1/14. urine glucose testing: reliable backup for whole blood glucose monitoring.urine glucose testing has been deemed by some to be nonessential in the management of diabetes mellitus since the technique and equipment for self-monitoring of blood glucose has become available. However, most physicians have experienced pitfalls in the management of diabetes mellitus when insulin dosage is adjusted daily based solely on the patient's monitoring of blood glucose. There have also been recent reports suggesting the use of urine glucose testing as a reliable and a reasonable alternative to monitoring of blood glucose in the management of diabetic subjects, including those using insulin as the mode of therapy. In this report, we describe a patient in whom diabetic ketoacidosis occurred during hospitalization as a result of inadequate insulin administration due to inaccurate capillary blood glucose test results. Furthermore, urine glucose and ketone values obtained simultaneously had been disregarded. If insulin therapy had been adjusted according to urine glucose results rather than blood glucose readings, diabetic ketoacidosis could have been averted in this patient. urine glucose testing may provide a reliable backup for suspect whole blood glucose values and may prevent catastrophic events requiring expensive hospitalization. This report also delineates several potential procedural problems that exist in the technique of whole blood glucose monitoring and provides recommendations to overcome these deficiencies.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
2/14. Latent autoimmune diabetes mellitus in children (LADC) with autoimmune thyroiditis and celiac disease.Latent autoimmune diabetes mellitus in adults (LADA) is characterized by clinical presentation as type 2 diabetes mellitus after 25 years of age, initial control achieved with oral hypoglycemic agents for at least 6 months, presence of autoantibodies and some immunogenetic features of type 1 diabetes mellitus. An 8.3 year-old girl was referred to our pediatric endocrinology department because of incidental glucosuria. She did not complain of polyuria, polydipsia, or weight loss. Her body mass index (BMI) was at the 80th percentile. fasting glucose was 126 mg/dl, and OGTT glucose level at 120 min was 307 mg/dl. Although c-peptide levels were normal, her first phase insulin response (FIR) was lower than the 1st percentile. Anti-insulin antibody (AIA), islet cell antibody (ICA), and anti-glutamic acid decarboxylase (antiGAD) were negative. According to the clinical and laboratory findings, she was diagnosed as having type 2 diabetes mellitus. She was started with oral anti-diabetic treatment for a period of 1 year. insulin had to be initiated for worsening of HbA1c levels. In the fourth year of follow-up, she was admitted to our hospital with diabetic ketoacidosis although she was on an intensive insulin regimen. At this time, c-peptide levels were low, antiGAD and AIA were positive with HLA DR3/DQ2 haplotype. In addition, her thyroid peroxidase antibody and endomysium antibody were found to be high at follow-up. Small intestinal biopsy revealed celiac disease. This patient may represent the first case of latent autoimmune diabetes mellitus in children (LADC) with autoimmune thyroiditis and celiac disease.- - - - - - - - - - ranking = 0.66666666666667keywords = diabetic (Clic here for more details about this article) |
3/14. Significance of increased serum elastase 1 level during the hyperosmolar hyperglycemic non-ketotic syndrome.An alteration in the serum elastase 1 level in a previously non-diabetic patient, who unfortunately developed the hyperosmolar hyperglycemic non-ketotic syndrome (HHNS), was observed after intravenous hyperalimentation for 6 days. The patient underwent the therapy because of the occurrence of severe persistent anorexia which appeared as a side effect of treatment of lung cancer with combined anticancer drugs. In parallel with progressive dehydration, levels of serum elastase 1 and urine glucose became greatly elevated at an earlier stage of HHNS. A slight increase in serum alpha 1-antitrypsin was observed. However, there were no significant changes in serum amylase activity and serum alpha 2-macroglobulin level before or during HHNS. The elevation of the serum elastase 1 level was considered to be due to serum electrolyte abnormalities and the defect of serum alpha 2-macro-globulin elevation. Rehydration therapy with half-normal saline solution immediately produced negative urine glucose, but the serum elastase 1 level only gradually normalized after improvement of HHNS.- - - - - - - - - - ranking = 0.33333333333333keywords = diabetic (Clic here for more details about this article) |
4/14. Hyperosmolar diabetes presenting as acute urinary retention: report of three cases.Three elderly patients presented at one hospital in a 2-week period with acute urinary retention precipitated by the hyperosmolar non-ketotic diabetic state. In each case routine urine testing was reported as showing 1 per cent glycosuria. The first two patients were admitted at night and blood glucose estimations were not done. This led to a delay of 16 and 12 h respectively before the appropriate therapy was instituted. It is suggested that this clinical presentation, previously unreported, may not be a rarity and represents an avoidable cause of death in patients with acute urinary retention.- - - - - - - - - - ranking = 0.33333333333333keywords = diabetic (Clic here for more details about this article) |
5/14. Diabetic hyperglycemia and glycosuria as a manifestation of bulimia.This is the first reported case of insulin dose manipulation as a manifestation of bulimia. The patient was diabetic, with fluctuations in control. Despite the guarded prognosis in bulimia, the patient's diabetic control improved with psychotherapy.- - - - - - - - - - ranking = 0.66666666666667keywords = diabetic (Clic here for more details about this article) |
6/14. organophosphate poisoning presenting as diabetic ketoacidosis.A 3-year-old boy was admitted to hospital following rapid-onset coma. Laboratory tests demonstrated hyperglycemia, glycosuria and keto-acidosis. Organophosphorus poisoning was the cause of the coma since he had been in contact with parathion, serum cholinesterase activity was undetectable and his condition returned to normal under atropine therapy.- - - - - - - - - - ranking = 1.3333333333333keywords = diabetic (Clic here for more details about this article) |
7/14. Cerebral edema complicating diabetic ketoacidosis in childhood.Three patients who developed fatal cerebral edema in the diabetes camp setting were reviewed with 14 previously reported instances in persons under 21 years of age. Seven occurred in the initial episode of diabetic ketoacidosis. Minimal blood glucose levels less than 250 mg/dl were recorded in 8/17. Rate of fluid administration, rate of Na or K infusion, and hyponatremia or hypokalemia were not consistent factors. Two of the 17 patients received oral fluids only. An etiologic role for rate of blood glucose correction or speed of hydration was not substantiated by this experience and review.- - - - - - - - - - ranking = 1.6666666666667keywords = diabetic (Clic here for more details about this article) |
8/14. Increasing the adherence of diabetic adolescents.This study examined the effects of sequentially introducing self-monitoring, goal setting, and behavioral contracting procedures on increasing the regimen compliance of nonadherent adolescent diabetics. For each of three insulin-dependent subjects, a multiple-baseline across-behaviors design was used to study three of the following target behaviors: urine testing, insulin injections, exercise, wearing diabetic identification, and home blood glucose testing. In addition to self-monitoring of adherence, measures of metabolic control of diabetes were collected before and after an 8-week treatment and at a 2-month follow-up. Adherence increased and was maintained at desired levels for two of the subjects following introduction of goal setting procedures. Metabolic control measures also showed substantial improvement for these subjects. The third subject, whose family was experiencing a variety of severe problems, did not show reliable improvement. The data suggest that graduated goal setting is a promising approach for improving adherence to diabetic regimens.- - - - - - - - - - ranking = 2.3333333333333keywords = diabetic (Clic here for more details about this article) |
9/14. Hyperosmolar non-ketotic coma in diabetic stroke patients.Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three patients, aged 59-67 years, who developed hyperosmolar coma during the first ten days after admission for stroke. Common to all three were normal plasma osmolality and slightly elevated plasma creatinine levels on admission, treatment with diuretics, parenteral dextrose administration before and low urinary glucose output during the coma. In the five days preceding the coma, total fluid deficits were 3.8, 6.5 and 9.4 1, respectively. In one patient the rate of glucose delivery had clearly exceeded utilization during adequate insulinization, in another a marked reduction in urinary glucose output preceded extreme hyperglycaemia and coma. Two of the three patients died, both from extensive thrombus formation in cerebral arteries and multiple emboli to the lungs. We conclude that enhanced endogenous glucose production and reduced renal clearance of glucose may contribute to precipitate hyperosmolar non-ketotic coma. A close monitoring of fluid and dextrose administration seems mandatory in diabetic stroke patients, in particular if renal function is impaired or if diuretics are given. insulin treatment should be considered in all diabetic patients during the first days after a stroke.- - - - - - - - - - ranking = 2keywords = diabetic (Clic here for more details about this article) |
10/14. diabetes mellitus is controlled by vitamin C treatment.The present study was started to investigate the question of whether or not vitamin C administration may help control diabetes mellitus (DM) by stimulating the insulin mechanism of a DM patient. We were motivated to take up the above thesis by the anticipation that vitamin C, being detectable in abundance in endocrine cells, may play a cardinal role in the production of hormones. In the preliminary experiment, we investigated the relation between glucose, insulin and vitamin C in the plasma of a non-diabetic male volunteer in whom vitamin C was introduced intravenously either by injection or by infusion, and with or without concomitant administration of glucose. In the follow-up study of 3 DM patients, the effect of the vitamin C infusion therapy on DM was assessed by summing up multiple clinical information. Results obtained are as follows: 1) the drip infusion system was superior to the ordinary injection system for maintaining plasma concentration of vitamin C at a high level and for a long period. 2) The plasma concentration of insulin, when tested in the vitamin C infusion system, followed a bimodal curve--a finding to suggest that vitamin C may stimulate the insulin mechanism in 2 distinct ways. The early mode was glucose-dependent at its height, but the late mode was independent of glucose charge. 3) The praxis of vitamin C infusion produced clinical improvements in 3 DM patients. The therapeutic efficacy of the treatment varied from patient to patient. In all cases, control of DM was started by combined use of the vitamin C infusion treatment and the insulin injection treatment.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.33333333333333keywords = diabetic (Clic here for more details about this article) |
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