PROBLEM Ilw
Ir n A 67-year-old woman with no previous history of diabetes mellitus was admitted to the Acute Medical Admission Unit with a four-day history of progressive drowsiness and dehydration. An urgent blood test showed pre-renal uraemia Na 174 mmol l K 4.0 mmol l urea 26.2 mmol l creatinine 168 mol l , severe hyperglycaemia 34.2 mmol l and arterial blood gas parameters of pO212.1 kPa, pCO2 5.2 kPa, HCO3-18.9 mmol l and pH 7.32. Urinalysis showed 2 protein, trace blood and nil else. How would you...
Case History Uky
A 32-year-old solicitor with type 1 diabetes and glycosylated haemoglobin HbA1c of 8.2 states that she is trying for a baby. She has had type 1 diabetes for 16 years and has mild background retinopathy. She takes lisinopril 10 mg per day as she has previously been noted to have microalbuminuria. She has never been pregnant before. She takes Mixtard insulin 32 units in the morning and 28 units in the evening. Would you advise a change of insulin
Further Reading Xqx
MRC Vitamin Research Group. Prevention of neural tube defects results of the Medical Research Council Vitamin Study. Lancet 1991 338 131-7. 2 Evers IM, de Valk HW, Visser GHA. Risk of complications of pregnancy in women with type 1 diabetes nationwide prospective study in the Netherlands. BMJ2004 328 915. 3 Loukovaara S, Immonen I, Teramo KA, Kaaja R. Progression of retinopathy during pregnancy in type 1 diabetic women treated with insulin lispro. Diabetes Care 2003 26 1193-8. 4 Boskovic R,...
Further Reading Wpw
2 Ide A, Eisenbarth GS. Genetic susceptibility in type 1 diabetes and its associated autoimmune disorders. Rev Endocr Metab Disord 2003 4 243-53. 3 Doolan A,Donaghue K, Fairchild J,Wong M, Williams AJ. Use ofHLA typing in diagnosing celiac disease in patients with type 1 diabetes. Diabetes Care2005 28 806-9. 4 Freemark M, Levitsky LL. Screening for celiac disease in children with type 1 diabetes two views ofthe controversy. Diabetes Care2003 26 1932-9. 5 Peretti N, Bienvenu F, Bouvet C, Fabien...
Explain Gmr In The Treatment And Testing Of Diabetes
ECG, indications for coronary angiography 188 use of magnesium 117-18 economic analysis, CSII 62 ECST European Carotid Surgery Trial 205 educational input, insulin pump therapy 63-4 educational interventions, adolescent diabetes 70-1 elderly people 93-6 embolectomy, limbs 48-9 ENDIT European Nicotinamide Diabetes Intervention Trial 3 endomysium antibodies, coeliac disease 221 endothelial function, effect of statins 194 endurance running 65-8 enteral feeding 85-8 enteroviruses, as risk factor...
Further Reading Npp
Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy diagnosis, prevention, and treatment. Diabetes Care2005 28 164-76. Siebenhofer A, Plank J, Horvath K, Berghold A, Sutton AJ, Sommer R, Pieber TR. Angiotensin receptor blockers as anti-hypertensive treatment for patients with diabetes mellitus metaanalysis of controlled double-blind randomized trials. Diabet Med 2004 21 18-25. Scheen AJ. Reninangiotensin system inhibition prevents type 2 diabetes...
Conclusion Dtx
. -J This patient has diabetic nephropathy and available evidence suggests that blockade of the RAS is the treatment of choice for management of her hypertension. Blood pressure control is generally more important than tight glucose control in slowing the advance of nephropathy. There is no indication to stop this patient's ACE inhibitor at present, but her renal function should be closely monitored every six weeks or so. An angiotensin receptor blocker would not offer an advantage in this...
Abbreviations
4S Scandinavian Simvastatin Survival Study ABCD trial Appropriate Blood Pressure Control in Diabetes Trial ABPI Ankle-brachial pressure index ABPM Ambulatory blood pressure monitoring ACAS Asymptomatic Carotid Atherosclerosis Study ACHOIS trial Australian Carbohydrate Intolerance Study in Pregnant Women AER Albumin excretion rate AHI Apnoea-Hypopnea Index ALLHAT Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial AMD Age-related macular degeneration ANG-1 and ANG-2...
Further Reading Jyr
2 Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med2005 142 403-11. 3 Aude YW,Agatston AS, Lopez-Jimenez F, Lieberman EH,Almon M, Hansen M, Rojas G, Lamas GA, Hennekens CHl. The National Cholesterol Education Program Diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat a randomized trial. Arch Intern Med 2004 164...
Recent Developments Akg
Further study is required to investigate the epidemiological evidence linking sleep-related disorders to risks of developing diabetes as well as cardiovascular and microvascular disorders. The SHHS is a multicentre cohort study implemented by the National Heart Lung and Blood Institute to determine the cardiovascular and other consequences of SDB. Further data analysis and collaborative study with the SHHS investigators is expected to improve our understanding on the metabolic complications of...
PROBLEM Jrf
B Type A B Diabetes and Insulin Resistance A motivated 42-year-old man, body mass index BMI 24.8 kg m2, with type 2 diabetes complained of persistent symptomatic hyperglycaemia despite taking a total of 400 units of insulin a day. Urinalysis revealed no ketonuria. Clinical examination showed no evidence of lipohypertrophy. Past medical history includes pemphigus vulgaris for which he is not on any treatment now. What further investigations would you request How would you manage this patient's...
Background Xef
The differential diagnosis of a unilaterally swollen lower limb is broad. It is important to reach a positive diagnosis so that appropriate treatment is offered particularly where the integrity of the limb is threatened by delay in treatment. Deep vein thrombosis, ankle sprain, cellulitis or simple fracture are all possible diagnoses, but the finding of metatarsal fractures is key in ensuring that an acute Charcot neuroarthropathic joint is considered. Jean-Marie Charcot described the...
B
1 Gale EAM.The rise of childhood type 1 diabetes in the 20th century. Diabetes 2002 51 3353-61. 2 Kukko M, Virtanen SM, Toivonen A, Simmell S, Korhonen S, Ilonen J, Simel O, Knip M. 8 Gale EA, Bingley PJ, Emmett CL, Collier T. European Nicotinamide Diabetes Intervention Trial ENDIT a randomised controlled trial of intervention before the onset of type 1 diabetes. Lancet2004 363 925-31. 9 Skyler JS, Krischer JP, Wolfsdorf J, Cowie C, Palmer JP, Greenbaum C, Cuthbertson D, Rafkin-Mervis LE, Chase...
Conclusion Hgn
. -J Evidence of prevalent cardiovascular disease should be sought, an electrocardiogram should be performed and urinary albumin excretion assessed probably by spot urinary albumin-creatinine ratio. Assuming hypertension remains uncomplicated, a low-dose diuretic would be a reasonable first-line agent. It is difficult to be dogmatic about a blood pressure target, though a target of lt 130 80 mmHg is reasonable acknowledging that the lower the target, the more difficult this will be to achieve...