1/10. Reversible amnesia in a Type 1 diabetic patient and bilateral hippocampal lesions on magnetic resonance imaging (MRI).AIMS: Intensive insulin therapy of Type 1 diabetes limits its chronic complications, but is associated with an increased risk of severe hypoglycaemia and its neuroglycopenic consequences. methods: Case report. RESULTS: A 24-year-old male with 15 years' history of Type 1 diabetes, who was missing for 48 h, was found at home in ketoacidosis coma. intensive care permitted a rapid improvement revealing an unexpected severe anterograde amnesia, confirmed by neuropsychological testing. MRI performed 4 days after admission showed abnormal bilateral hyperintensity signals on T2-weighted images in the hippocampus. Three months later, the patient had nearly completely recovered and resumed work. MR images and neuropsychological testing returned to normal. CONCLUSIONS: The most likely course of events favours an initial prolonged hypoglycaemic coma following insulin overdose. The hippocampal injury may be a result of hypoglycaemia. Neuropsychological testing and MRI abnormalities were completely reversible. This case underlines the potential risks of intensive insulin therapy.- - - - - - - - - - ranking = 1keywords = diabetes (Clic here for more details about this article) |
2/10. memory of insulin pumps and their record as a source of information about insulin therapy in children and adolescents with type 1 diabetes.BACKGROUND: This study was designed to provide information regarding basal and bolus insulin dosage in children and adolescents using continuous subcutaneous insulin infusion (CSII) and to evaluate the safety and efficacy of the CSII method in youths. patients AND methods: Data from 100 patients (1.6-18 years old) were collected during scheduled visits in an outpatient clinic. The mean duration of diabetes was 4.57 years (range 0.6-16 years), and mean duration of CSII therapy was 1.75 years (range 0.5-3.0 years). Each child had his or her insulin doses reviewed using the Medtronic MiniMed (Northridge, CA) Pumps&Meters software program. At each visit glycosylated hemoglobin (HbA1c) values and growth parameters (weight and height) were assessed, and episodes of severe hypoglycemia and ketoacidosis were recorded. RESULTS: The mean HbA1c value in our study group was 7.63 /- 0.09% (range, 5.15-12.5%). Statistically significant better metabolic control was found in children under 10 years of age, in children with lower body mass index (r = 0.33), in patients with a lower contribution of basal insulin to the total daily dose (r = 0.35; P < 0.05), and in boys. Ten percent of participants skipped mealtime boluses, which correlated with their glycemic control; in those children HbA1c was 8.67 /- 0.57% (r = 0.34; P < 0.05). The mean total daily insulin was 0.79 /- 0.02 U/kg/day (range, 0.3-2.0 U/kg/day). Basal insulin constituted on average 35.6 /- 1.1% (5-70%) of the daily insulin dose. We found a statistically significant higher contribution of basal insulin dose in patients who missed mealtime boluses (r = 0.42; P < 0.05) and a significantly lower contribution in pre-pubertal children and in boys (P < 0.05). Around 7% of patients made mistakes in programming the basal insulin. CONCLUSIONS: CSII may be safely and efficiently used in children with type 1 diabetes in different age groups. This method of treatment requires regular visits to an outpatient clinic, proper education, and frequent revisions of the pump's memory.- - - - - - - - - - ranking = 3keywords = diabetes (Clic here for more details about this article) |
3/10. Unexplained deaths of type 1 diabetic patients.The suggestion of an increase in the number of sudden deaths of young people with Type 1 diabetes in the UK has been investigated. It was suggested that such deaths were due to hypoglycaemia and related to the increasing use of human insulin. In total we were notified of 50 deaths of people with Type 1 diabetes under age 50 years in the UK in 1989 which our informants (relatives, physicians, and pathologists) considered sudden and unexpected. An autopsy had been done in all cases and we supplemented this with detailed clinical information from relatives and case records. Of the 50 cases we excluded five with a definite cause of death, 11 suicides or self-poisonings, six cases of ketoacidosis, and four in which there was insufficient information about the circumstances of death to drawn any conclusions. Of the other 24 cases, two patients had been found with irreversible hypoglycaemic brain damage and died after a period of artificial ventilation. The most puzzling group were 22, aged 12-43 years, most of whom had gone to bed in apparently good health and been found dead in the morning. Nineteen of the 22 were sleeping alone at the time of death and 20 were found lying in an undisturbed bed. Most had uncomplicated diabetes and in none were anatomical lesions found at autopsy. There are major difficulties in diagnosing hypoglycaemia post-mortem, but the timing of death and other circumstantial evidence suggests that hypoglycaemia or a hypoglycaemia-associated event was responsible. All patients were taking human insulin at the time of death but most had been changed from animal insulin between 6 months and 2 years earlier and there was nothing to implicate the species of insulin as a factor in these deaths.- - - - - - - - - - ranking = 1.5keywords = diabetes (Clic here for more details about this article) |
4/10. fetal heart rate in maternal hypoglycemic coma.In pregnancies complicated by diabetes mellitus fetal heart rate (FHR) monitoring is widely utilized to detect early fetal compromise. Never, however, was the fetal heart rate monitored during a maternal hypoglycemic coma. Such a case is here presented.- - - - - - - - - - ranking = 0.5keywords = diabetes (Clic here for more details about this article) |
5/10. Hypoglycaemia unawareness in diabetics transferred from beef/porcine insulin to human insulin.The case-histories of 3 patients with insulin-dependent diabetes mellitus (IDDM) suggested that, after a switch from beef/porcine to human insulin, a given level of hypoglycaemia may cause less pronounced sympathoadrenal symptoms (tremor, sweating, &c), so that there is less warning of impending unconsciousness. This possibility was investigated by questioning of 176 IDDM patients who had switched from beef/porcine to human insulin with negligible change in dosage 1-48 months earlier. 66 (36%) said that their symptoms of hypoglycaemia had changed from those of sympathoadrenal activation to those of neuroglycopenia. This disadvantage of human insulin is an argument for continued availability of beef/porcine insulin.- - - - - - - - - - ranking = 0.5keywords = diabetes (Clic here for more details about this article) |
6/10. cerebrospinal fluid lactate in patients with diabetes mellitus and hypoglycaemic coma.cerebrospinal fluid (CSF) lactate and pyruvate concentrations were determined in 20 patients with diabetes mellitus but without disturbance of consciousness and five who recovered from hypoglycaemic coma. CSF lactate was slightly but significantly higher in diabetes mellitus (1.78, SEM 0.04 m mol/l) than that in 15 control subjects (1.40, SEM 0.05 m mol/l). In those who recovered from hypoglycaemic coma, CSF lactate was markedly elevated to 2.45-4.43 m mol/l. CSF glucose concentrations, however, were substantially the same between treated hypoglycaemic and diabetes mellitus groups. These findings indicate that CSF lactate levels increase with glycaemic levels in diabetes mellitus owing to enhanced glucose influx into glycolytic pathway of the brain, and also increases in treated hypoglycaemic coma probably due to mitochondrial dysfunction or damage.- - - - - - - - - - ranking = 4keywords = diabetes (Clic here for more details about this article) |
7/10. diabetes mellitus and Graves' disease in pregnancy complicated by maternal allergies to antithyroid medication.The pregnancy of a women with diabetes mellitus was complicated by Graves' disease and maternal allergies to propylthiouracil and methimazole. Preparations for surgical removal of the thyroid gland were being made until pregnancy intervened. Several well-documented mechanisms of hyperthyroidism, including increased intestinal absorption of glucose, decreased insulin responsiveness, and increased glucose production may exacerbate glucose intolerance; the daily insulin requirement of this patient rose 80% from her pregestational dosage. When large doses of propranolol failed to control her thyrotoxic symptoms and led to severe, recurrent hypoglycemic episodes, subtotal thyroidectomy was performed. A 42% decrease in insulin requirements was observed postoperatively, with return to the euthyroid state. A propensity for symptomatic postoperative hypoglycemia should be anticipated in diabetic patients undergoing thyroidectomy.- - - - - - - - - - ranking = 0.5keywords = diabetes (Clic here for more details about this article) |
8/10. Nocturnal convulsions and insulin-induced hypoglycaemia in diabetic patients.Convulsions may occur as a consequence of insulin-induced hypoglycaemia. We report three patients with insulin-dependent diabetes, who presented with generalized tonic-clonic seizures associated with nocturnal hypoglycaemia. None of the patients had experienced hypoglycaemia during waking hours and the convulsions were mistakenly diagnosed as idiopathic epilepsy. Recognition of the possible hypoglycaemia aetiology of these convulsions permitted appropriate alteration of the insulin regimens with no recurrence of convulsions. In one case, the seizure was associated with bilateral fractures of the neck of the humerus. Unrecognized hypoglycaemia should be considered as a possible cause of convulsions in insulin-dependent diabetic patients.- - - - - - - - - - ranking = 0.5keywords = diabetes (Clic here for more details about this article) |
9/10. Factitious brittle diabetes mellitus.Five patients are described in whom factitious disease was the cause of brittle type I diabetes mellitus. The patients were referred from throughout the united states because their physicians had been unable to establish the reason for recurrent hospitalizations for diabetic ketoacidosis or coma. In three of the patients, unexplainable signs, symptoms, and/or laboratory results lead to the diagnosis of factitious disease. In the two remaining patients, long-term follow-up was necessary before a factitious cause was established. These five patients exemplify the extraordinary measures that some patients will utilize to continue as a "patient" rather than return to a normal lifestyle.- - - - - - - - - - ranking = 2.5keywords = diabetes (Clic here for more details about this article) |
10/10. Lessons to be learned: a case study approach. Severe hypoglycaemia in insulin-dependent diabetes mellitus (IDDM)--living to tell the tale.The case is presented of a 62 year old doctor with insulin-dependent diabetes mellitus (IDDM) who experienced severe nocturnal hypoglycaemia following a total intake for the day of fruit and yoghurt (providing 230 kcal) for breakfast, four pints of beer (providing 540 kcal-which included the energy from 37.0 g carbohydrate) later in the day and an evening meal containing approximately 123 g of carbohydrate (providing 1050 kcal). He had taken insulin, as was his custom, just before breakfast, half-an-hour prior to the evening meal and again two-and-a-half hours afterwards. He felt entirely well when he retired to bed at 2100 h. He awoke later, having dreamt that he was practically immobile-but then found to his horror that the dream was true. He soon realised that he was severely hypoglycaemic and, as he had no glucose immediately available, had no alternative but in some way to attempt the journey to the kitchen where there was non-diet mandarin drink available in tin cans inside a refrigerator. He was able later to recall and, in consequence, describe the whole terrifying experience in great detail, on account of the remarkable preservation of mental clarity. The clinical features of the episode are viewed in terms of the relationships between alcohol intake, carbohydrate ingested and the insulin administered. exercise was minimal on this day.- - - - - - - - - - ranking = 2.5keywords = diabetes (Clic here for more details about this article) |
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