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Query: UMLS:C0011849 (diabetes)
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The pancreas was generally ignored in antiquity, both as an organ and as a seat of disease. The first description of the pancreas is attributed to Herophilus. It was in the 17th century that the main duct of the organ was described and its significance demonstrated. At that time, Brunner thought that the pancreas was not essential to digestion, and he failed to associate the pancreas with diabetes. Claude Bernard discovered the function of the pancreas in digestion. In 1922, Banting and Best obtained isletin and demonstrated the capacity of the substance to cause a dog to recover from diabetic coma. In 1889, Reginald Fitz firmly established pancreatitis as a disease entity. In 1927, the first case of hyperinsulinism due to a tumor of the islet cells was reported. Twenty-eight years later, Zollinger and Ellison described two patients with unusually severe peptic ulcer disease, both of whom had noninsulin-secreting tumors of the pancreatic islets. Subsequently, gastrin was isolated as the hormone responsible for this syndrome. In March 1940, Dr. O. Whipple performed the first recorded one-stage pancreaticoduodenectomy. Much progress has been made since then and today transplantation of isolated islets and portions of whole pancreas is a reality.
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PMID:History of the pancreas. 635 46

It has been reported that sand rats, naturally feeding on low-caloric-value plants containing a high concentration of salt, become obese and develop hyperglycemia when fed on a standard laboratory diet. The aim of this study was to examine the long-term effects of a synthetic-chow diet on the metabolic pattern of the diabetic syndrome in a large group of sand rats. While a few animals had a fulminant reaction with markedly decreased glucose tolerance, low plasma insulin levels, and death within 3-4 wk, most sand rats developed obesity and elevated plasma insulin levels. From the third month and forward, 40% of sand rats presented with a diabetic syndrome with hyperinsulinemia, hyperglycemia, markedly decreased glucose tolerance, and insulin resistance. This diabetic syndrome can be compared with maturity-onset (type II) diabetes. When this synthetic-chow diet was given for more than 6 mo, the majority of animals lost considerable weight and showed a major depletion of fat stores. Serum immunoreactive insulin levels fell, while blood glucose rose to above 500 mg/dl with glycosuria and ketonuria. The elevated triglyceride content of plasma and the lipid deposits in the liver were greatly augmented, and no glycogen was present. Animals developed frank insulin-dependent diabetes, and diabetic animals not treated with insulin died in diabetic coma with presumed ketoacidosis. The disease was essentially confined to sand rats showing abnormal glucose tolerance, even before eating laboratory chow. This observation suggests a genetic factor. Thus, the sand rat appears to be a potentially interesting model for investigation of both maturity-onset and insulin-dependent diabetes.
Diabetes 1984 May
PMID:Diabetes mellitus in sand rats (Psammomys obesus). Metabolic pattern during development of the diabetic syndrome. 637 52

Ensuring the diagnosis of diabetes mellitus by morphological findings is very difficult. Postmortem determination of blood glucose is of no value because of the influence of glycolysis. In clinical studies, Hb A1 determination is used for long-time therapy control of diabetes. Values of less than 10% Hb A1 show that assimilation of glucose is in order. This study is based on the investigation of blood from 174 cadavers (125 men aged between 17 and 84 years; 49 women aged between 27 and 89 years) with many different causes of death, including some cases of coma diabeticum. Blood was frozen immediately; in 48 cases it was stored at +4 degrees C, too. Besides, we took cerebrospinal fluid and urine from each corpse (frozen at -80 degrees C) for determination of glucose, lactic acid, and acetone. Hemoglobin A1 was analyzed by a chromatographic method: the concentrations of Hb A1 ranged from 7.5% to 20% independent of the actual amount of total hemoglobin in our samples (total Hb from 5 to 32 g/dl). Obviously, there is very little influence of autolysis or prefinal glucose fluctuations in blood on its quantity. There is a positive correlation to the concentration of glucose and lactic acid in cerebrospinal fluid (according to the formula of Traub) and also to the presence of acetone in case of diabetic coma. According to our experience, Hemoglobin A1 is a very useful marker to ensure the diagnosis of diabetes mellitus post mortem. As Hb A1 seems to be very constant and stable vs. autolysis, it may help to clear up cases of unexpected death.
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PMID:[Initial results of postmortem diagnosis of diabetes mellitus by Hb A1 determination]. 663 56

It is generally accepted that etiology of diabetes mellitus is heterogeneous and term "diabetes mellitus" becomes too oldfashioned and vague to apply for the disease. A new term "hyperglycemosis" which involves all states of chronic blood glucose elevation irrespective of etiology, is proposed and tentative etiological classification of hyperglycemosis is shown. The provalence of diabetes mellitus has increased remarkably in Japan as well as other countries and the factors influencing on this increase are concluded as following: an increase in body mass index probably due to reduction of physical exercise and relative excess of energy intake, an increase of elder population and an accumulation of diabetic patients due to an improvement of prognosis of the disease. The phenomenon observed in Japan is thought to be a model in rapidly modernizing countries. Etiological classification was made in 10272 diabetic autopsy cases collected from Annual Reports of Pathological Autopsy Cases 1958-1980 and the result showed 85.9% of the cases was classified as idiopathic and 14. 1% was classified as other types of WHO classification. This study showed a difficulty to discriminate idiopathic diabetes mellitus in field studies and a reasonability to use an expression of hyperglycemosis instead of diabetes mellitus. Death of diabetic coma has decreased and death of malignant neoplasms and cardiovascular diseases, especially myocardial infarction, have increased. As frequency of the chronic complications is different according to the quality of the population and also to the examination methods, consideration for these points is important in planning of the study. The modern machine civilization has caused an increase of diabetic population and in the long history of the evolution of mankind, this increase is understood as a dysadaptation of the human body to excess food intake, less physical exercise and other diabetogenic environmental factors. The epidemiological study of diabetes will give a guide line of ideal life style of human being and contribute to sound prosperity of human society.
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PMID:Epidemiological problems in diabetes mellitus. 668 Apr 75

Eighty-six cases of renal papillary necrosis (RPN) published in Japan over the years 1949-1980 were studied. While several hundreds cases of RPN were reported in certain European countries and the USA, only 5 cases were published in Japan up until 1960. However, the number of case reports has increased to 28 over the 5 year period of 1976-1980. The ratio of diabetics (62 cases) to nondiabetics (24 cases) is about 2.6:1 and is the same as that reported by Lauer in the USA. In diabetics, RPN was more frequently seen in females (3.4:1) and at more advanced age. Frequency of bilateral occurrence was high (47.5%). The prevalence of the association of glomerulosclerosis (75.0%) was higher than that reported by Silverman et al. in the USA (47.1%). The Incidence of the association of disturbances of consciousness (29.5%) was similar to that reported by Edmondson et al.. It was concluded that the number of cases of RPN with diabetes mellitus in Japan started to increase about 20 years later than in the USA, and that the frequency of the association between RPN and diabetic glomerulosclerosis in Japan seems to be higher than in the USA. Furthermore, it was noted that RPN was frequently associated with hyperosmolar nonketotic diabetic coma.
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PMID:Epidemiological studies on renal papillary necrosis with diabetes mellitus in Japan. 668 May 17

The principal causes of death among 9,737 diabetics who died in 280 hospitals all over Japan during the period 1971-1980 have been analyzed retrospectively in this study. The main cause of death in Japanese diabetics was vascular complications. The mortality from vascular complications was 41.5%, 37.9% for males and 46.8% for females, increasing with the duration of diabetes and with age. The most interesting findings were of cardiovascular disease which was the cause of death in 12.3% of the subjects in our study as compared to 54.6% of the Joslin Clinic patients (1971). However, our incidence rate was almost twice that reported in Japan in 1967 by Goto (Japan). In contrast, cerebrovascular disease and nephropathy are much more common in Japanese than in American diabetics. Recently cancer has become more common in Japanese diabetics and 25.3% of the deaths have been assigned to it. In contrast, diabetic coma due to hyperglycemia accounted for only 4.1% of deaths. The average life span of Japanese diabetics is still over 10 years shorter than that of non-diabetics.
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PMID:The features of causes of death in Japanese diabetics during the period 1971-1980. 668 May 40

We investigated the causes of death of 98 subjects with diabetes mellitus over the past 10 years at our hospital. As was expected, the cause with the highest incidence (48.0%) was vascular disease including cerebral vascular disease (20.4%), coronary heart disease (15.3%), aortic disease and miscellaneous (3.1%), followed by malignant tumors (39.8%), infectious diseases (4.1%) and other diseases. Only one patient died from diabetic coma. The abnormal ECG findings of these patients were analyzed according to the Minnesota Code and 57%, 31%, 26%, 24%, 19% of them showed arrhythmias, ST-T abnormalities, LVH, VPC, and abnormal Q-wave, respectively. These findings showed no statistical difference between diabetics and non-diabetics. Abnormal p-wave, especially LA-load was found more often in diabetics (35%) than in non-diabetics (21%). Q-T interval corrected by Bazett's formula (Q-Tc) was 430 +/- 3.03 (M +/- SEM) msec in diabetics and it was significantly longer (p less than 0.01) than 417 +/- 3.73 msec in patients with other diseases.
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PMID:Causes of death of diabetic patients in the past 10 years and their ECG findings. 668 May 44

Analysis of causes of death in a population of 3,113 diabetics was carried out for a period of eight years and those patients dying of some form of diabetic coma identified. Of 1,274 deaths, only 22 (1.73%) were primarily due to coma; 7 hypoglycaemia, 8 ketoacidosis, 3 hyperosmolar coma and 4 lactic acidosis. Three of the ketoacidosis patients may have died from other causes. Most deaths occurred in patients with long-standing diabetes. In the hypoglycaemic group all were on insulin and several had been difficult to control for many years. Infection was an important precipitating factor for ketoacidosis and hyperosmolar coma. Phenformin was the cause of all cases of fatal lactic acidosis. It is reassuring that death from coma is a comparatively rare event in known treated diabetic patients.
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PMID:Fatal coma in diabetes. 677 28

Diabetic coma is frequently associated with thromboembolic complications. A prospective study was undertaken of the haemostatic changes occurring in 15 patients (12 with ketoacidosis, three with the hyperosmolar syndrome) during diabetic coma. When compared with the results after stabilization of the diabetes, ketoacidosis was associated with significantly higher levels of factor VIII coagulant activity, factor VIII-related antigen and fibrin degradation products, a shorter partial thromboplastin time and reduced concentrations of antithrombin III. These results suggest that in uncomplicated ketoacidosis, haematological changes occur which may reflect vascular endothelial damage and intravascular fibrin deposition. Out of three deaths, two patients (both with the hyperosmolar syndrome) had evidence of disseminated intravascular coagulation. To reduce further the mortality and morbidity from diabetic coma, controlled clinical trials of anticoagulant and antiplatelet drugs may be indicated.
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PMID:Haemostatic changes in diabetic coma. 679 75

Von Willebrand factor (VIII: vWf) is a glycoprotein which is essential for normal platelet adhesion to vascular subendothelium, particularly at the high shear rates encountered in small blood vessels. VIII: vWf is distributed in plasma, platelets and subendothelium, though the contributions of each pool to normal hemostasis is unknown. Raised plasma of VIII: vWf have been frequently described in association with diabetes, the highest concentrations being found in patients with retinopathy. In addition, concentrations of VIII: vWf appear to be influenced by the degree of metabolic control of the diabetics, particularly high levels being found during diabetic coma. Plasmatic concentrations of VIII: vWf greater than normal have not been shown to result in increased platelet adhesion or aggregation, so that is seems unlikely that the high levels of plasmatic VIII: vWf contribute directly to the pathogensis of retinopathy. On the other hand, increases in VIII: vWF during episodes of poor metabolic control could be evidence of reversible injury to the vascular endothelium, whereas stable, high concentrations may indicate the presence of microangiopathy.
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PMID:Von Willebrand factor, diabetes mellitus and retinopathy. 679 13


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