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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Non-insulin-dependent diabetes mellitus (NIDDM) is a heterogenous disorder characterized by defects in insulin action and secretion. This study was aimed at developing a rat model in which these pathogenic factors might be studied. Male Wistar rats were injected at 2 days of age with 45 or 30 mg/kg streptozocin (STZ) or vehicle (control). Fasting plasma glucose and insulin levels were not significantly different between the two groups between 5 and 8 wk of age. At 8 wk, half of each group was randomly assigned to isocaloric diets high in either fat (59% of calories) or starch (70% of calories). After 1 wk on the diets, 45-mg/kg-STZ-administered fat-fed animals displayed significant fasting hyperglycemia (8.6 +/- 0.2 mM; P less than 0.01), which was exacerbated by the stress of anesthesia and/or cannulation, whereas no changes were observed in any of the other groups before (STZ starch fed, 6.7 +/- 0.1 mM; control fat fed, 6.8 +/- 0.1 mM; control starch fed; 6.4 +/- 0.1 mM) or after anesthesia and/or cannulation. In the 30-mg/kg-STZ animals, fat feeding did not significantly elevate plasma glucose concentration, but a significant hyperglycemic response was seen with anesthesia and/or cannulation. In all STZ groups, substantial impairment of glucose-induced insulin secretion was observed, particularly early-phase insulin secretion. Further studies indicated that STZ animals on a diet conferring normal insulin sensitivity (starch) maintained basal normoglycemia and mildly impaired (i.v.) glucose tolerance despite this gross insulin secretory defect.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Inducement by fat feeding of basal hyperglycemia in rats with abnormal beta-cell function. Model for study of etiology and pathogenesis of NIDDM. 214 80

The hyperglycemia usually observed in patients undergoing heart surgery with extracorporeal circulation (EC) represents a difficult therapeutic problem. We studied the effects of several regimens of insulin therapy on serum glucose (SG) in 24 noninsulin dependent diabetic patients (NIDDs). The patients were randomly divided in five groups; group A received on IV bolus of 10.0-50.0 U/h according to glycosuria; groups B, C, D and E were given a continuous iv insulin infusion of 2.5, 5.0, 7.5 and 10.0 U/h respectively. In 10 non-diabetic patients (NDP) SG levels were also measured, but insulin was not given. A mean of 5.0 l/m2 of body surface of fluids containing 300 g of glucose were administered to all patients during surgery. At the operations SG levels rose progressively soon after the anesthesia was started, reached the highest values during the period of EC, and decreased slowly in blood samples taken after the EC phase and by 24h. This patterns was shown by all groups studied statistically significant lower SG levels, however, were observed in patients of group C, whose values were similar to those seen in the NDP group. Groups D and E had slightly higher SG levels than those of group C. An additional NIDDM patient with advanced chronic renal failure (CRF), had a tendency to hypoglycemia even during the EC period in response to relatively low doses of insulin (2.5 U/h), given by a continuous iv infusion and, although the insulin administration was stopped, his SG levels remained well below the mean values of the other patients for the rest of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Perioperative management of the diabetic patient in cardiac surgery with extracorporeal circulation]. 293 94

The major premise by which weight reduction is used as a medical therapy is the fact that obesity is a primary risk factor in the onset and severity of many medical diseases. Hypertension, coronary artery disease, adult onset diabetes mellitus, complications of major abdominal and thoracic surgery, cancer of the breast and colon, and degenerative joint disease are prevalent diagnoses. The data to support weight reduction use as a medical therapy derive primarily from studies of cardiovascular disease. These studies show lowering of blood pressure and reduction of risk factors for glucose intolerance, angina, and hyperlipidaemia. The magnitude of weight loss (percent reduction in excess body weight) is important; 10 per cent reduction is a firm threshold in obese patients (greater than 130%- less than 200% ideal body weight). Success at achieving this medical therapy is most frequent using very low calorie diets which average 30-40% reduction of excess body weight. Mild and moderate hypertension will respond in 90% of patients. Type II diabetes mellitus patients can become free of exogenous insulin requirement. Response to general anaesthesia and control of respiratory distress syndrome will improve if preoperative weight loss is achieved. Improved cardiovascular fitness and relief of exertional dyspnoea are other clinically important outcomes of very low calorie diet therapy. A high priority exists to investigate the use of comprehensive professional weight control therapy as medical treatment.
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PMID:Benefits of reducing--revisited. 624 29

The usual treatment of diabetic patients during surgery with general anesthesia owes little to logic, common sense, or knowledge of requirements, and mortality and morbidity remain high in many centers. In the nondiabetic patient, surgery is accompanied by a rise in secretion of catabolic hormones, insulin-resistance and loss of protein. Therapy of the diabetic patient should be designed to account for these changes and to avoid hypoglycemia, hyperglycemia, and hyperketonemia. It is suggested that for major operations for well-controlled non-insulin-dependent diabetic (NIDDM) persons and for all minor and major operations for insulin-dependent diabetic (IDDM) persons and poorly controlled NIDDM, a combined insulin (3.2 U/h), glucose (10 g 10% dextrose/h), and potassium infusion should be used until oral feeding recommences. The insulin dose should be modified periodically according to bedside glucose monitoring. Fluids should be used as in nondiabetic patients, except that lactate-containing solutions should be avoided. Insulin requirements will be increased (1) by infection, (2) in patients with hepatic disease, (3) in obese patients, (4) in steroid-treated patients, and (5) during cardiovascular surgery. A diabetes-care team should preferably be responsible for the care of the diabetic pre-, per-, and postoperatively.
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PMID:Insulin delivery during surgery in the diabetic patient. 676 22

We have compared intraoperative glycaemic control, insulin requirements and metabolic and endocrine variables in 40 non-insulin-dependent diabetic patients (NIDDM) and 40 insulin-dependent diabetic patients (IDDM) undergoing general anaesthesia for elective procedures. Two i.v. insulin regimens were used: continuous i.v. infusion (group A: 1.25 u.h-1) and repeated i.v. boluses (10 u./2 h). Blood concentrations of glucose were measured every 15 min from just before induction of anaesthesia until 2 h after surgery. Plasma lactate and pyruvate concentrations, ketone bodies, C-peptide and counter-regulatory hormones were also measured. Glycaemia did not differ significantly in the two types of diabetes, regardless of the insulin therapy used. The amounts of insulin administered were similar in NIDDM and IDDM. There was no significant difference for other metabolic variables. Plasma concentrations of growth hormone (GH) increased significantly during surgery, especially in IDDM patients, but this change did not alter intraoperative glycaemic control. We conclude that mean glycaemic control, insulin requirements and development of ketone bodies in NIDDM and IDDM patients did not differ during the operative period, regardless of the insulin regimen used. Therefore, during the operative period, it is not necessary to modify the insulin regimen according to the type of diabetes. The consequences of increased plasma GH concentrations on glycaemic control in IDDM patients after operation are unknown.
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PMID:Intraoperative glycaemic control in non-insulin-dependent and insulin-dependent diabetes. 799 82

We recorded median nerve action potentials in 40 healthy individuals and 40 patients with type II diabetes mellitus by means of microneurography. The latter group included 20 patients complicated by dysesthesia of distal extremities (mean diabetic history: 12.4 years), and another 20 patients without dysesthesia (mean diabetic history; 5.5 years). Mean age of each group was about 60 years old and had no significant difference among three groups. Patients and healthy controls gave an informed consent for participation in this study. A tungsten microelectrode with a tip diameter of about 1 micron was inserted percutaneously into the median nerve trunk at elbow without anesthesia. With supramaximal electric stimulation on the median nerve at wrist, the largest compound nerve action potential was recorded. In healthy controls the median nerve action potential showed a large triphasic wave (positive-negative-positive, 400 microV in average amplitude) followed by small multiphasic waves. In diabetics maximal conduction velocity (NCV) and amplitude of this triphasic wave (Amp) were decreased and multiphasic waves became more prominent. Reproducibility of potentials in the same subject was acceptable. The differences among three groups were most conspicuous in Amp, and the amplitude of the multiphasic wave was increased in diabetic patients with dysesthesia. Thus, the diminution of Amp appeared to be associated with temporal dispersion due to segmental demyelination. In diabetic polyneuropathy NCV and Amp decreased along with the disease progression; in patients with advanced disease and subjective symptoms, small Amp and prominent multiphasic waves became apparent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Electrophysiological analysis of diabetic polyneuropathy with microneuronography]. 837 Jan 98

We conducted a randomized, prospective study to assess the effect of i.v. insulin on blood glucose control, development of ketone bodies and hormonal changes in 60 well-controlled, non-insulin-dependent diabetics (NIDDM) undergoing major surgery. In group A, patients were given only 0.9% saline; in group B, patients were given insulin as a continuous i.v. infusion (1.25 u. h-1); in group C, patients were given insulin 10 u. i.v. boluses every 2 h. Patients in all three groups were given insulin 5 u. when their intraoperative blood glucose concentration increased to greater than 11.1 mmol litre-1. Blood glucose concentrations were measured every 15 min, from just before induction of anaesthesia to 2 h after surgery. Plasma lactate, pyruvate, ketone body, C-peptide and counter-regulatory hormone concentrations were also measured. Blood glucose concentrations in the three groups did not differ significantly. There was a mild-to-moderate increase in plasma ketone body concentrations in group A, but without any deleterious consequences. Plasma C-peptide concentrations decreased significantly in groups B and C, especially in patients given bolus injections of insulin. Plasma growth hormone concentrations also increased significantly in group B and C patients. This study indicated that the "no insulin--no glucose" regimen was a simple, effective way to control blood glucose in well-controlled NIDDM patients, provided blood glucose was measured frequently and insulin used appropriately.
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PMID:Use of i.v. insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery. 877 97

Incidence of essential hypertension has been reported to be significantly higher in the population afflicted with non-insulin dependent diabetes mellitus (NIDDM). The present studies were under taken in the insulin resistant, Zucker obese rats to evaluate various factors that could lead to the development of high blood pressure. Direct blood pressure measurements in the conscious obese rats indicated that they were not consistently hypertensive although the blood pressures of the obese rats tended to be higher than that of the control lean rats. However, after Inactin anesthesia blood pressures of the obese rats were significantly elevated which can be related to an increase in sympathetic tone since autonomic ganglionic blockade eliminated the differences between the pressures of the two groups. Under anesthesia, cardiac output per 100 gm body weight was significantly lower indicating inadequate tissue perfusion in the obese rats. In a separate series of studies carried out in conscious rats, reflexly mediated alterations in the heart rate to intravenous phenylephrine and sodium nitroprusside were significantly blunted in the obese rats. These observations which include enhanced central sympathetic discharge, inadequate systemic hemodynamics and attenuation of baroreceptor compensation collectively suggest that the insulin resistant obese rats are in a pre-hypertensive state and could develop sustained hypertension if they are exposed to other risk factors.
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PMID:Evaluation of hemodynamics, vascular reactivity and baroreceptor compensation in the insulin resistant Zucker obese rats. 892 47

A new model of noninsulin-dependent diabetic (NIDD) is described which exhibits more prominent defects in renal function than does the standard neonatal NIDD model. To produce this model, 2-day-old neonatal male Wistar Kyoto (WKY) rats were injected intraperitoneally with streptozotocin (90 mg/kg; NIDD), while their corresponding nondiabetic controls were administered vehicle (citrate buffer, pH: 4.5; control). At 3 weeks of age, the animals were weaned, and 1 week later, under ether anesthesia, the animals underwent a right nephrectomy or a sham operation. Diabetes was confirmed by intraperitoneal administration of a glucose load (2g/kg), which resulted in significantly higher blood glucose concentration in the NIDD, compared to the nondiabetic rats. Surgical reduction of renal mass had no effect on the glycemic response to a glucose tolerance test in either group. Intravenous administration of an isotonic saline load resulted in a similar pattern of enhanced sodium and fluid excretion in the two-kidney sham-operated nondiabetic and NIDD rats. These responses were significantly higher than those observed in their counterparts with one remaining kidney. Yet, the natriuretic and diuretic responses to the saline load were significantly lower in the nephrectomized NIDD, compared to the nephrectomized nondiabetic rats. The glomerular filtration rate was similar in the sham-operated (two kidneys) NIDD and nondiabetic rats. In contrast, both the basal and saline-stimulated glomerular filtration rate were lower in the nephrectomized NIDD rats compared to the nephrectomized nondiabetic group. Mean arterial pressure was similar between the two nephrectomized groups, thereby ruling out a significant contribution from the pressure-diuresis-natriuresis mechanism to the reduction in sodium and fluid excretion in the nephrectomized NIDD rats. Thus, unilateral nephrectomy is an effective method of accelerating the manifestation of NIDD-related renal alterations. The mild, but progressive, nature of diabetes in this model should facilitate the investigation of temporal changes in renal function in NIDDM.
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PMID:Renal function in the noninsulin-dependent diabetic rat: effects of unilateral nephrectomy. 927 75

A national survey on permanent hemodialysis catheters was conducted in 99 hemodialysis centers between january 1998 and january 2000. It was a prospective, national and multicentric study. Data were gathered in 1552 patients (mean age 65 +/- 15 years) with chronic end stage renal failure. A questionnaire was filled out each time a permanent hemodialysis catheter was inserted. Two permanent catheters (72%) were inserted under local anesthesia (92%), using the right internal jugular vein (81%) with a percutaneous technique (96%). The two main indications were: end stage chronic renal failure without creation of a vascular access (52%) and dysfunction of a preexisting vascular access (35%). Patients have been followed a mean time period of 58 days and 179 cases of death have been reported. The median duration of catheters was 500 days. The two main causes of catheter removal were creation of a functional A-V fistula (40%) and death of the patient (28%). The incidence of bacteriemia/septicemia was 0.74 episode/patient/1000 days of follow-up while that of any type of infection was 0.85 episode/patient/1000 days. The risk of infection increased with time especially in type 2 diabetes patients.
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PMID:[Permanent catheters for hemodialysis: indications, methods and results. French national survey 1998-2000]. 1181 Sep 93


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