Patients On Insulin Therapy
Patients on insulin therapy having anything other than a minor surgical procedure should, optimally, be admitted prior to the day of planned surgery to allow stabilization of the blood glucose levels. On the day of surgery, which, as stated above, should always be in the morning, an intravenous infusion of insulin and glucose should be set up with potassium supplementation. Most centers utilize a continuous intravenous infusion of insulin via a pump driving a syringe containing 50 units of...
Bibliography
Alberti KGGM. Preventing insulin dependent diabetes mel-litus. Promising strategies but formidable hurdles still to clear. Br Med J 1993 307 1435-6 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part I diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998 15 539-53 American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000 23 381-9 Diabetes care...
Preface
The world is witnessing an increase in new cases of diabetes, in both the developed and the developing nations, of near epidemic proportion. This ubiquitous condition will have an ever-increasing impact on all aspects of medicine and public health. It follows that all practicing physicians must seek to gain at least a basic knowledge and understanding of this important global health problem that is so closely linked to the increasing prevalence of obesity. Diabetes is the paradigm of a...
Hypochlorhydria
Figure 22 Insulin deficiency results in increased hepatic glucose production and, hence, hyperglycemia by increased gluconeogenesis and glycogenolysis. Insulin deficiency also results in increased proteolysis releasing both glucogenic and ketogenic amino acids. Lipolysis is increased, elevating both glycerol and non-esterified fatty acid levels which further contribute to gluconeogenesis and ketogenesis, respectively. The end result is hyperglycemia, dehydration, breakdown of body fat and...
Insulin Hypertrophy
Figure 60 Effect of adding twice-daily soluble insulin injections to a regimen based on twice-daily intermediate-acting isophane insulin. Many newly presenting type 1 diabetes mellitus patients who have residual endogenous insulin secretion can be controlled with twice-daily isophane, two-thirds in the morning and one-third in the evening. However, if postprandial hyperglycemia is pronounced, soluble insulin can be added to one or both injections. Alternatively, fixed mixtures of soluble...
BIBLIOGRAPHY Bbp
Cryer PE, Fisher JN, Shamoon H. Hypoglycemia. Diabetes Care 1994 17 734-55 Frier BM, Fisher BM, eds. Hypoglycemia and Diabetes. London Edward Arnold, 1993 Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycaemic crises in patients with diabetes. Diabetes Care 2GG1 24 131-53 Schade DS, Eaton RP, Alberti KGGM, Johnston DG. Diabetic Coma, Ketoacidotic and Hyperosmolar. Albuquerque University of New Mexico Press, 1981 Small M, Alzaid A, MacCuish AC. Diabetic hyperosmolar...
Future developments in diabetes
Research activity in the field of diabetes has increased greatly in recent years. People with diabetes would want this to translate into more effective treatment of diabetes and its complications. Patients with type 1 diabetes would like to be freed from the need to self-inject with insulin. Pancreatic and islet-cell transplantation can achieve this however, it is unlikely that these techniques will find widespread application in the immediate future. It may prove possible to generate mature...
Diabetic Dermopathy
Fall in visual acuity 2 lines or more on Snellen chart Established maculopathy edema of macula, hard exudates on macula New vessels at periphery or disc Rubeosis iridis Advanced diabetic retinopathy e.g. retinal detachment Immediate referral to an ophthalmologist Fall in visual acuity 2 lines or more on Snellen chart Established maculopathy edema of macula, hard exudates on macula New vessels at periphery or disc Rubeosis iridis Advanced diabetic retinopathy e.g. retinal detachment Urgent...
Acknowledgments
I wish to extend great thanks to Professor Peter Sonksen and Dr Clara Lowy formerly of St Thomas' Hospital, London, UK, who kindly supplied many of the slides in this Atlas. I am greatly indebted to Dr Tom Barrie, of The Glasgow Eye Infirmary, Glasgow, UK, who provided a splendid set of eye slides Figures 82, 87, 97 and 99-101 , Dr Alan Foulis, of The Royal Infirmary in Glasgow, UK, who supplied some magnificent pathology slides Figures 23-26, 29-33, 35-39, 41 and Eli Lilly and Company for...
Info Tnk
Figure 72 This patient is wearing a Guardian RT, continuous real-time glucose monitor. The sensor measures interstitial fluid glucose levels providing up to 288 glucose readings per day. The glucose sensor is connected to a transmitter that communicates with a monitor using radiofrequency technology to display real-time glucose values every 5 minutes on the monitor screen. Alarm thresholds can be set to alert patients when glucose levels become too high or too low. Unfortunately, the device is...
Hypoglycemia
Hypoglycemia is the greatest fear of patients treated with insulin. Hypoglycemia in patients with type 1 diabetes is a major source of disruption to their lives. It also occurs in patients treated with sulfonylureas, although to a lesser extent. Over 30 of insulin-treated diabetic patients experience hypoglycemic coma at least once in their lives, and approximately 3 experience frequent and severe episodes. In the Diabetes Control and Complications Trial, the incidence of severe hypoglycemia...
Insulin Crystals
Alberti KGGM, Gries FA. Management of non-insulin dependent diabetes in Europe a consensus view. Diabetic Med 1988 5 275-81 American Diabetes Association. Nutritional recommendations and principles for people with diabetes mellitus. Diabetes Care 2000 23 Suppl I s43-6 American Diabetes Association. Nutritional principles and recommendations in diabetes. Diabetes Care 2004 27 Suppl 1 s36-s46 DeVries JH, Snoek FJ, Heine RJ. Persistent poor glycaemic control in adult type 1 diabetes. A closer look...
Intraretinal Microvascular Abnormalities
Aiello LP, Gardner TW, King GL, et al. Diabetic retinopathy. Diabetes Care 1998 21 143-56 Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002 346 1221-31 Archer AG, Watkins PJ, Thomas PK, Sharma AK, Payan J. The natural history of acute painful diabetic neuropathy. J Neurol Neurosurg Psychiatr 1983 46 491-9 Arkkila PE, Kantola IM, Viikari JS, et al. Dupuytren's disease in type 1 diabetic patients a five-year prospective study. Clin Exp Rheumatol 1996 14 59-65 Barnett AH, Dodson PM....
Human Monotard Humulin Lente Hypurin Bovine Lente
Figure 50 Over 300 insulin preparations are available worldwide. They may be classified according to their duration of action short-acting soluble, neutral or regular , intermediate-acting isophane , long-acting insulin-zinc suspensions , and fixed mixtures of short- and intermediate-acting biphasic insulins . Some of the most commonly used insulins are summarized in this figure. It is preferable for the non-specialist to become familiar with a small number of appropriate insulins and insulin...
Bibliography 1
Andersen RE, Crespo CJ, Bartlett SJ, et al. Relationship of physical activity and television watching with body weight and level of fatness among children results from the Third National Health and Nutrition Examination Survey. JAMA 1998 279 938-42 Atkinson MA, Eisenbarth GS. Type I diabetes new perspectives on disease pathogenesis and treatment. Lancet 2001 358 221-9 Bottazzo GF. Death of a beta cell homicide or suicide Diabetic Med 1986 3 119-30 Chiasson JL, Gomis R, Hanefeld M, et al. The...
Amyloid Diabetes Pancreas
Figure 30 The same pancreas as in Figure 29 has been immunostained to show P-cells note the destruction of the P-cells in this islet owing to inflammation compare with Figure 24 Figure 31 This histologic section of pancreas was obtained at autopsy from a patient 5 years after the onset of type 1 diabetes. It shows persistence of an infiltrate of lymphocytes insulitis some of which have been indicated by arrows, affecting this islet, immunostained for insulin. This shows that P-cell destruction...
BIBLIOGRAPHY Ydk
Day C. Amylin analogue as an antidiabetic agent. Br J Diabetes Vasc Dis 2005 5 151-4 DeFronzo RA, Ratner RE, Han J, et al. Effects of exenatide exendin-4 on glycemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes. Diabetes Care 2005 28 1092-100 Finer N, Pagotto U. The endocannabinoid system a new therapeutic target for cardiovascular risk factor management. Br J Diabetes Vasc Dis 2005 5 121-4 Green BD, Irwin N, Gault VA, et al. Development and therapeutic...
Nonalcoholic Steatohepatosis
Non-alcoholic fatty liver disease, has recently become increasingly recognized and may progress to end-stage liver disease. It is histologically indistinguishable from the liver damage that is secondary to alcohol abuse, but occurs in people with no history of alcohol excess. Non-alcoholic fatty liver disease has a wide spectrum of liver damage ranging from simple steatosis to steatohepatitis, advanced fibrosis and cirrhosis. The combination of steatosis, infiltration by mononuclear or...
Human Monotard Humulin Lente Hypurin Bovine Lente 1
Figure 50 Over 300 insulin preparations are available worldwide. They may be classified according to their duration of action short-acting soluble, neutral or regular , intermediate-acting isophane , long-acting insulin-zinc suspensions , and fixed mixtures of short- and intermediate-acting biphasic insulins . Some of the most commonly used insulins are summarized in this figure. It is preferable for the non-specialist to become familiar with a small number of appropriate insulins and insulin...