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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case history and the autopsy findings of a 44-year-old women who died shortly after her flight to Khartoum (Sudan) in a hospital is presented. The clinical diagnosis in Africa was "shock caused by gastroenteritis". The body was embalmed thoroughly and brought back to Germany. The autopsy was performed just prior to the cremation (according to "section 3 Abs. 2 Nr. 2 Feuerbestattungsgesetz"). Morphological findings (nodular glomerulosclerosis and glycogen nephrosis with Armanni-Ebstein-cells) and postmortem biochemical analyses of vitreous humour led to the diagnosis of a hyperglycaemic coma. The fatal course might have been prevented by sufficient health information to the patient (who suffered from type 1 diabetes); the diagnostic errors in the hospital could have easily been avoided by careful anamnesis and diagnostic procedures.
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PMID:[Fatality in diabetic coma during foreign travel]. 128 47

Diabetic Ketoacidosis (DKA) remains the leading cause of death in children with type 1 diabetes mellitus. Complications occurring during DKA treatment include cerebral edema and neurologic collapse. Developmental outcomes following neurologic deterioration during DKA have varied from no sequelae to severe developmental disabilities. A total of three children developed neurologic deterioration during treatment of DKA at Buffalo Children's Hospital between 1984 and 1987. The authors treated aggressively for cerebral edema. Characteristic findings on the computed tomography (CT) scans and magnetic resonance imaging (MRI) of the brain included hemorrhagic infarctions of the thalami, basal ganglia and lentiform nuclei. The authors conducted developmental follow-up examinations between 1-1/2 - 3 years following recovery from DKA coma. Although they noted significant recoveries over time, developmental disabilities persisted. The clinical courses and neuroradiographic findings of these patients are compatible with sequelae of central brain stem herniation and cytotoxic brain injury. Continued efforts are needed in the prevention and early detection of clinically significant cerebral edema during treatment of DKA.
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PMID:Diabetic ketoacidosis. Neurologic collapse during treatment followed by severe developmental morbidity. 169 85

Comparative investigation of indices of lipid peroxidation and blood lipid unsaturation was carried out in 91 pediatric inpatients (aged 7 to 15) with type I diabetes mellitus and in 10 controls of the same age. Activation of free radical lipid peroxidation was shown to occur in children with diabetes mellitus. A degree of compensation of diabetes did not influence the level of hydroxyperoxides (HP) and final decay products (FP) of lipid peroxidation. In ketoacidotic decompensation HP and FP concentrations in the patients were increased as compared to those in the controls by 284 and 255%, respectively. At the same time children who were admitted in coma, demonstrated low values of blood lipid unsaturation. Insulin therapy (irrespective a drug dose) was accompanied by a 1.8-2-fold increase (p less than 0.05) in a HP level as compared to control values. Change in the level of lipid unsaturation depended upon a daily dose of insulin. In diabetes over 1 year different types of changes in lipid peroxidation and unsaturation were detected, and individual differences in their levels required a differentiated approach to therapeutic tactics.
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PMID:[The indices of the lipid peroxidation and desaturation of the blood serum in diabetes mellitus in children]. 178 82

Ninety-seven patients with insulin dependent diabetes mellitus (IDDM) were randomized to intensified conventional treatment (ICT, n = 44) or regular treatment (RT, n = 53). The mean HbA1c level (+/- SEM) was reduced from 9.5 +/- 0.2% to 7.4 +/- 0.1% in the ICT group (P less than 0.001), and from 9.4 +/- 0.2% to 9.0 +/- 0.2% (P less than 0.01) in the RT group. The difference between the groups was significant (P less than 0.001). During a period of 3 years, 57% of the ICT patients (95% confidence interval 44-73%) and 23% of the RT patients (95% CI, 11-34%) (P less than 0.001) had at least one episode of serious hypoglycaemia, with the need for third-party assistance or resulting in coma. Eighteen of the 32 ICT patients who initially had adrenergic symptoms during hypoglycaemia changed to predominantly neuroglycopenic symptoms. This was the case with only 8 of 38 RT patients (P less than 0.01). The change in symptoms was related to the increased frequency of serious hypoglycaemia, but neither symptoms nor frequency of hypoglycaemia bor any relationship to insulin dose, body mass index, duration of diabetes or autonomic nerve function. The results of several neuropsychological tests did not differ between the groups at baseline, and did not change during the study. There were no signs of deteriorating cognitive function in the patients with serious hypoglycaemic episodes.
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PMID:Hypoglycaemic episodes during intensified insulin treatment: increased frequency but no effect on cognitive function. 199 69

Despite many advances in the overall treatment of type I diabetes mellitus during the last few years, no major advance has been made in decreasing the mortality rate of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic coma. A major concern in both of these disease states is the development of cerebral edema during treatment. The guiding principles of therapy in both disease states are rehydration, electrolyte replacement, insulin therapy, and treatment of any underlying illnesses. If the patient is hypotensive, therapy begins with colloid or normal saline administration to support blood pressure. Fluid and electrolyte deficits should be calculated and replaced during 48 hours. Low-dose insulin therapy is employed for treatment of hyperglycemia. Neurologic function should be carefully monitored and mannitol administered if a change in neurologic function occurs.
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PMID:Concepts of fluid therapy in diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma. 210 50

One hundred and fifty-eight patients with insulin dependent diabetes mellitus attending two Auckland outpatient clinics answered a questionnaire about hypoglycaemia. Almost all (98%) had experienced hypoglycaemic episodes and for 30% these were a major problem. Seventy-seven percent reported nocturnal hypoglycaemia, 39% of whom required external assistance during episodes. Forty-three percent had experienced coma, or convulsions during hypoglycaemia and a small group, 7%, had recurrent severe episodes. Twenty percent carried no diabetic identification and 13% did not routinely carry a glucose supply. Only 38% of patients kept glucagon at home. Forty percent of patients driving vehicles had experienced hypoglycaemia while driving and 13% reported traffic accidents attributed to hypoglycaemia. Hypoglycaemia is a major problem for many patients taking insulin. Improved education, wider availability of glucagon and more liberal glycaemic control of patients with problematic hypoglycaemia may be advisable.
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PMID:Hypoglycaemia in insulin dependent diabetic patients attending an outpatients' clinic. 237 62

Hyperglycemia and other metabolic derangements resulting from absolute or functional deficiency of insulin are accompanied by typical signs and symptoms of diabetes. The clinical signs and the findings of hyperglycemia over 200 mg/dl should establish a diagnosis of diabetes mellitus. An oral glucose tolerance test (O-GTT) is rarely necessary for diagnosis of diabetes in a child. A small proportion of children, however, present less severe symptoms, and may require an O-GTT. Approximately 14% of IDDM children were in coma at diagnosis in Tokyo, and 11 onset deaths (0.94%) were observed among the 1172 newly diagnosed IDDM cases in Japan. A significant decline in the onset mortality, however, has been observed in the past 20 years in Japan in association with the improvement of early management of childhood diabetes. The clinical distinction of IDDM from NIDDM is often difficult in diabetic children of Oriental origin without obesity. Japanese IDDM can be divided into two forms, abrupt and slow onset forms, but they may be essentially the same disease. There was no difference in the frequency of being tested positive for circulating ICA between the two groups of the patients. But a difference in the frequency of HLA DR4 and DRW9 was noticed between the two groups. Clinical features of 107 children with NIDDM were studied and about 75% of these cases were obese. All of them can be detected by routine urinalysis for glucose. Diet and exercise therapy in most of the newly diagnosed patients resulted in remission but some of them may require insulin or an oral hypoglycemic agent to get better glycemic control.
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PMID:Initial signs and diagnosis of diabetes--special considerations of Oriental patients. 263 91

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

The descriptive epidemiology of diabetic coma at onset was investigated in a nationwide survey of insulin-dependent diabetic (IDDM) children (age at onset less than 18 yr) throughout Japan for the years 1970-81. Of the 1172 cases, 148 (12.6%) were unconscious at onset. Diabetic coma was highly associated with abnormalities in the biochemical variables. There was no sex difference in the frequency of coma; however, there was an inverse association with age wherein children under 5 yr of age were approximately two times more likely to present in coma than older children. There was a strong association with reported infections wherein patients with coma were more than twice as likely to report infection than patients without coma. It seemed that the frequency of coma did not decline during the study period. The risk of dying at onset was very high; diabetic children in coma (4.7%) were 12 times more likely to die than patients without coma.
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PMID:Coma at the onset of young insulin-dependent diabetes in Japan. The results of a nationwide survey. Japan and Pittsburgh Childhood Diabetes Research Groups. 386 5

Five patients are described in whom factitious disease was the cause of brittle type I diabetes mellitus. The patients were referred from throughout the United States because their physicians had been unable to establish the reason for recurrent hospitalizations for diabetic ketoacidosis or coma. In three of the patients, unexplainable signs, symptoms, and/or laboratory results lead to the diagnosis of factitious disease. In the two remaining patients, long-term follow-up was necessary before a factitious cause was established. These five patients exemplify the extraordinary measures that some patients will utilize to continue as a "patient" rather than return to a normal lifestyle.
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PMID:Factitious brittle diabetes mellitus. 392 20


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