reached a peak in two to seven days after the procedure. In six patients, recovery was complete by two to three weeks. The seventh patient experienced only partial recovery. These cases taken together with a mounting number of recent reports suggest that contrast media-induced oliguric renal failure is more common than generally believed. Diabetes mellitus, older age, and underlying renal insufficiency seem to be important predisposing factors.
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PMID:Contrast media-induced oliguric renal failure. 62 32


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