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

The management of diabetes mellitus involves patient education and dietary modifications, both of which play a key role in determining the success of therapy. Other therapeutic measures include oral hypoglycaemic agents and insulin. In type II diabetic patients not responding to diet alone the second-generation sulphonylureas are preferred. Biguanides are indicated in the very obese type II diabetic, provided there are no contraindications. Where insulin therapy is indicated (e.g. type 1 diabetes mellitus), the trend is to use a human preparation because it evokes a very weak antibody response. Optimal diabetes control, as gauged by home blood glucose monitoring and glycosylated haemoglobin levels or, in the case of type II diabetics, fasting blood glucose levels, prevents the acute symptoms of diabetes mellitus as well as coma and in addition appears to minimise the risk of vascular complications.
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PMID:Management of diabetes mellitus. 355 61

A variety of infectious processes produce cutaneous and soft-tissue involvement of the lower extremities. Patients with conditions leading to ischemia and devitalized tissues, and those with diabetes mellitus are predisposed to developing these infections. The signs and symptoms and bacteriology of many of these infections may overlap, leading to confusion in diagnosis and subsequent management. Very often the progression of some of these infections is rapid and life-threatening, although mutilating-type infections are not uncommon. Optimal management requires a multidisciplinary approach, with the surgeon, microbiologist, pathologist, internist, and infectious disease specialist working in close cooperation with each other.
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PMID:Infections involving the skin and soft tissues of the lower extremities. 355 52

Contributors to CHD include atherogenic personal attributes, living habits which promote these, signs of preclinical disease, and host susceptibility to these influences. Atherogenic traits include the blood lipids, blood pressure, and glucose tolerance. High LDL cholesterol is positively and high HDL cholesterol inversely related to CHD incidence. Hypertension, whether systolic or diastolic, labile or fixed, casual or basal, at any age in either sex contributes powerfully to coronary heart disease. The impact of diabetes on CHD is greater for women than for men and varies according to the level of the foregoing risk factors. The faulty life-style is typified by a diet excessive in calories, fat, and salt, a sedentary habit, unrestrained weight gain, and cigarettes. Alcohol used in moderation may be beneficial. Oral contraceptives worsen atherogenic traits and, when used for long periods beyond age 35 in conjunction with cigarettes, predispose to thromboembolism. Type A persons with an overdeveloped sense of time urgency, drive, and competitiveness develop an excess of angina pectoris. Men married to more highly educated women are at increased risk, as are men married to women in white-collar jobs. Preclinical signs of a compromised coronary circulation include silent MI, ECG-LVH, blocked intraventricular conduction, and repolarization abnormalities. Exercise ECG may elicit still earlier evidence. Measures of innate susceptibility include a family history of premature cardiovascular disease, diabetes, hypertension, and gout. Optimal prediction of CHD requires a quantitative combination of risk factors in multiple logistic risk formulations that identify high-risk persons with multiple marginal abnormalities. Preventive management should also be multifactorial.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Psychosocial and other features of coronary heart disease: insights from the Framingham Study. 377 1

Optimal treatment for children younger than 5 years of age with insulin-dependent diabetes mellitus is not well defined. Nineteen young children with this disease were treated with a program in which frequent home blood-glucose monitoring was used as the basis for an educational program emphasizing parental adjustment of insulin in response to current glucose levels and anticipated diet and exercise. Eleven children were treated from diagnosis (group I) and another eight (group D) were referred after less intensive treatment. The mean duration of observation of group I children was 13.6 months (range, six to 24 months). For group D, the mean time between diagnosis and referral was 14.9 months (range, seven to 24 months) and 14.6 months (range, six to 24 months) after referral. Before referral, there were 11 hospitalizations in group D. During the intensified program there were two hospitalizations in group D and one in group I. There were 3.3 episodes of severe hypoglycemia per child per 18 months in group D before referral, 1.7 episodes after referral, and 0.4 episodes in group I. Ten of 14 severe hypoglycemic episodes during intensified treatment occurred when there was no or infrequent home blood-glucose monitoring. Only four episodes seemed to have been unpredictable and unpreventable. Mean glycosylated hemoglobin levels were higher in group D patients when compared with both the duration of insulin-dependent diabetes mellitus and the time of initiation of intensified treatment. Mean daily insulin doses increased progressively in group I patients following diagnosis, and were comparable with those in group D patients at 15 and 18 months' duration of illness. Thus, frequency of hospitalization and severe hypoglycemia can be decreased in young children. Frequent home blood-glucose monitoring is required and extensive educational and psychosocial support is necessary for families to implement this intensive approach. The long-term effects on psychoneurological development need evaluation.
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PMID:Management of diabetes mellitus in children younger than 5 years of age. 388 16

Optimal assay conditions have been determined in human liver preparations for the catalytic transfer of mannose and N-acetylglucosamine from GDP-mannose and UDP-N-acetylglucosamine, respectively, to dolichyl phosphate. Both enzymatic reactions have an absolute requirement for divalent cation (5 mmol/l Mn2+ optimal), detergent (Triton X-100 or Nonidet P-40) and dolichyl phosphate (as acceptor substrate) and both reactions have optimal activity at a pH value of 7.8. Preliminary characterization of the glycolipid products for both enzymatic reactions indicates that phosphorylated dolichol is the major acceptor substrate for radiolabeled mannose and N-acetylglucosamine. The activity levels and specific activities of dolichyl phosphate-mannosyltransferase are comparable in liver homogenates from normal controls and patients with cystic fibrosis and diabetes mellitus. The activity levels and specific activities of dolichyl phosphate-N-acetylglucosaminyltransferase are comparable in liver homogenates from normal controls and patients with cystic fibrosis and diabetes mellitus but considerably lower than the activity levels of dolichyl phosphate-mannosyltransferase. It appears that two of the initial steps of the lipid-mediated glycosylation pathway are normal in livers from patients with cystic fibrosis and diabetes mellitus.
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PMID:Dolichyl phosphate-mannosyltransferase and dolichyl phosphate-N-acetylglucosaminyltransferase activities in liver preparations from normal controls and patients with cystic fibrosis and diabetes mellitus. 622 43

Dispersed islet cells were prepared from collagenase-isolated lean mouse pancreatic islets by Dispase-II and subsequent mechanical treatment in calcium depleted media. An average yield of 600 cells per islet was obtained, 84% of the cells being beta-cells. Cells were incubated with radioactive chromium as a marker of cell viability. Optimal labelling of 1--2 cpm per cell was obtained by incubating 10(5) cells with 10(6) cpm of [51]Cr for 90 min. When islet cells were incubated with streptozotocin, this drug induced [51]Cr-release after a lag time of 2--4 hours. Furthermore, a positive correlation between streptozotocin concentrations and [51]Cr-release was found. This assay of cytotoxicity was highly reproducible and might be applicable in the study of other beta-cell damaging agents or autoimmune phenomena in the pathogenesis of diabetes.
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PMID:Direct streptozotocin toxicity on dispersed mouse islet cells determined by [51]Cr-release. 645 61

The interaction between the daily distribution of carbohydrates and frequent self-blood-glucose monitoring (SBGM) was studied in 13 pregnant women who had had diabetes for 4 to 19 years. Before and during SBGM, data were obtained on dietary history, daily blood glucose levels, and HbA1C. Optimal control was found with 3 main meals and 5 snacks. The total daily caloric intake decreased without change in the proportions of protein, fat, and carbohydrate. Consumption of starch increased, and that of simple sugars decreased. Although no changes were made in the daily amount of insulin, the women's diabetic control improved significantly.
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PMID:Dietary adjustment during self-blood-glucose monitoring in pregnant women with insulin-dependent diabetes mellitus. 673 10

Diabetes in rats inhibits the migration of neutrophils into the healing gingival crevice, an effect associated with impaired in vitro neutrophil chemotactic activity. We recently described the in vivo response of human and rat crevicular neutrophils to a chemotactic challenge and used this assay in the present study on streptozotocin-induced diabetic rats. Optimal concentrations of two chemotactic agents, casein (0.2 mul, 2 mg/ml) or N-formylmethionylleucylphenylalanine (0.2 mul, 10(-4) M), were placed into the gingival crevices of control and diabetic rats (time zero) after the resting neutrophil count was measured. After a 15-min delay, the neutrophil counts and gingival crevicular fluid flow were assessed every 5 min for another 0.5 h. The control rats (n = 14) showed an increase in neutrophil counts which reached maximum levels 30 min after the N-formylmethionylleucylphenylalanine challenge ("peak" neutrophil response) and decreased dramatically 5 min later. Diabetes of 4 days (n = 4), 14 days (n = 8), and 20 days (n = 5) duration reduced the peak neutrophil response 45, 66, and 71%, respectively. Casein produced the same response as N-formylmethionylleucylphenylalanine in control rats. Uncontrolled diabetes of 20 days duration reduced the peak neutrophil response to casein by 83%; diabetics administered insulin on a daily basis showed a reduction of only 34%. The pattern of change in gingival crevicular fluid flow in response to chemoattractants paralleled the neutrophil response. The chemotactic activity of peritoneal neutrophils was assessed in vitro with the agarose gel technique and was found to be correlated (r = 0.84; P < 0.01) with the in vivo chemotactic response in the same rats. If the same in vivo defect is observed in humans with diabetes (or with other systemic diseases associated with leukocyte dysfunction), this test could be useful diagnostically to rapidly assess neutrophil chemotaxis in lieu of in vitro assays and to identify patients who are unusually susceptible to aggressive periodontal disease.
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PMID:In vivo crevicular leukocyte response to a chemotactic challenge: inhibition by experimental diabetes. 675 17

Optimal control of diabetes should achieve not only euglycemia and normal levels of glycosylated hemoglobin but also absence of the reversible concomitants of diabetes such as red cell rigidity, hyperlipidemia, increased capillary permeability, enlargement of the kidneys, proteinuria, etc. Unfortunately, in most patients consistent euglycemia cannot be assured even with two daily injections of insulin. However, self-measurement of blood glucose as a guide to insulin taken before each meal and at bedtime can, in selected patients, increase the frequency of normal glucose levels without undue hypoglycemia.
Diabetes Care
PMID:Parameters of good control in diabetes mellitus. 699 74

A 19-year-old woman with insulin-dependent diabetes mellitus (IDDM) of 3.5 years duration had been suffering from recurrent episodes of diabetic ketoacidosis (DKA), dizziness, and weight loss (16 kg, 29%) for 6 months. History and physical examination gave evidence of severe peripheral and autonomic neuropathy. Radionuclide retention on gastric emptying test at 60 min was greater than 90% (normal < 60%). On autonomic cardiovascular testing there was evidence of both parasympathetic and sympathetic damage. There was no evidence of nephropathy or retinopathy. Optimal diabetic control using 4 insulin injections (2 u/kg/day) and high-dose cisapride terminated the vomiting, and she regained the weight lost within 5 months. This case is unique in that severe diabetic neuropathy followed relatively soon after onset of disease, without other microvascular complications. The correct diagnosis of gastroparesis as the cause of the recurrent DKA and weight loss, and the specific prokinetic therapy and nearly normoglycemic control of the diabetes led to dramatic clinical and functional improvement. Specific prokinetic therapy and the nearly normoglycemic control of the diabetes led to dramatic clinical and functional improvement. Gastroparesis can cause recurrent DKA even in young patients with IDDM of short duration.
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PMID:[Severe neuropathy in a young diabetic]. 784 56


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