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Query: UMLS:C0011849 (diabetes)
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Chronic calcific pancreatitis (CCP) is the most clear-cut form of chronic pancreatitis. Till date, the common treatment of CCP has been directed toward discontinuation of alcohol consumption if the disease is associated closely with alcohol abuse, relief of pain, enzyme replacement, and the management of some complications like diabetes mellitus, cyst or abscess of the pancreas, malnutrition etc. In 1979, the research group for chronic pancreatitis in Japan proposed the therapeutic policy for this disease as illustrated in Fig. 1. A plausible new treatment is the dissolution of protein precipitates or calcified stones in pancreatic ducts by oral or intravenous administration of drugs.
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PMID:Dissolution of pancreatic stones. 221 44

In the critically ill patient, wound repair can be impeded by processes inherent to the illness, its treatment, and the critical care environment. This vulnerability to wound complications increases patient morbidity and mortality as well as length of stay, resource consumption, and hospital cost. The physiology of wound healing and factors that impede wound repair are discussed. Those factors commonly seen in critical illness include advanced age, diabetes mellitus, compromised immunocompetence, inadequate perfusion, and oxygenation, infection, malnutrition, obesity, and preoperative illness. Knowledge of management of the physiologic factors that affect wound healing enables the nurse to maximize tissue repair and prevent wound complications.
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PMID:Physiology of wound healing and risk factors that impede the healing process. 222 20

Dietary treatment of diabetes has long been the cornerstone of management of this common disease. Recent recommendations to increase the proportion of carbohydrate with concomitant reduction of dietary fat appear to be prudent, but scant data are available to support this supposition in the elderly. Modification of the source of carbohydrate as a means of providing better blood glucose control is based on limited data in controlled settings and needs to be tested in community settings before widespread alterations in the dietary composition can be widely recommended. Current recommendations for protein composition of the diet are probably adequate for the elderly diabetic patient who does not have obvious protein depletion. General guidelines for the dietary management of elderly diabetic patients are summarized in Table 5. Management of the elderly diabetic patient presents a strong challenge to the physician. Dietary recommendations for such patients should be highly individualized; patients' food preferences, ethnic background, financial resources, and support system should be taken into consideration. Simple recommendations drafted with the help of the patient are more likely to be successful. The elderly are often at risk for nutritional deficiency, and the presence of chronic disease such as diabetes profoundly affects metabolism, putting these individuals at still higher risk. Unfortunately, our current understanding of this problem is limited and additional research in this area is essential.
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PMID:Nutritional status and dietary management of elderly diabetic patients. 222 53

The elderly patient with type II diabetes should be treated in much the same fashion as a younger person with the same disease, although emphasis needs to be placed on minimizing side effects, drug interactions, and hypoglycemia. Chlorpropamide should not be used in these patients, unless there is no other choice. The remaining agents--tolbutamide, acetohexamide, tolazamide, glyburide, and glipizide--should be started at low doses and gradually increased until optimal diabetic control is reached. The initial treatment goal is a FPG level of less than 180 mg/dl and a final goal is a 1- to 2-hour PPG concentration between 140 and 180 mg/dl. The glycosylated hemoglobin value should be no greater than 1.5% above the upper limit of normal, and should be lower, if possible. It must be kept in mind, however, that the closer diabetic patients are to achieving euglycemia, the more likely is hypoglycemia. Treatment goals therefore may have to be relaxed in someone at increased risk of hypoglycemia (e.g., patients with irregular eating habits or renal insufficiency) or when hypoglycemia may pose a greater hazard (e.g., patients with coronary artery or cerebral vascular disease). Patients on sulfonylurea agents should have blood glucose values measured once a month and glycosylated hemoglobin levels determined once every 3 months to alert the clinician to the possible need to adjust therapy. In this way, potential hypoglycemia can be avoided if blood glucose levels are drifting too low and chronic hyperglycemia can be identified and treated within a short period of time. When a patient's status changes--e.g., he is placed on new medication, becomes depressed and anorexic, or develops another medical problem--care must be taken to re-evaluate his diabetes management. Drugs such as sulfonamide antibiotics can potentiate the action of the sulfonylureas and cause hypoglycemia, renal insufficiency may necessitate changing the type of sulfonylurea agent or decreasing the dose, and malnutrition may obviate any need for therapy with an oral hypoglycemic agent. If these guidelines are kept in mind, the older diabetic patient can be managed on a sulfonylurea agent in conjunction with the appropriate diet. Should these measures prove to be ineffective, then insulin therapy should be instituted. Controlling chronic hyperglycemia will help improve the quality of life for patients with diabetes and decrease the probability of developing some of the devastating complications associated with this disease.
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PMID:Use of sulfonylurea agents in older diabetic patients. 222 54

The prevalence and clinical features of diagnosed mellitus secondary to chronic pancreatitis (CP) were assessed from northern (Hokkaido) to southern (Okinawa) Japan by means of a questionnaire to elucidate whether WHO-classified malnutrition-related diabetes mellitus (MRDM) exists in Japan. Of a total 17,500 diabetic patients, only two (0.011%)-one fibrocalculous pancreatic diabetes (FCPD) and one protein-deficient pancreatic diabetes (PDPD) - exhibited MRDM characteristics. A total of 649 CP were collected and classified into 268 cases with chronic alcoholic pancreatitis (CAP), 150 cases with chronic calcified pancreatitis (CCP) and 231 cases with other CP. The prevalence of diabetes mellitus was found to be 50.7% in CAP, 72.7% in CCP and 22.8% in other CP. Among all diabetics, 56.6% was noninsulin-dependent (NIDDM) and 26.4% insulin-dependent (IDDM). IDDM was most frequent in CP. Satisfactory and less than satisfactory glycemic control was obtained in approximately three quarters of all subjects. Only one quarter showed poor glycemic control. Insulin treatment was frequent in CAP (52.2%) and CCP (61.7%), but less in other CP (27.5%). The prevalence of diabetic retinopathy was observed in 33.1% of all subjects, nephropathy 21.0% and neuropathy 36.3%, respectively. The prevalence of complications, including macroangiopathy tended to be higher in CAP and CCP (40.3 and 56.9%) than in other CP (31.4%).
Diabetes Res Clin Pract
PMID:Prevalence and clinical features of diabetes mellitus secondary to chronic pancreatitis in Japan; a study by questionnaire. 224 5

This study was designed to investigate any differences in cellular binding of insulin between phasic insulin-dependent (malnutrition-related) diabetes mellitus (PIDDM) and insulin-dependent, non-insulin-dependent, and normal controls. Isolated, washed red and white blood cells obtained after 12-14 hr fast, were separately incubated with varying concentrations of non-radioactive insulin, and a fixed quantity of radioactively labelled insulin. After the 3-hr incubation, cells were washed with buffer, and radioactivity determined on an autogamma counter. Percentage binding, receptor sites number and affinity were all determined by linear regression of the Scatchard plot. Fasting plasma insulin and glucose levels were also assayed. The results obtained show decreased binding of insulin in red blood cells [11.3 +/- 1.3%) and white blood cells 2.9 +/- 0.5%) in PIDDM. This was due to decreased receptor sites (red blood cells 39 +/- 11; white blood cells 0.5 +/- 0.11 x 10(4] as well as decreased affinity (red blood cells 0.14 +/- 0.03 x 10(9) M-1; white blood cells 0.17 +/- 0.04 x 10(9) M-1) when compared to the normal and diabetic (both insulin and non-insulin-dependent) controls. Phasic insulin-dependent diabetes (malnutrition-related diabetes mellitus) is characterized by decreased red and white cellular binding to insulin, in addition to decreased production of insulin.
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PMID:Insulin receptor studies of erythrocytes and mononuclear leucocytes in phasic insulin diabetes mellitus. 226 26

The metabolism of proteoglycans in normal growth plate and the changes in growth plate morphology induced by diabetes and malnutrition were studied in rats. The proteoglycans had a significantly faster turnover (half-life measured with [35S]sulfate labeling: 25-30 h) than the cells in the growth plate. Morphometric studies showed significant reductions of cell number, zone height, and [3H]thymidine incorporation in growth plates from rats with untreated streptozotocin-induced diabetes compared to normal rats. Similar, although less pronounced alterations were observed in malnourished, nondiabetic rats. Disaggregation and degradation of proteoglycans are probably necessary prerequisites for calcification. Our data indicate that the proteoglycans are in a dynamic state of rapid biosynthesis and degradation throughout the growth plate with a shift in the balance at the calcification front toward less synthesis and more degradation.
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PMID:Kinetics of proteoglycans and cells in growth plate of normal, diabetic, and malnourished rats. 229 70

Although malnutrition-related diabetes mellitus (MRDM) is reported to affect about 40-50% of young adult diabetics in the Indian subcontinent and possibly other tropical and subtropical countries, anecdotal reports have suggested its relative uncommonness in Africa. The presentation of subjects (aged 15-30 years) attending a major Nigerian diabetic clinic in 1984 was therefore reviewed. The results (i) confirm previous observations on the rarity of diabetes in young adult Africans: only 45 of a total of 756 registered diabetics presented when aged 15-30 years; (ii) indicate that classical MRDM from established clinical criteria was uncommon, affecting only about 6% of the subjects, the majority of whom were either atypically or classically insulin-dependent (about 90%), although a small proportion (about 6%) appeared non-insulin-dependent. These observations suggest that diabetes in young adult Nigerians is heterogeneous in clinical presentation and aetiopathogenesis and, furthermore, that classical malnutrition-related diabetes mellitus is rarely seen, being much the least common mode of presentation, unlike the indication of the WHO Expert Committee on Diabetes Report (1985).
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PMID:Malnutrition-related diabetes mellitus in young adult diabetic patients attending a Nigerian diabetic clinic. 230 28

Young diabetics in tropical countries are often undernourished, insulin-requiring and ketosis-resistant, and are sometimes considered to have a distinct type of diabetes. Therefore, a survey of young adult diabetics attending Yekatit 12 Hospital, Addis Ababa, was made to determine clinical features and the relation between their diabetes and their nutritional state. In May, 1988, 894 of 1490 registered diabetic patients were attending regularly, of whom 248 became diabetic between the ages of 15 and 35 years. Many had been followed for 6 years or more. Of the 248,69 males and 29 females (39.5%) had body mass index (BMI) of less than 18 kg/m2 at diagnosis of diabetes. However, only 3.5% of the 199 who knew their pre-diabetic weight had been less than 18 kg/m2; 13.8% of males and 48.5% of females had been obese. At their last attendance, 50% of those whose BMI at diagnosis was less than 18 were of normal weight and only 13% had gained no weight. Of the 98 with BMI less than 18 at diagnosis, and the further 18 less than 18 kg/m2 by the time insulin was started, ketosis occurred at some time in 22%. Only 1 patient takes more than 1.5 units of insulin per kg per day, and 30% of those needing 1.0 to 1.5 U/kg have had tuberculosis. Only 15 of the 116 patients who had BMI less than 18 failed to gain weight on treatment. It is concluded that, in most, the malnutrition at presentation was due to the diabetic state and did not precede the diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nutritional status of young adult Ethiopians before onset and after treatment of diabetes mellitus. 230 53

While fifty years ago 20 p. 100 of cystic fibrosis patients only reached the age of one year, more than 50 p. 100 of the patients now live more than twenty years. The clinical manifestations of cystic fibrosis are more diverse in adults than in children, so that the diagnosis might concern several specialties. In actual fact, only 3 to 7 p. 100 of cystic fibroses are diagnosed after thirteen to sixteen years, and in half the cases the symptoms had been present before the age of one year. In adults, the respiratory manifestations of cystic fibrosis are predominant, whereas the gastrointestinal manifestations tend to be blurred. Radiography of the chest shows interstitial lesions (opacities, cystic images, disorders of ventilation), principally located in the right side and the apex. The most common functional defect is an obstructive syndrome corresponding to a gradual involvement of the peripheral airways. A number of complications may develop, including recurrent Pseudomonas infection of the lung, pneumothorax, heart failure, malnutrition, liver cirrhosis, episodes of intestinal occlusion, etc. The longer life span of these patients raises the problems of diabetes with its vascular complications, infertility or pregnancy, social and professional insertion, and so forth. The prognosis of cystic fibrosis in adults depends on the date the diagnosis was made, on the therapeutic follow-up and on the creation of specialized centres. The control of Pseudomonas infections and the development of lung transplantation are the main advances to be expected.
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PMID:[Cystic fibrosis in adults]. 236 14


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