1/8. Factitious diabetic instability.Factitious diabetic instability is described in four patients. In three the predominant problem was recurrent hypoglycaemia. The fourth presented with apparent insulin resistance and episodes of ketoacidosis. The methods used to make the diagnosis are described, and the factors which contribute to this type of diabetic instability are discussed.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
2/8. Anaphylactoid reaction to 50% solution of dextrose.Two patients with extrinsic asthma and coexistent insulin-dependent diabetes mellitus sustained an anaphylactoid reaction after the intravenous administration of 50% solution of dextrose. Investigations suggested that the dextrose, rather than any additives, was responsible for the reaction. The effect of varying concentrations of dextrose on the histamine content of the blood of normal, allergic, non-diabetic and diabetic, and non-allergic patients was studied. Preliminary results suggest that the higher concentrations of dextrose induce increased histamine release from blood cells, and that this phenomenon is more marked in diabetic, and particularly diabetic-allergic, individuals. We suggest that the treatment of hypoglycaemia with 50% solution of dextrose is associated with a significant risk factor in those diabetic individuals who are either allergic or are receiving beta-adrenoreceptor blocking drugs.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
3/8. Hypoglycaemia due to azapropazone-tolbutamide interaction.We report a case of hypoglycaemia due to a 'first-dose' interaction between azapropazone and tolbutamide. The mechanism was probably by displacement of tolbutamide from protein binding sites, and it is recommended that azapropazone should be avoided in patients receiving tolbutamide.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
4/8. blood glucose control and diabetic microangiopathy.There is overwhelming evidence that the microangiopathy complications (retinopathy, nephropathy, and neuropathy) of diabetes can be minimised, prevented or improved by optimal blood glucose control. There is little evidence to show otherwise. This paper reviews evidences to demonstrate that poor diabetic control predisposes to diabetic microangiopathy. The only way to minimise diabetic microangiopathy is to avoid hyper glycaemia and achieve euglycaemia for most part of the day. In doing so, the dangers of hypoglycaemia must be clearly recognized and avoided.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
5/8. Self-monitoring of blood-glucose. Improvement of diabetic control.An accurate pattern of blood-glucose changes in everyday life is the basis for treatment in insulin-dependent diabetes. 69 patients were taught to obtain their own blood-glucose profiles with a 'Reflomat' Boehringer Mannheim) reflectance meter on one working and one rest day, and to repeat these where necessary after adjustment of treatment. 2 did not complete the study satisfactorily. The other 67 produced profiles on 241 dyas. Even patients with a limited education could use the technique accurately and their readings correlated closely with simultaneous laboratory values (r = 0.96). Self-monitoring was especially useful in elucidating problems in diabetic control, preventing hypoglycaemia, and managing diabetic pregnancy. Unlike the measurement of HbA1c which only detects poor diabetic control, self-monitoring also shows how to improve it. patients found self-monitoring more informative than urine tests; their active involvement in management of their disease resulted in better motivation, greater understanding of diabetes, and a sustained improvement in control. By the end of the study 32 of the 67 patients ahd profiles in which no more than one blood-glucose value exceeded 10 mmol/l. Smaller and more portable machines will make the technique more widely applicable.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
6/8. Serious, prolonged hypoglycaemia with glibenclamide in a patient with Mendenhall's syndrome.Mendenhall's syndrome, characterized by familial insulin resistant diabetes, pineal hyperplasia and multiple somatic abnormalities, is associated with defects involving the alpha-subunit of the insulin receptor. The associated insulin-resistant diabetes is extremely difficult to treat; insulin is required in very large doses to control hyperglycaemia and oral hypoglycaemic agents are ineffective. We report a case of severe, prolonged hypoglycaemia that occurred in a 24-year-old patient with Mendenhall's syndrome following therapy with glibenclamide. He had glibenclamide 10 mg daily for 1 week following which he was admitted to hospital in hypoglycaemic coma with blood glucose levels < 1.0 mmol/l. This subject had undergone hypophysectomy at the age of 11 years. Prior to pituitary ablation, oral hypoglycaemic agents did not improve glycaemic control. Thus, previous hypophysectomy in this patient appears to have made it possible for glibenclamide to exert its hypoglycaemic effect. The occurrence of hypoglycaemia in this patient suggests alternative mechanisms for insulin action in conditions characterized by severe insulin resistance due to insulin receptor defects.- - - - - - - - - - ranking = 6keywords = hypoglycaemia (Clic here for more details about this article) |
7/8. Attempted suicide by insulin overdose in insulin-requiring diabetics.Four cases of suicidal insulin overdose in insulin-requiring diabetics presented to one hospital in three years. In three cases there was a history of depression; but despite huge doses of insulin (3,000 and 1,500 units) in two, no patient died and only one had residual signs of clinical brain damage. The estimated plasma insulin level was not well correlated with the severity of the hypoglycaemia. It is probable that suicidal insulin overdose is more common than reports in the literature suggest, and may often be unrecognized. The dissociation between huge doses of insulin and the severity of the subsequent hypoglycaemia in diabetics is unexplained.- - - - - - - - - - ranking = 2keywords = hypoglycaemia (Clic here for more details about this article) |
8/8. Renal glycosuria treated as diabetes mellitus: case report.A case of renal glycosuria is reported. A 55 year old female was diagnosed and treated in an upcountry hospital for diabetes mellitus. She developed symptoms of hypoglycaemia while on an oral hypoglycaemic agent, leading to her admission in Mulago Hospital. Persistent glycosuria was noted despite treatment and normal serum glucose. Oral glucose tolerance test and timed urine glucose showed a normal curve but high urine sugar. A diagnosis of renal glycosuria was made, oral hypoglycaemic therapy was stopped, patient improved and was discharged. Though renal glycosuria is a benign condition, mistaken diagnosis for diabetes mellitus puts patients at risk of hypoglycaemia due to treatment. diagnosis of the condition requires physicians' awareness of its existence in our community and the use of Marbles' criteria obviates confusion with diabetes mellitus though it does not absolutely exclude fanconi syndrome.- - - - - - - - - - ranking = 2keywords = hypoglycaemia (Clic here for more details about this article) |