UMLS:C0033687 - FACTA Search

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Query: UMLS:C0033687 (proteinuria)
24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Long term experience with the use of sulfonylurea and/or biguanide oral hypoglycemic agents in patients under the age of 30 years shows the following results: 1) Oral treatment under 30 years of age is effective only for a limited period of time, in the large majority less than 24 months;--2) The success of oral treatment of diabetics and the period of effectiveness is increased if the subject is overweight at the time of discovery of the diabetes mellitus;--3) The type of antidiabetic treatment, i.e., insulin only, oral only, or oral and insulin, does not influence the susceptibility to the complications likely to appear in this age group, such as retinopathy, coronary disease, neuropathies and urinary and dental infections;--4) Poteinuria, peripheral vascular disease and various abnormalities of plasma lipids involving cholesterol and triglycerides, are significantly more common in patients under oral therapy than in those receiving insulin. These findings suggest the necessity for serious reconsideration of therapy as soon as any of these pathological events appear, especially the proteinuria or the lipid anomalies;--5) The duration of the oral treatment preceding therapeutic insulin does not have influence on the subsequent metabolic disturbance (hypoglycemia, deto-acidosis) and thus on the ultimate control of the diabetic state;--6) The somatic growth of the diabetic child is maintained regardless of the type of treatment as long as it is effective. Growth is interrupted however very early if oral treatment becomes ineffective with regard to control of the diabetes. Monitoring of somatic growth during oral antidiabetic treatment is of obvious importance. An interruption in growth is an indication for insulin therapy even if the diabetic control appears satisfactory;--7) The course and the outcome of pregnancy do not appear to be affected by the use of oral therapy at the time of conception. This holds true also for cases in which oral treatment precedes the use of insulin, the pregnancy having commenced during the course of insulin therapy.
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PMID:[Diabetes mellitus under 30 years of age. Results of 18 years experience with oral treatment (author's transl)]. 123 68

The author treated since 1985 on a long-term basis (for more than one year) 228 diabetic patients with an insulin pump. She gives an account for her experience of three years' treatment of 32 diabetics type 1 and 2, incl. 5 treated already for a period of 5 years. Eight type 1 diabetics treated on account of a great lability of the disease are free from specific complications. In 10 type 1 diabetics treated on account of developing nephropathy and neuropathy the condition has stabilized and does not develop further. In 14 type 2 diabetics progression of complications which led to the indication of pump treatment did not occur. Treatment had the most favourable effect on sensitive neuropathy and incipient nephropathy where a reduction of proteinuria was recorded. From the total number of 228 patients treated on a long-term basis in 31, on failure of the pump, decompensation occurred. Five of these patients developed ketosis which called for hospitalization. Clinically severe hypoglycaemia was observed only once.
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PMID:[Long-term treatment with an insulin pump. 3 years' experience]. 148 76

The renal disease in an adult woman with Type 1 glycogen storage disease (GSD) is reported. Since she was 15 years old, several episodes of gouty arthritis had developed. At the age of 18, proteinuria was pointed out. Hepatomegaly, renomegaly out of proportion to the impairment of renal function, hyperuricemia, hyperlipidemia, fasting hypoglycemia and lactic acidemia were observed. The diagnosis of GSD was established on the basis of a glucose tolerance test, glucagon test and liver biopsy. The findings of renal biopsies performed at the ages of 24 and 27 years old suggested that glomerular damage might have preceded the tubulo-interstitial lesion.
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PMID:Renal disease in an adult with type 1 glycogen storage disease. 203 36

Diabetic nephropathy is now the leading cause of renal failure in patients referred for uremia therapy. The diabetic patient is a complicated treatment problem from the first detection of microalbuminmuria, at which time decisions regarding choice of antihypertensive and strictness of metabolic control assume increasing importance. At present, our policy is to advocate strict control of blood pressure, aiming for a systolic blood pressure of less than 140 mm Hg and a diastolic blood pressure of less than 80 mm Hg. We attempt to maintain hemoglobin Alc levels at less than 8%, if the patient does not develop frequent episodes of hypoglycemia. We extend these recommendations to the patient with frank proteinuria, nephrotic syndrome and early uremia, understanding that strict metabolic control may be impossible as patients lose GFR. In addition, we recommend avoidance of a high protein diet in the early nephropathic diabetic, with diet of approximately 1 gm/kg/d. As renal failure progresses, we embark on an analysis of the patient's abilities, lifestyle, and social support. At a GFR of approximately 10 mL/min, we initiate preparations for uremia therapy. If a willing and appropriate living related kidney donor is available, the patient is referred for cardiovascular evaluation and kidney transplantation performed subsequently. If no donor is immediately available, we refer the patient for vascular access placement and/or insertion of a Tenckhoff peritoneal catheter, if preferred. Most of these predialysis patients also undergo screening for placement on the cadaveric kidney transplant list, including cardiac work-up as is done for the patients who receive living-related renal transplants. Because of the long waiting list in Brooklyn, and the universal shortage of organ donors, many of these patients eventually end up on dialysis for some period of time. Other extrarenal problems (urologic, ophthalmologic) are addressed at initial referral and followed up, in hopes of maintaining the patient in optimal physical shape as uremia progresses. The care of the diabetic patient with ESRD ideally involves a consortium of caregivers. We include a nurse-educator familiar with options for uremia therapy, a podiatrist, a cardiologist, and often a urologist, an endocrinologist, and a gastroenterologist. In addition, a social worker is helpful to assess psychologic difficulties in adjustment to uremia, socioeconomic considerations, and rehabilitation status. Finally, the nephrologist, as coordinator of this team works with the vascular or transplant surgeon, to facilitate the transition to ESRD and its therapy.
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PMID:Care of the diabetic patient with end-stage renal disease. 219 Feb 84

The triad of insulin, diet and exercise has been the basis for treatment of diabetes for several decades. However, the choice of sporting activities for young diabetics requires an understanding of: (a) the energy metabolism and the adaptation to physical activity in the healthy; (b) the metabolic adaptation during physical activity in the diabetic child; and (c) the practical recommendations concerning diet and insulin that have to be learned by the children themselves. The healthy child utilises immediately available substrates, such as ATP and creatine phosphate in much the same fashion as the adult. However, the capacity for anaerobic degradation of glycogen and glucose seems limited in the muscles of children relative to that of adults. Consequently, the adaptation to resistance exercise should be undertaken with prudence in children and adolescents. In diabetic children, an adequate insulin therapy is required to allow the full benefit of muscular activity on glucose assimilation and to reach the same level of physical performance as the non-diabetic. In the case of insufficient metabolic control, exercise can provoke severe hypoglycaemic episodes, even after muscle activity has ceased, or increase glucose levels and lead to ketoacidosis. Regular physical training induces a reduction in postexercise proteinuria measured in diabetic adolescents but its role in metabolic control remains controversial. If a diabetic child or adolescent follows individual recommendations concerning diet and insulin, he or she can perform physical activity much the same as a young non-diabetic. These recommendations include: (a) self-measurement of blood glucose concentration before and after exercise; (b) ingestion of carbohydrates before, during, and after exercise; (c) reduction of the insulin dose during and immediately after exercise; and (d) not choosing an injection site involved with muscular work. The only prohibited sports are those which constitute a danger to the diabetic child by provoking an eventual hypoglycaemia. The best sports are those that require progressive physical effort and that are spread out over several hours.
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PMID:Sport and the diabetic child. 265 64

Hypertension, common in diabetic patients, worsens not only the risk of cardiovascular complications, but also that of microangiopathic complications (nephropathy, retinopathy) of diabetes mellitus. It is thus important to ensure the perfect control of even mild hypertension in diabetic patients. However, treatment sometimes becomes difficult given that certain categories of antihypertensive drugs interfere with blood glucose control and/or lipid metabolism, interfere with the symptomatology of hypoglycemia, or promote orthostatic hypotension, a complication of autonomic neuropathy. A study was undertaken to determine the effects of rilmenidine, administered for 16 weeks, in 29 diabetic patients treated with insulin and experiencing mild-to-moderate hypertension (supine diastolic blood pressure, 96.7 +/- 0.5 mmHg). Administered as single-drug therapy, rilmenidine rapidly normalized blood pressure (systolic blood pressure, less than 160 mmHg; diastolic blood pressure, no more than 90 mmHg--supine) in 17 patients; this persisted throughout the trial period. Addition of a diuretic after 12 weeks in the remaining 12 patients led to normalization of blood pressure in nine additional patients. Blood glucose control (evaluated at home by weekly blood glucose measurements and by glycosylated hemoglobin levels) was unaffected by treatment. Plasma levels of cholesterol (total, high-density lipoprotein and low-density lipoprotein), triglycerides and proteinuria (or microalbuminuria) showed no change during the course of the trial. In conclusion, rilmenidine offers an effective and safe treatment for mild-to-moderate hypertension in diabetic patients treated with insulin and does not interfere with their blood glucose control.
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PMID:Treatment of hypertension in diabetic patients. 278 24

The author treated for prolonged periods 179 diabetics type I and II using an insulin pump. The shortest period of treatment was 6 months, the longest three years. Treatment failed only in six patients, i.e. in 3.3%, in all instances because they were incapable of adhering to the dietetic regime or to control the function of the pump. Complications had also mainly technical reasons, in 43 patients the pump failed and had to be replaced. Indicators of metabolic compensation reached normal levels in 173 patients and the triacylglycerol and cholesterol blood levels declined significantly. Laboratory hypoglycaemia was recorded in all patients, hypoglycaemia with clinical symptoms only in 17 patients. As to specific complications of diabetes, proteinuria and neuropathy were influenced most favourably. Long-term treatment with an insulin pump is useful in type I diabetes with metabolic lability and in obese type II diabetics where weight reduction is essential because of insulin resistance. So far the effectiveness of treatment with a pump to suppress permanently progression of specific complications is controversial.
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PMID:[Long-term therapy with the insulin pump]. 280 Mar 84

A case of central pontine myelinolysis (CPM) followed by hyperglycemia and hypoglycemia was reported. The case was 53-year-old female. Diabetes mellitus was found when she was 32 years old, insulin therapy was started at 37 years of age. Since she was 50 years old, proteinuria and ankle edema had developed and she was admitted to The Keihin Hospital. The peritoneal dialysis (PD) was performed next year, followed by the hemodialysis (HD). In January 1978, strange movements and the disturbance of her consciousness were occurred during PD, then blood glucose level showed over 1,800 mg/dl and serum osmolarity was over 390 mosm/KgH2O. Then she was diagnosed as non-ketotic hyperosmolar coma. After that, during HD and PD, hyperglycemia (approximately 1,200 mg/dl) and hypoglycemia (approximately 40 mg/dl) developed frequently. She died soon after HD on 19th December 1979. The autopsy disclosed bilateral atrophic kidneys due to diabetic changes and atrophic pancreas. Gross neuropathological findings revealed a few small infarcts at the putamen and the globus pallidus, however, other area were observed to be normal. The most remarkable change in microscopical finding was nearly symmetrical demyelinative lesion in the center of the basis pontis. The nerve cells and axon cylinders were relatively well preserved in the demyelinative lesion. The hyaline degeneration was observed in the arterial wall, however, any arterial obstruction was not found. Recent studies would suggest that the electrolyte disturbance, such as hyponatremia, may lead to CPM, particularly when this disturbance was rapidly corrected. On the other hand, CPM induced by diabetic coma has been reported, however, its pathogenesis has been unclear.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Central pontine myelinolysis followed by frequent hyperglycemia and hypoglycemia--report of an autopsy case]. 280 35

The natural history of brittle diabetes is unknown. We have followed up 13 patients with disabling brittle diabetes unresponsive to continuous subcutaneous insulin infusion (CSII) for 3-6 yr. All were young, C-peptide deficient females. One patient has died (of hypoglycaemia). In the others, disruption of life has generally lessened, but only one patient is currently considered metabolically stable. Insulin treatment regimens have included long-term intravenous insulin infusions and intraperitoneal insulin, but all but four have now reverted to subcutaneous injections. Eleven patients intermittently required greater than 200 U/day of insulin and two have needed greater than 1,000 U/day. Insulin dosages have fallen significantly during follow-up (from 6.8 +/- 3.1 to 1.4 +/- 0.3 U/kg/day). Diabetic complications, initially present in only 2 cases (1 cataract, 1 proliferative retinopathy), have now developed in 5 others (2 background retinopathy, 1 proliferative retinopathy, 1 mixed peripheral neuropathy and 1 intermittent proteinuria). Psychosocial disturbance and non-compliance were common. We conclude that brittleness generally seems to improve, which probably explains the scarcity of older brittle patients. However, these patients are at considerable risk from diabetes, its complications and its treatment.
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PMID:The natural history of brittle diabetes. 304 51

The clinical features of 47 frail nursing home diabetic patients with a mean age of 81 +/- 1.6 years were compared to those of 61 nondiabetic nursing home residents with a mean age of 80.2 +/- 1.2 years. Diabetic patients had a higher prevalence of renal failure, proteinuria, retinopathy, neuropathy, and infections than did other nursing home residents. Macroangiopathic disease tended to be equally common in both age groups. Diabetic nursing home residents had higher body weights compared to nondiabetic nursing home residents. Surprisingly, however, 21% of nursing home diabetics were greater than 20% below average body weight (compared to 24.5% of other nursing home residents), suggesting that undernutrition is a major problem in diabetic patients in a nursing home setting. Overall, the diabetic nursing home patients had better blood glucose control than younger ambulatory diabetic patients (mean age 66.2 +/- 4.7 years). The glycosylated hemoglobin (HbA1) level in those on oral agents was 8.9% +/- 0.7% for nursing home patients compared to 11.8% +/- 0.7% in ambulatory patients (P less than 0.01). The HbA1 in insulin-treated patients was similarly lower in nursing home diabetics (9.6% +/- 0.4% vs 11.8% +/- 0.7, P less than 0.05). There were only two mild hypoglycemic episodes in nursing home patients over 6-month observation period, whereas 12 ambulatory patients reported hypoglycemic episodes during the same period of time. We conclude that although the diabetic nursing home patients are sicker than the ambulatory diabetics, it is possible to achieve a fair blood glucose control in nursing home patients without a significant risk of recurrent hypoglycemia.
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PMID:Diabetes mellitus in elderly nursing home patients. A survey of clinical characteristics and management. 328 97

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