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

We report on the case of a 10-month-old infant with Down's syndrome and acute insulin-dependent diabetes mellitus, who died of hyperosmolar diabetic coma 4 days after admission to the hospital in spite of intensive therapy. Characterizing this disease, a lymphocytic infiltration of the islets of Langerhanns with destruction of the islets was found. The specific localization of the inflammatory infiltrates as well as the histological findings correspond with experimental immune-insulitis in aminals, suggesting that immunological mechanisms play an essential pathogenic role. Virus etiology, diagnostic procedures, and therapeutic approaches are discussed.
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PMID:[Insulitis and peracute diabetes mellitus (author's transl)]. 12 75

The author discusses abnormalities in gastric emptying due to diabetes mellitus, and in particular, diabetic gastroparesis, on the basis of his own experience and the relevant literature. Diabetic gastroparesis is a result of a diabetic neuropathy of the vagus. Even in the presence of mild abdominal symptoms, particularly with repeated hypoglycaemic episodes, this condition should be considered and the stomach should be examined readiologically. A diabetic phytobezoar may develop. It may be presumed that these changes are more common than had previously been realized. The author has observed six cases. The gastric atony associated with diabetic coma has to be differentiated from the condition under discussion. Conservative treatment is recommended.
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PMID:[Disturbance of gastric emptying in diabetes mellitus (author's transl)]. 12 11

Nonketotic hyperosmolar diabetic coma is a rare manifestation of juvenile diabetes, in contrast to adult onset diabetes. To date only 20 cases have been published, the majority of them infants and toddlers. This type of diabetic coma is seen with unusual frequency in children with Down's syndrome and psychomotor retardation. The clinical picture is characterised by severe dehydration, hyperglycemia with often extremely high blood sugar levels, hyperosmolarity and glucosuria without ketonuria. Mortality in children has been high (24%). This paper reports the case of a 14-month-old girl with Down's syndrome. Clinical and therapeutic as well as pathogenetic aspects are discussed.
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PMID:[Hyperosmolar nonketotic diabetic coma in children]. 15 87

Four cases of sudden and unexpected death caused by the acute onset of diabetes mellitus are reported. Three are examples of acute juvenile diabetes while the fourth demonstrated the aketotic form of diabetic coma. Such instances can present a diagnostic problem to the forensic pathologist. The usefulness of vitreous humor glucose analysis to diagnose such a condition is stressed.
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PMID:Sudden and unexpected deaths after the acute onset of diabetes mellitus. 26 33

During the past decades insulin has been given in relatively high doses when treating diabetic coma. Recently low-dose insulin treatment has been proposed by several groups. In the reported investigation insulin was initially given in moderate to high doses (12-200 U/h) with a steady reduction in dose during the course of treatment. Insulin infusion was regulated either manually with an adjustable infusion pump (7 patients) or automatically with an artificial endocrine pancreas (glucose-controlled insulin infusion system; 11 patients). Thus 18 patients with decompensated diabetes mellitus (coma or precoma) were treated. In 14 patients with ketoacidotic decompensation laboratory data on hospital admission were: blood glucose 7.35 +/- 0.61 g/l, serum potassium 4.7 +/- 0.4 mmol/l, pH 7.1 +/- 0.04, base excess - 19,7 +/- 2.2 mmol/l (x +/- SEM). The other patients had hyperglycaemic or hyperosmolar non-ketotic decompensation. In all patients controlled reduction of blood glucose levels was achieved within 2.3 to 18 hours. The amounts of insulin infused during this ranged from 17 to 320 units, but in one instance was 1950 units. There were no complications.
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PMID:[Insulin treatment of decompensated diabetes mellitus with a new artificial endocrine pancreas (author's transl)]. 33 2

It is today's general medical opinion that children's diabetes mellitus was uncommon in the past. It was generally admitted at that time the initail stages were so sudden as to make difficut its early diagnosis. It's increased incidence is at present an alarming truth; however, a parallel increase of diabetic coma or of mulminant types has rather dropped. Diabetes may be diagnosed by just considering the main symptoms at the onset which are polydipsia, polyuria and weight loss. If an early diagnosis is not made, acidosis (abdominal pain, nausea, vomiting) may appear within a few days or weeks followed by coma (Kussamul's acidotic respiration and dehydration). Coma may be avoided by an early diagnosis and a life may be saved. It must be stressed that an important percentage of children and adolescents show a slow and gradual evolution (week or months) of their diabetes: gradual weight loss, sometimes with noticeable polyphagia, occasional enuresis, but without other associated symptoms. Asymptomatic, intermittent glucosurias are also frequent; they vary in magnitude an almost always they appear without ketonuria and with fasting normal glycemia. According to our experience they may precede in weeks or months the clinical manifestations of the disease. Postprandial glycemia is a sure diagnostic resource; it is of greater trustworthines than fasting glycemia; therefore we advise it as a routine diagnostic procedure which we recommend widely. In uncertain situations, the oral glucose tolerance test is advisable.
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PMID:[Diabetes mellitus in childhood and adolescence. Clinical types]. 48 58

BANTING and BEST revolutionized diabetes therapy with the discovery of insulin 57 years ago. Since then, progress in this area has been slow despite tremendous reseach efforts. The subcutaneous injection of a depot insulin does not provide optimal control of blood sugar. True progress has been brought about by intravenous insulin administration for the management of diabetic coma. The authors do not recommend ultra low dose therapy. The prognosis of diabetic coma is much better than 20 years ago, in particular because of much improved and continuous supervision of the circulation (CVP, ECG, K+ etc.). Pancreas and islet transplantation fail in man due to immunological rejection. The "artificial pancreas" with a glucose sensor is useful for research purposes, and for controlling blood sugar for a few days at most. The implantable glucose sensor is not yet in sight. The authors have treated diabetics successfully with a programmable flexible open loop infusion program. The basal insulin infusion rate can be varied from 0.25 to 2 U/h, and rectangular one hour extra insulin infusions between 2 and 10 U/h are superimposed by pushing a button on the steering unit. The pump automatically switches back to the basal rate after one hour. No hypoglycemic reactions have been observed in patients on ths program on the ward or at home. At present, technical problems with the catheter remain to be solved before this simple therapeutic approach can be applied routinely.
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PMID:[Progress and developments in insulin therapy]. 51 16

We report the case of a boy aged 9 1/2 years with hyperosmolar, nonketotic diabetic coma. He was not known to be diabetic prior to the onset of coma. Pathogenetic aspects of this rare manifestation of juvenile diabetes are discussed. It is dangerous to decrease osmolarity too rapidly during infusion of very hypotonic solutions. Treatment with continuous low-dose insulin infusion may cautiously be tried.
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PMID:[Hyperosmolar nonketotic diabetic coma. Treatment with continuous low-dose insulin infusion (author's transl)]. 73 22

In a comparative period of 20 years is reported on the frequency of diabetes mellitus in urological diseases. It was found that 0.87% of the patients suffer from a concomitant diabetes. The peak of the disease is between the 60th and 70th year. As to the distribution of sex was established that the concomitant diabetes is to be found more frequently in males (ratio 2.4: 1). The lethality in diabetics with a urological disease is with 9.4% more than twice as high as in the other urological patients (4.3%). At the top of the immediate causes of death is the cardiovascular failure (30.7%), followed by the pulmonary blood clot embolism and the uraemic coma with 15.4% each. A diabetic coma never appeared. In the analysis of the urological diseases with concomitant diabetes the lithiasis (34.4%) is in the first place; then follow the adenoma of the vesical cervix (32.4%), the chronic relapsing pyelonephritis (12.9%), and the malignant tumours (7.1%). Many urological forms of diseases appeared combined. In the investigation of the complications without lethal exitus which appeared in 25.1% of all cases with concomitant diabetes the cardiovascular failure is again in the first place, then follow thrombotic diseases, urea-nitrogen disturbances. Peculiarities in conduction and treatment of the diabetes mellitus are shown and a close collaboration between several specialities is considered necessary.
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PMID:[Frequency of diabetes mellitus and nature of treatment in urologic diseases]. 73 75

In potential diabetics, environmental factors, especially overweight, appear to be more significant for the prognosis than genetic factors. The frequency of overt diabetes is higher in females than in males. Mean life expectancy amounts to about 70%, compared with the whole population. Mean survival after manifestation is more than 18 years. Diabetic coma has almost disappeared as cause of death. Today, approximately 75% of diabetics die from vascular complications, mainly from coronary heart disease. The coronaries are affected with same frequency in diabetic males and females. Renovascular complications are the leading cause of death only in young diabetics. Diabetic macro- and microangiopathy is correlated with the duration, not with the severity of diabetes. It should be imperative to physicians to control diabetes very strictly, especially during the first years following manifestation, in order to reduce frequency and/or severity of vascular complications.
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PMID:[Course of disease and prognosis of diabetes mellitus]. 79 63


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