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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 prevalence of anti-insulin antibodies (AIABs) and their association with clinical parameters, metabolic control and severe hypoglycaemia were investigated in a geographically defined population of insulin-treated diabetic patients. Eighty per cent of the patients (479) delivered venous blood samples and answered a questionnaire on severe hypoglycaemic problems during a 12-month period. Circulating AIABs were demonstrable in 78% of the patients, being more common among those with type 1 diabetes and in long-duration patients. High levels of AIABs were also more frequent in patients in whom insulin treatment had been initiated prior to the era of highly purified insulins. The AIABs did not correlate to metabolic control, insulin dose or severe hypoglycaemia. It is concluded that AIABs is not a risk factor for severe hypoglycaemia in insulin-treated diabetic patients.
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PMID:Prevalence of anti-insulin antibodies and its relation to severe hypoglycaemia in insulin-treated diabetic patients. 223 67

The mean additional energy requirement for pregnancy has been calculated at 285 kcal daily and it reflects the energy needs for production of the fetoplacental unit and for the maternal physiological adaptations to pregnancy. In practice there is considerable variation in energy requirement due to alterations in maternal energy expenditure. Optimal energy intakes are dictated also by the pre-pregnancy maternal weight. The outcome of pregnancy is improved in the underweight mother by an intake which produces a weight gain in pregnancy of approximately 14 kg, whereas a rise of only 7 kg may be optimal for the obese mother. Obesity with or without diabetes is associated with macrosomia and other problems and it is sensible to attempt to limit weight gain in pregnancy at a time when maternal motivation is high. Diabetes in pregnancy may arise in patients with pre-existing NIDDM or IDDM, but more commonly it is diagnosed for the first time during pregnancy and it usually disappears after delivery (gestational diabetes). Recent evidence suggests that gestational diabetes has a strong genetic component and is usually NIDDM precipitated early in life by the pregnancy. Both gestational diabetes and NIDDM are characterized by insulin deficiency and by insulin resistance. Long-term follow-up studies have demonstrated that NIDDM or impaired glucose tolerance develop in later life in 50-70% of women with previous gestational diabetes. The adverse effects of pregnancy on the mother with pre-existing diabetes may be minimized by good diabetic control as may be adverse effects on the fetus and neonate of diabetes in the mother. An increased incidence of fetal malformations persists in pregnancies with pre-existing maternal diabetes. Diabetes of any form may be associated with neonatal hypoglycaemia. The aim of therapy is to produce maternal normoglycaemia throughout pregnancy by dietary measures and insulin treatment if required. Women with pre-existing diabetes should tighten their blood glucose control from before conception. Optimization of insulin therapy and diet are required for IDDM and most NIDDM women will require insulin treatment in pregnancy. Gestational diabetics require diet and possibly insulin. Most pregnancies now proceed to term.
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PMID:Diabetes and diet in pregnancy. 224 97

In a planned 5-year study, 97 patients with insulin dependent diabetes mellitus (IDDM), non-proliferative retinopathy and unsatisfactory blood glucose control were monitored for 3 years. The patients were randomized to an intensified conventional treatment (ICT, n = 44) or a regular treatment (RT, n = 53) group. HbA1c (normal range 3.9-5.7%) was reduced from 9.5 +/- 0.2 (mean value +/- SEM) to 7.4 +/- 0.1% in the ICT group (P = 0.0001), and from 9.5 +/- 0.2 to 9.0 +/- 0.2% in the RT group (P = 0.004). Nerve conduction velocities in the sural and peroneal nerves (P = 0.01-0.0001) were impaired in the RT group, but not in the ICT group. Retinopathy increased in both groups. The condition of 22 ICT patients (50%, 95% confidence interval 34-66%) and 37 RT patients (73%, 61-84%) deteriorated with regard to at least one microvascular complication (retinopathy, nephropathy, neuropathy) (P = 0.024). Lower HbA1c levels during the study significantly reduced the risk of deterioration (P = 0.01). In total, 57% of the ICT patients had at least one episode of serious hypoglycaemia, compared with 23% in the RT group (P = 0.001). The patients in the ICT group also gained weight (P = 0.0001). Improved blood glucose control slowed down the progression of microangiopathy during a 3-year period in patients with non-proliferative retinopathy, but at the price of an increased frequency of serious hypoglycaemic episodes, and some gain in body weight.
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PMID:Metabolic control and complications over 3 years in patients with insulin dependent diabetes (IDDM): the Stockholm Diabetes Intervention Study (SDIS). 225 23

Fifty two children with insulin dependent diabetes mellitus were randomised to receive human isophane or lente insulin preparations in combination with soluble insulin in a double blind trial. Patients were seen every two months, and crossed over after four months of treatment. Control assessed by glycated haemoglobin was significantly lower in children on human isophane insulin, but fasting blood glucose and fructosamine concentrations and the number of episodes of hypoglycaemia were similar on both regimens. In five children on twice daily insulin regimens, insulin profiles throughout a 24 hour period demonstrated greater variability on lente compared with isophane insulin despite identically administered insulin doses. A questionnaire completed at the end of the study showed that two thirds of the children and/or their parents preferred the isophane insulin, and they gave perceived improvement of metabolic control as the major reason for their choice.
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PMID:Human isophane or lente insulin? A double blind crossover trial in insulin dependent diabetes mellitus. 227 Sep 41

There is a significant need for revised, safe and more effective insulin delivery methods than subcutaneous insulin therapy, including CSII, in the treatment of type 1 diabetes. The aim of the review is to describe the current status, issues and prospects of insulin therapy with implantable insulin pumps. The International Registry of Human Implantation reports that, as of May 1988, 249 pumps have been implanted, using the intravenous or intraperitoneal route for insulin infusion. The data suggest a reasonable safety of the method, no pump run-away having been reported and only one patient having died of severe hypoglycemia possibly related to the pump. The more recent European (POINT) and U.S. (PIMS) trials with programmable pumps have confirmed the safety and suggested a better efficacy of the method over subcutaneous insulin administration. They also have pointed out that in order to represent an acceptable alternative to existing methods, implantable pumps still have to a) cope with or increase catheter longevity, presently of 2-3 years only, namely by improving catheter biocompatibility and b) clearly prove its superiority over subcutaneous methods at controlling diabetes, using large-scale, randomized, prospective controlled studies.
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PMID:Implantable insulin pumps: a major piece of computerized diabetes therapy. 227 20

In order to find out objective indices for "hidden" hypoglycemia in diabetic patients the urine excretion of the catecholamines adrenaline, noradrenaline, dopamine and the serum levels of cortisol and somatotrophic hormone (STH) were followed up. 45 diabetics on insulin treatment were included in the study: 32 patients with type I diabetes mellitus and 13 patients with diabetes mellitus type II with secondary resistance to sulfanilurea drugs and insulin. The patients were classified into the following groups: I. without hypoglycemia--28 patients; 2. with diurnal hypoglycemia--6 patients and 3. with nocturnal hypoglycemia--II patients. In the patients with hypoglycemia the 24 h adrenaline urine excretion was higher than in the patients without hypoglycemia. No such differences were found for noradrenaline and dopamine. The separate examination of the diurnal and nocturnal catecholamines excretion showed in all groups that they cannot serve as an objective index for determination of hypoglycemia. The STH showed no differences in all groups of diabetics. Disturbances in the circadian rhythm of cortisol secretion in diabetics were found. This could be a good and available marker for detecting "hidden" hypoglycemia in diabetics.
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PMID:[Catecholamine excretion in diabetics on insulin treatment]. 228 57

Diabetes mellitus is characterized by recurrent metabolic abnormalities which postmortem studies suggest might be associated with degenerative changes in the central nervous system. Acute hypoglycemia does indeed lead to cognitive impairment, whereas acute hyperglycemia in the absence of ketoacidosis or hyperosmolarity does not. Insulin-dependent diabetes mellitus is associated with cognitive deficits that tend to be relatively slight, inconsistent between different studies, and unrelated to clinical indicators; they can be ascribed as plausibly to psychogenic factors as to degenerative disease. In contrast, cognitive impairment in noninsulin-dependent diabetes mellitus is more conspicuous in tests of learning and memory, consistently associated with a patient's level of glycemic control, and more plausibly to be ascribed to structural neuropathology. Nevertheless, in both cases the deficits in question are unlikely to interfere significantly with patients' everyday functioning.
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PMID:Cognitive function in diabetes mellitus. 228 78

Alterations in the control of arginine-vasopressin (AVP) secretion have been described in type I diabetes mellitus. In order to gain a better insight into this problem, we examined whether insulin-dependent diabetics in good metabolic conditions and without diabetic complications had an abnormal AVP responsiveness to metoclopramide (MCP), an AVP-stimulating agent with a central site of action. In addition, we tested the AVP response to insulin-induced hypoglycemia in the same subjects. Twenty insulin-dependent diabetic men without neuropathy or other diabetic complications were divided into two groups according to the duration of their illness (10 patients who had been diabetic for less than 10 years, group 1, and 10 patients who had been diabetic for more than 10 years, group 2). Eleven age- and weight-matched normal men participated as controls. All groups were tested with MCP (20 mg in an intravenous bolus) and, on a different occasion, with insulin-induced (0.15 IU/kg) hypoglycemia. Experiments started after optimization of the metabolic status of the diabetic men by 3 days of treatment with continuous subcutaneous insulin infusion. Basal concentrations of AVP were similar in all groups (diabetics of group 1: 2.2 +/- 0.2 pmol/l, mean +/- SE; group 2: 2.3 +/- 0.2 pmol/l; normal controls: 2.2 +/- 0.2 pmol/l). Administration of MCP induced a striking elevation of plasma AVP levels in the normal controls and in the diabetic subjects of groups 1 and 2. All subjects showed a mean peak response at 15 min.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abnormal arginine-vasopressin responses to metoclopramide and insulin-induced hypoglycemia in type I diabetes mellitus. 228 81

Insulin autoantibodies (IAA) are well documented in patients with insulin-dependent diabetes (IDDM) prior to the administration of insulin and in patients with reactive hypoglycaemia--the insulin autoimmune syndrome (IAS). It has been suggested that IAA can be induced by the administration of drugs containing sulphydryl groups, such as carbimazole, and they have been frequently described in Graves' disease. An alternative explanation is the clustering of autoantibodies in autoimmune disease. We studied 39 patients (37 females, two males, age range 14 to 61 years; mean 33.8 years) with proven Graves' disease and no previous treatment with carbimazole. Fifteen of the 39 patients had a family history of other autoimmune diseases. IAA and thyroid autoantibodies were assayed at diagnosis and monthly thereafter while on treatment with carbimazole, for up to 6 months. IAA were measured using a direct-binding solid-phase ELISA and specificity was confirmed by absorption studies using insulin covalently coupled to Sepharose beads. At diagnosis 33 of the 39 patients (85%) were positive for thyroid microsomal antibodies, 13 (33%) were positive for thyroglobulin antibodies, and 4 (10%) were positive for IAA. All IAA-positive patients had microsomal antibodies at diagnosis, and two had thyroglobulin antibodies in addition. After 4 months on carbimazole, the frequency of thyroid microsomal autoantibodies was unchanged (83%), while that of anti-thyroglobulin antibodies had fallen (8.6%). All four IAA-positive patients remained positive, and studies of binding to human, porcine and bovine insulin demonstrated that one serum, initially human insulin specific, later became cross-reactive with all three. We conclude that low titres of IAA are found in Graves' disease, and are associated with the presence of autoimmunity rather than the carbimazole. Symptomatic hypoglycaemia, however, is rare in Caucasian patients.
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PMID:Insulin autoantibodies in Graves' disease--before and after carbimazole therapy. 234 Jul 91

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


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