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

Between April 1986 and December 1987 30 adolescent patients with type 1 diabetes were changed from a conventional twice daily insulin regimen to the basal-bolus system, using pen-injectors. Actually, 26 patients are still using the new system. A comparison was made over a three-year period with a group of 26 patients on conventional therapy matched for age, sex and diabetes duration. A questionnaire was sent to the pen-injectors for subjective evaluation of the new system. The insulin dose remained unchanged. The incidence of hypoglycemic coma in the control group (4.3 per year/26 patients) was similar to the one in the pen-injector group prior to installation of the new system (4.0 per year/26 patients) and increased, but not significantly, on the new system (8.9 per year/26 patients). In both groups, the relative body weight increased significantly, the increase being greater in the pen-injectors (p = 0.001) than in the controls (p = 0.042); however, the difference of weight gain between the two groups was not significant. Fasting plasma cholesterol and triglycerides did not change. Glycosylated hemoglobin (Hb-A1 corrected for Hb-F) dropped significantly in the pen-injectors three months after installation of the new system (p = 0.026), but reached the preceding level already after six months. In the controls, the Hb-A1 remained constant over the three years. Greater flexibility in lifestyle, easier handling and better subjective diabetes control were the main advantages mentioned by the patients on the new system. Negative statements were the necessity for multiple injections, the high frequency of blood glucose control and strongly increased problems with weight control.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Basal bolus therapy in adolescent diabetic patients]. 240 79

Continuous subcutaneous insulin infusion (CSII) with a portable pump was compared to unchanged conventional treatment (UCT) in long-term treated patients with IDDM in order to evaluate changes in glucose homeostasis, metabolites, hormones and quality of life. We found that the mean blood glucose values, measured at home, and the HbA1c values were significantly lower in the CSII group compared to the UCT group. The improved control during CSII was followed by a nearly normalization of the diurnal pattern of FFA and ketone bodies in plasma. Plasma free insulin values were significantly higher in the morning (fasting) during CSII compared to UCT, whereas the mean diurnal concentrations and the diurnal pattern were identical in the 2 groups. Both peak values of growth hormone during the day and the fasting values were significantly lower in the CSII group compared to the UCT group. In patients treated with the insulin pump (CSII) the wellbeing (quality of life) was estimated to be significantly improved. Two patients developed ketoacidosis during CSII, whereas 2 controls (UCT) were hospitalized with hypoglycemic coma. We conclude that insulin pump treatment for 6 months results in a near normalization of glucose and FFA metabolism, resulting in an improved quality of life. The improved control seems not to be explained by a change of the diurnal pattern of plasma insulin. However, the higher morning values may be of significant importance.
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PMID:Insulin pump treatment: effect on glucose homeostasis, metabolites, hormones, insulin antibodies and quality of life. 388 95

Neuropsychological testing was carried out and the rate of oxygen metabolism in the brain was measured by PET in 15 highly selected patients with type 1 diabetes. The aim was to investigate the impact on the brain of hypoglycaemic comas resulting from insulin treatment. No significant difference was found between nine patients with a history of more than 10 hypoglycaemic comas and six others who denied any history of such events. These data suggest that intensified insulin treatment, although increasing the frequency of hypoglycaemic coma, may not always be harmful for the brain. This may be explained by the limited duration of hypoglycaemic coma induced by conventional insulin treatment.
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PMID:Brain metabolism after recurrent insulin induced hypoglycaemic episodes: a PET study. 796 12

Intensive insulin treatment of IDDM is associated with increased frequency of hypoglycemic coma. The extent of possible cerebral sequelae after recovery is still unknown. We studied the impact of previous hypoglycemic coma on neurophysiological measures of cognitive brain function in 108 patients with adult-onset IDDM receiving intensive insulin treatment. In the study, 55 IDDM patients (age 38 +/- 14 years, mean +/- SD) who had a history of > or =1 (median 3, range 1-35) comatose hypoglycemic event were compared with 53 IDDM patients (age 34 +/- 12 years) with no history of hypoglycemic events using P300 event-related potentials and psychometric tests (the Mini-Mental State Exam and trailmaking test, part A). Findings on these patients were compared with those from 108 matched healthy control subjects. No difference was observed in P300 latencies and psychometric tests between patients with and without a history of hypoglycemic coma (P300 latency, 346 vs. 342 ms; trailmaking test, 31 vs. 30 s; Mini-Mental State Exam, 29.5 vs. 29.6; NS). In diabetic patients, however, P300 latencies were delayed compared with those of healthy control subjects (344 vs. 332 ms; P < 0.001) and were correlated to diabetes duration but not to total hypoglycemic episodes. Scores on the Mini-Mental State Exam (29.5 vs. 29.6; P = 0.59) and trailmaking test (31 vs. 28 s; P = 0.10) were not different between patients and control subjects. In conclusion, previous episodes of hypoglycemic coma are not associated with permanent impairment of cognitive brain function in patients with adult-onset IDDM receiving intensive insulin treatment compared with patients without such episodes. Cognitive brain function, however, is subclinically impaired in relation to duration of diabetes.
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PMID:Previous episodes of hypoglycemic coma are not associated with permanent cognitive brain dysfunction in IDDM patients on intensive insulin treatment. 983 23

The treatment of patients with type 1 diabetes mellitus has to focus on short-term and long-term risks of the disease which means to avoid hyperglycemic or hypoglycemic coma as well as late complications. As we know from the DCCT study metabolic control substantially lowers the risk for retinopathy, nephropathy and neuropathy. We also know, that keeping the blood glucose in a nearly normal range inevitably is connected with a marked increase of severe hypoglycemia, an event which occurs more frequently when normoglycemia has been reached and the further slow decline of blood glucose is not recognized by the patient (autonomous neuropathy, hypoglycemia unawareness of other origin, long duration of diabetes etc.). Furthermore, counterregulatory hormones as glucagon and epinephrine may be lacking due to diminished or even lost alpha cells within the islets and as recently observed due to fibrosis of the adrenal medulla in long-term diabetes. The consequences of severe hypoglycemia are manifold: in the actual situation of unconsciousness the risk of heavy injuries and as long-term consequences irreversible brain damage may occur. Finally, the effort of the patient to reach normoglycemia includes the burden of an intensive blood glucose self-control day by day. This broad scenario of all the achievements and of all the problems connected with an intensified insulin treatment has to be regarded when the indication for an islet transplant will be discussed. From our point of view as clinicians it seems adequate not to give definite recommendations but to express our considerations for islet transplantation in patients with type 1 diabetes mellitus with the following list (table 1). It must be clearly stated, that at present transplantation of isolated islets by no means can serve as a treatment for a larger number of patients and this may hold through also for the foreseeable future. In this context, also the many contraindications should be summarized (table 2). Consequently we have to deal with several questions and problems which can be subdivided into those regarding the possible benefit for the patients from an islet graft (full success = insulin independence, partial success = lower exogenous insulin requirement due to additional endogenous insulin, measured by C-peptide levels, more stable glucose metabolism) and those regarding possible side effects (primary risk of implantation, threat for rejection of the primarily transplanted kidney). Furthermore, one may ask for risks when islets are transplanted alone (ITA). We therefore will address the following areas: 1. Simultaneous islet and kidney transplants 2. Islet transplants after kidney transplantation alone (IAK) 3. Islet transplantation after pancreas transplantation failure (P-failure) 4. Defect hypoglycemia counterregulation--life threatening hypoglycemia unawareness as indication for islet transplantation? 5. Autonomous cardiac neuropathy as indication for islet transplantation? 6. Significant clinical problems with exogenous insulin therapy as indication for islet transplantation?
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PMID:Indications for clinical islet transplantation today and in the forseeable future--the diabetologist's point of view. 993 Sep 51

The pathophysiology of brain damage induced by severe hypoglycemia is still unknown. We experienced a case with type 1 diabetes and recurrent severe hypoglycemic coma who showed a central brain atrophy and an abnormal cerebrospinal fluid flow, suggesting normal pressure hydrocephalus. Following this case, the CSF flow was studied using 111In-DTPA cisternography in six consecutive diabetic patients admitted for repeated episodes of hypoglycemic coma. All the patients showed the central brain atrophy on computed tomography and four of them (67%) had the ventricular reflux, with delayed clearance of 111In-DTPA. Two patients with abnormal CSF flow showed cognitive dysfunction by WAIS or WAIS-R. In contrast, none of five randomly selected diabetic patients, without hypoglycemic coma showed abnormal CSF flow. Our results suggest the presence of normal pressure hydrocephalus in diabetic patients with recurrent hypoglycemic coma. It may associate with the cognitive dysfunction.
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PMID:Normal pressure hydrocephalus in diabetic patients with recurrent episodes of hypoglycemic coma. 1067 Sep 9

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

We evaluated the outcome of pregnancies followed between 1990 and 2000 in 93 women with type 1 diabetes, treated with conventional intensive insulin therapy (n=68) or continuous subcutaneous insulin infusion (n=25). We evaluated metabolic control (fasting and 1-hour post-prandial plasma glucose and HbA1c levels), spontaneous or induced abortions, time and mode of delivery, maternal outcome (pregnancy-induced hypertension, preeclampsia, placental insufficiency, hydramnios, hypoglycemic coma, ketoacidosis) and fetal outcome (weight, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal distress, asphyxia, hyaline membrane disease, polycythemia, shoulder dystocia, malformations). Patients treated with insulin pump more frequently had background retinopathy and clinical neuropathy. No significant differences were observed between the two groups in metabolic control and maternal outcome. Glycemic control, non-optimal in the prepregnancy state, improved significantly during pregnancy, as shown by the progressive reduction in HbA1c levels. As regards fetal outcome, no differences were observed between the two groups in morbidity and especially in malformation rate. Patients with malformed babies did not have optimal metabolic control at conception. Thus, maternal and perinatal outcomes were comparable in patients treated with insulin pump and continuous subcutaneous insulin therapy, and depended on metabolic control. In patients in higher White's class and with more unstable glycemia, we achieved metabolic control and outcomes comparable with those of women of lower White's class and more stable glycemic values using the insulin pump. Our data suggest that insulin pump therapy is useful in problematic, complicated cases of women who want a baby.
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PMID:Analysis of outcome of pregnancy in type 1 diabetics treated with insulin pump or conventional insulin therapy. 1460 71

The hypoglycaemic coma is a severe complication for type 1 diabetic patients. Rarely fatal it may be associated with various paroxysmal accidents, potentially harmful, especially during driving. Hypoglycaemia certainly alters the quality of life because it markedly increases the anxiety of both the patient and his/her family. It is considered as a major limiting factor in the glycaemic management of type 1 diabetic patients. Being the consequence of numerous causal factors, hypoglycaemic coma is not always easy to prevent and may occur as a paroxysmal phenomenon, sometimes without obvious contributing circumstances. After having defined the various hypoglycaemic thresholds, we will analyse the pathophysiology of insulin-induced hypoglycaemia and of its hormonal counterregulation, and we will describe the hypoglycaemia unawareness phenomenon. These elements should help to better understand why a hypoglycaemic coma may suddenly occur in a diabetic patient. Some advices will also be given to reduce the risk of such a paroxysmal complication in patients with type 1 diabetes.
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PMID:[Hypoglycaemic coma, a feared paroxysmal phenomenon in type 1 diabetic patient]. 1526 74

We report a very rare case of acute pulmonary edema caused by hypoglycemia from insulin overdose during an attempted suicide. A 16-year-old woman with type 1 diabetes was brought to our hospital because of hypoglycemic coma. She exhibited severe hypoxia; upon intubation, bloody froth poured out of the tube. Chest X-ray revealed bilateral infiltrates. Endocrinological data revealed high concentrations of catecholamines. This case indicates that pulmonary edema remains a potential complication of insulin overdose. The possible mechanisms of pulmonary edema associated with hypoglycemia are discussed.
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PMID:Acute pulmonary edema caused by hypoglycemia due to insulin overdose. 1560 2


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