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

Severe hypoglycaemic episodes are defined as need of assistance and may progress to profound coma. They can occur in patients treated with insulin, generally for type 1 diabetes, or in patients receiving sulphonylureas, for type 2 diabetes. Diagnosis is usually obvious, at least in insulin-treated patients, and requires an urgent intervention from the entourage. Such an intervention should comprise the oral administration of carbohydrates with high-glycaemic index if consciousness allows it or, if not, the injection of glucagon. When necessary, people should ask the help of a physician who will inject hypertonic glucose intravenously. Hypoglycaemic coma related to an absolute or relative excess of insulin should, in most cases, be treated at home. In contrast, a hypoglycaemic coma due to a too high dosage of sulphonylurea always requests a hospitalisation in order to carefully supervise the patient and to provide a prolonged intravenous infusion of glucose. It is mandatory that family or entourage members of any diabetic patient at risk to develop severe hypoglycaemia receive a specific education in order to promptly apply the best treatment capable of a rapid and safe recovery from hypoglycaemic coma.
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PMID:[How I treat...severe hypoglycemia in a diabetic patient]. 1272 4

In type 1 diabetes an absolute deficiency of insulin secretion requires exogenous insulin supply to guarantee the patient's life avoiding ketoacidotic coma and to prevent the chronic complications of diabetes. In order to obtain a more physiological replacement therapy different approaches have been pursued since the early 70s to create an artificial wearable pancreas able to deliver insulin according to the blood glucose values as determined by continuous monitoring. Four components are considered essential for the realisation of an artificial pancreas: the sampling system, the glucose sensor, the mathematical models and the related algorithms for the calculation of the insulin doses and the infusion system for the insulin delivery. At present the still unsolved issues are mainly represented by the availability of reliable continuous glucose monitor and control algorithms, while the new technologies allow for the miniaturisation of the system.
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PMID:The artificial pancreas. 1275 31

As we learn more about the pathophysiology of diabetes mellitus, we find that there is more yet to be learned. This may sound like a trite statement, but in reality it is true. The following article reviews the basic pathophysiology of both type 1 diabetes mellitus and type 2 diabetes mellitus as we understand it today. It continues on to reveal the "things that go wrong" when there is too much or too little glucose available to the body organs and especially to the brain. The article points out the signs and symptoms to be aware of when the person is in the acute state of diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic coma (or state), and severe hypoglycemia. It concludes with important considerations when the individual is in one of these acute states and contributes key points related to the control of diabetes when the person is in the state of compromise.
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PMID:Pathophysiology of diabetes mellitus. 1513 54

Hypoglycemia is a common side effect of intensive insulin therapy in patients with type 1 diabetes. Mild hypoglycemia is any episode that can be self-treated, while a severe episode requires external help for recovery. Acute hypoglycemia produces autonomic and neuroglycopenic symptoms, including cognitive impairment and mood changes, while sympathoadrenal stimulation can provoke acute hemodynamic changes with alterations in regional vascular perfusion and a risk of cardiac dysrhythmias. Neurological manifestations include coma, convulsions and focal abnormalities. Long-term morbidities associated with hypoglycemia include impaired awareness of hypoglycemia, counterregulatory hormonal deficiencies, hypoglycemia-associated autonomic failure, and, in rare cases, permanent cognitive impairment. Hypoglycemia affects all aspects of life for the person with type 1 diabetes, including employment, social interactions, driving, sport and leisure activities, and sleep. Appreciation of the potential morbidities of hypoglycemia should encourage physicians to utilize therapeutic regimens that decrease the risk of severe hypoglycemia.
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PMID:Morbidity of hypoglycemia in type 1 diabetes. 1531 71

A case of palatal perforation occurring in 7-year-old girl with IDDM due to nasotracheal intubation is reported. The child, who was not previously diagnosed of IDDM, was brought to hospital in comatose stage and was put on nasotracheal tube for maintaining respiration. This paper highlights the link between IDDM and palatal perforation communicating the nasal cavity due to naso-tracheal intubation.
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PMID:Nasotracheal intubation: an unusual cause of palatal perforation in an insulin dependent diabetes mellitus patient. 1555 9

Apparent increase of the incidence of childhood diabetes mellitus has been observed in many countries over the last decades. Data of seasonality are not consistent, especially in younger group. The triggering of the autoimmune process in genetically susceptible individuals may be the result of a variety of environmental factors including viral infections, specific nutrients, early introduction of cow's milk proteins and ingestion of nitrosamines, stress-inducing events, early perinatal lesions. Clinical studies of the last decade have confirmed that diabetes mellitus in young children is specific type of type 1 diabetes. At presentation, children in preschool age group, who have type 1 diabetes, have higher incidence of ketoacidosis with coma because of immaturity of the central nervous system. Delays in diagnosis in small children often lead to more severe dehydration and ketoacidosis. Chi dren in the young age group who have type 1 diabetes represent unique set of problems for their families and health care team.
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PMID:[New aspects of etiopathogenesis and clinical characteristics of diabetes mellitus type 1 in children]. 1561 86

The case of 22 years old woman admitted with ketoacidotic coma and newly diagnosed insulin dependent diabetes mellitus is described. The signs of mixed sensoromotoric polyneuropathia in this patient have been discovered. After the correction of ketoacidotic hyperglycemic coma the significant tachycardia and hypertension with the abnormalities of diurnal rhythm with necessity of the intensive treatment persisted for the period of the several monthes. These changes we attributed to the significant dysfunction of the autonomic system. In the course of 1 year of good diabetes compensation the above mentionned hemodynamic changes subsided completely. In the same time the signs of mixed polyneuropatia and the incipient retinopathia disappeared. The causes of the described changes are discussed, mainly the importance of reversible microvascular changes.
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PMID:[Reversible long-term tachycardia and hypertension as a symptom of autonomic neuropathy in combination with sensorimotor polyneuropathy in a patient with newly discovered type 1 diabetic mellitus]. 1563 57

Chryseobacterium indologenes is a non-fermentative Gram-negative bacillus that is a rare pathogen in humans. Its occurrence in diabetic children has not been previously reported. In this report, a case is described of C. indologenes bacteraemia possibly associated with the use of a peripheral venous catheter. A 2-year-old boy with type I diabetes mellitus was admitted due to a coma caused by cerebral oedema and was successfully treated for his neurological condition but presented on the tenth day after admission with fever of 40 degrees C, agitation, restlessness, lack of appetite, somnolence and fatigue. His pulse rate was 90 min(-1) and his respiratory rate was 20 min(-1). Laboratory studies revealed a white blood cell count of 4900 mm(-3) with 67% neutrophils and 27% lymphocytes. Two separate blood cultures yielded C. indologenes. Treatment with ceftriaxone was started before the culture results were obtained, and was continued after susceptibility test results were obtained. The patient became afebrile after 48 h, and his general condition improved within 36 h. The infection did not recur. This is believed to be the third case of bacteraemia outside of Asia due to C. indologenes and the first in a diabetic child not otherwise immunocompromised. This case indicates that C. indologenes infection can occur in diabetic children without ventilator or central venous catheter and might be treated with a single agent after in vitro susceptibility tests have been performed.
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PMID:Chryseobacterium indologenes bacteraemia in a diabetic child. 1594 33

Hypoglycaemia is defined as a plasma glucose concentration equal or below 54 mg/dl (3 mmol/l). It represents the most frequent acute metabolic complication among diabetic patients. Rarely fatal in patients with type 1 diabetes, it markedly alters the quality of life and hinders the achievement of a good metabolic control. Hypoglycaemia in type 2 diabetic patients treated with insulin secreting agents is less frequent, but it may be more dangerous in case of prolonged coma. Numerous intrinsic and extrinsic factors may influence the kinetics of plasma glucose concentrations among diabetic patients, which limits the prevision, and thus the prevention, of hypoglycaemic episodes. However, some basic rules, repeatedly emphasized during the multidisciplinary educational process, allow minimizing both the number and the severity of hypoglycaemic episodes. The present paper briefly describes some clinical situations increasing the risk of hypoglycaemia in diabetic patients treated with insulin or insulin secreting agents, emphasizing upon important therapeutic implications.
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PMID:[Risk of hypoglycaemia: therapeutical implications]. 1603 12

Nonketotic hyperosmolar coma (NHC) is characterized by severe hyperglycemia; absence of, or only slight ketosis; nonketotic acidosis; severe dehydration; depressed sensorium or frank coma; and various neurologic signs. This condition is uncommon in type 1 diabetes. Because of little or no osmotic diuresis in patients with diabetic nephropathy, increases in plasma osmolality and therefore the likelihood of neurologic symptoms are limited. A 20-year-old male patient with type 1 diabetes with chronic kidney disease on conservative treatment (glomerular filtration rate [GFR], 18 mL/dk) presented with acute nonketotic hyperosmolar syndrome. The patient was admitted presenting with thirst, fatigue, and drowsiness. Blood biochemistry levels were urea 87 mg/dL, creatinine 5.09 mg/dL, glucose 830 mg/dL, glycosylated hemoglobin (HbA1c) 8%, C peptide <0.3 ng/mL, sodium 131 mmol/L, chloride 93 mmol/L, potassium 5.2 mmol/L, and calculated serum osmolality 385 mOsm/kg. The presumptive diagnosis on admission was nonketotic hyperosmolar syndrome precipitated by urinary infection. This is the first case report of hyperosmolar coma in a patient with type 1 diabetes with chronic kidney disease.
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PMID:Nonketotic hyperosmolar coma in a patient with type 1 diabetes-related diabetic nephropathy: case report. 1641 50


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