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Biomedical subjects

B M Frier

Publications and source records attributed to B M Frier.

At least 55 records · Page 3Linked to original sources
PubMed1999

Appraisal of mood and personality during hypoglycaemia in human subjects.

This study used the biological model of experimental hypoglycaemia to examine the effect of a manipulation in mood-state on appraisal. Controlled hypoglycaemia was achieved using the hyperinsulinaemic glucose clamp technique. Mood, appraisal, and personality traits were assessed using well validated questionnaires. Our findings 1) reaffirm the existence of multiple arousal systems in the generation of moods, 2) show that the induction of a negative mood state does lead to more negative appraisals of a life situation, and 3) show that personality traits remain stable during the experience of negative emotions and cognitions. We conclude that hypoglycaemia, by inducing a state of tense tiredness in some individuals, may lead to more negative appraisals of a life situation but does not alter people's reporting of behavioural dispositions.

Adult↗
PubMed1999

Anger state during acute insulin-induced hypoglycaemia.

This study sought to examine the effects of insulin-induced hypoglycaemia on anger state, and to describe the associations between change in the anger state and measures of anger trait and anger expression (assessed using the State-Trait Anger Expression Inventory). A hyperinsulinaemic glucose clamp was used to achieve controlled euglycaemia (5.0 mmol/L) and hypoglycaemia (2.6 mmol/L) in 18 nondiabetic subjects and 30 people with insulin-dependent diabetes mellitus (IDDM). Subjects underwent both hypoglycaemic and euglycaemic conditions, separated by 2 weeks, in a counterbalanced order. During each study condition subjects were asked to complete a questionnaire on anger state. Results at euglycaemia and hypoglycaemia were compared, and differences between the conditions were correlated with measures of anger trait and anger expression. Hypoglycaemia caused both nondiabetic and IDDM subjects to report a significant increase in feelings of anger, despite being in a nonconfrontational setting. However, there were no clear associations between an individual's change in reported anger and measures of anger trait and anger expression. No association was found between the change in anger state and the intensity of an individual's symptomatic response to hypoglycaemia.

Adult↗
PubMed1998

Type 1 diabetes mellitus and Down's syndrome: prevalence, management and diabetic complications.

Type 1 insulin-dependent, diabetes mellitus (Type 1 DM) is thought to be more prevalent in individuals with Down's syndrome. To ascertain the local prevalence of Type 1 DM in patients with Down's syndrome in a geographically defined area, the four diabetes clinics in Lothian were surveyed and 13 patients with Down's syndrome and Type 1 DM were identified. Using data from previous epidemiological surveys which determined the prevalence of Down's syndrome in the general population, the prevalence rate of Type 1 DM in patients with Down's syndrome was calculated to be between 1.4 and 10.6%, a prevalence considerably higher than in the general population. Although 7 (54%) of the Down's syndrome patients were treated with once daily administration of insulin, the mean HbA1c value of the group was similar to that observed in a control group of 39 age-, sex- and duration-matched Type 1 patients, all of whom were taking two or more injections of insulin daily. Glycaemic control was therefore of similar quality to matched Type 1 patients without Down's syndrome, despite the frequent use of simple insulin regimens, which may relate to the more stable lifestyle of these patients.

Adult↗
PubMed1998

Perceived symptoms of hypoglycaemia in elderly type 2 diabetic patients treated with insulin.

Elderly insulin-treated diabetic patients have a high risk of severe hypoglycaemia, yet their hypoglycaemic symptom profile has attracted little research. In this study, the frequency and intensity of symptoms of hypoglycaemia were recorded using a validated questionnaire in 132 insulin-treated diabetic patients, aged 70 years or more. Principal components analysis (PCA) was used to discover the factorial structure of the symptoms. Lightheadedness and unsteadiness were prominent symptoms in the elderly patients. PCA suggested three separate groups of symptoms: (1) those related specifically to impairment of co-ordination and articulation; (2) more general neuroglycopenic symptoms, and (3) autonomic symptoms. The frequency and classification of hypoglycaemic symptoms in this elderly population is different from those seen in younger diabetic patients treated with insulin. Neurological symptoms of hypoglycaemia were more commonly reported and may be misinterpreted as features of cerebrovascular disease. Health professionals and carers involved in the treatment and education of diabetic patients should be aware of the age-specific differences in hypoglycaemic symptoms.

Aged↗
PubMed1998

Hypoglycaemic symptoms reported by children with type 1 diabetes mellitus and by their parents.

To compare the hypoglycaemic symptoms reported by children with Type 1 diabetes and signs observed by and symptoms reported to their parents, 101 pairs, consisting of a child with diabetes and one of their parents, were asked to report the frequency with which they experienced, or witnessed, each of 31 symptoms during hypoglycaemia. The hypoglycaemic symptoms reported by the children and the reported symptoms and signs observed by their parents were classified, using multivariate statistical analyses, and compared. Close agreement was observed between the children and their respective parents' scores for frequencies of most symptoms/signs, as demonstrated by Spearman's rank correlations (median tau s = 0.25, p < 0.02). Principal Components Analysis of the symptoms/signs observed by the parents showed three factors: autonomic, neuroglycopenic, and behavioural disturbance. Analysis of the symptoms experienced by the children also identified three factors: behavioural disturbance, malaise and a third factor consisting of a combination of autonomic and neuroglycopenic symptoms. The parents could differentiate three separate groups of reported hypoglycaemic symptoms and signs (autonomic, neuroglycopenic, and behavioural disturbance) in their children. The children reported a similar group of behavioural symptoms but did not discriminate between autonomic and neuroglycopenic symptoms. These findings have important implications for the education of parents and children with Type 1 diabetes regarding the symptoms and signs of hypoglycaemia.

Adolescent↗
PubMed1998

Effect of acute hypoglycemia on visual information processing in adults with type 1 diabetes mellitus.

Acute hypoglycemia in people with type 1 (insulin-dependent) diabetes mellitus causes general impairment in cognitive performance. The effects on more specific cognitive processes are less well defined. Acute hypoglycemia has been shown to impair visual information processing in nondiabetic human subjects and has now been examined in 16 adult subjects with type 1 diabetes. All subjects had normal visual acuity and no diabetic retinopathy, and their median (range) age was 24 (18-47) years with a median (range) duration of type 1 diabetes of 8 (2-18) years and a mean (SD) HbA1c of 8.5 (1.3)%. A hyperinsulinemic glucose clamp technique was used to maintain arterialized blood glucose at 5.0 mmol l(-1), and on separate test days, either euglycemia was continued or hypoglycemia (2.6 mmol l(-1)) was induced. During each condition subjects performed tests of visual processing and cognitive function. Hypoglycemia caused a significant disruption in general cognitive ability as assessed by digit symbol (p < 0.001) and trail-making B (p < 0.05) tasks. Conventional measures of visual acuity were unaffected by hypoglycemia, but visual information processing deteriorated significantly as indexed by inspection time (p < 0.005) and visual change detection (p < 0.01). Contrast sensitivity tended to deteriorate during hypoglycemia (p = 0.06). In conclusion, hypoglycemia impairs important aspects of early visual information processing and contrast sensitivity in adults with type 1 diabetes. Further research is needed to evaluate the functional relevance of such changes for everyday tasks that require the intake of visual information at speed and under conditions of low contrast.

Adolescent↗
PubMed1998

Factors influencing preference of insulin regimen in people with type 1 (insulin-dependent) diabetes.

The two commonest insulin regimens in current use in the UK are twice daily administration of short- and intermediate-acting insulins in combination, and soluble insulin before meals with intermediate-acting insulin at bed-time (basal-bolus regimen). A cross-sectional sample of patients with type 1 diabetes was studied using either a twice daily insulin regimen (n = 30) or a basal-bolus regimen (n = 30), to assess their satisfaction with choice of insulin regimen and to examine the relationships between type of insulin regimen, personality, demographic variables and glycaemic control. Patients treated with a basal-bolus insulin regimen tended to be younger (P = 0.07), had an earlier onset of type 1 diabetes (P = 0.04), adjusted their dose of insulin more frequently (P = 0.01), had received more secondary and further education (P = 0.03), belonged to a higher socio-economic class, tended to be unmarried (P = 0.07) and were less likely to be smokers (P = 0.03), than the group treated with twice daily administration of insulin. Current and previous glycaemic control assessed by glycated haemoglobin concentration, showed no correlation with type of insulin regimen, demographic data or personality variables.

Adult↗
PubMed1998

Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission.

In the community, acute hypoglycaemia is commonly caused by therapies for diabetes mellitus or the excessive consumption of alcohol. Although most episodes do not require admission to hospital, little information is available on the causes and outcome of those that do. We retrospectively surveyed adult patients admitted to a large urban teaching hospital with acute hypoglycaemia in a 12-month period, identifying 56 admissions of 51 patients. Forty-one had diabetes mellitus, 33 (80%) of whom were receiving treatment with insulin. The others had hypoglycaemia induced by excessive consumption of alcohol or by deliberate self-poisoning with insulin. A history of psychiatric illness and/or chronic alcoholism was common. Neurological manifestations of hypoglycaemia were the principal reason for admission, observed on 50 occasions (89%), and 11 events (20%) had precipitated convulsions. Although many patients (59%) had received treatment for hypoglycaemia before admission, hypoglycaemia recurred in 16% of patients in hospital. Four patients (7%) died following admission, but in only one case was this the direct result of hypoglycaemia. However, within 15 months of the index hypoglycaemia event, a further six patients (11%) had died, mostly of causes unrelated to hypoglycaemia. Patients who require hospital admission for treatment of hypoglycaemia have a high incidence of neurological manifestations, a high rate of mental illness and other medical disorders, and may represent a high-risk subgroup with a poor long-term prognosis.

Acute Disease↗
PubMed1998

Seeing beyond retinopathy in diabetes: electrophysiological and psychophysical abnormalities and alterations in vision.

Contrast sensitivity testing, in common with color vision (another test of psychophysical function), demonstrates significant changes in diabetic subjects compared with nondiabetic controls, and there is some evidence for a relationship with grade of retinopathy. Changes in contrast sensitivity have been demonstrated in children and adults with diabetes of short duration, and some evidence exists for a correlation with poor glycemic control, although prospective studies are required to assess this relationship over a longer time period. Although both color vision and contrast sensitivity demonstrate similar patterns, studies that directly compare the two tests suggest that measurement of contrast sensitivity is the more sensitive and specific.

Adult↗
PubMed1998

Optimal time of administration of insulin lispro. Importance of meal composition.

OBJECTIVE: To compare the glucodynamics of pre- and postprandial administration of insulin lispro using test meals of differing composition. RESEARCH DESIGN AND METHODS: Twenty subjects with IDDM were studied on four separate occasions. Ten subjects ingested high-carbohydrate and high-fat breakfasts with a large liquid component, and 10 subjects ingested high-carbohydrate and high-fat breakfasts in a more solid form. With each meal, insulin lispro was injected 10 min preprandial on one occasion and 20 min postprandial on another. The magnitude and temporal pattern of postprandial glucose excursions were observed. RESULTS: With all meal types studied, postprandial blood glucose excursions were significantly smaller when insulin lispro was administered preprandially (P < 0.05). With both high-carbohydrate meals and the liquid high-fat meal, preprandial administration of lispro was associated with modest postprandial increments of blood glucose. With the solid high-fat meal, preprandial lispro produced a cumulative decline in postprandial blood glucose, whereas blood glucose rose when lispro was administered postprandially. CONCLUSIONS: For meals with a high carbohydrate content, the optimal time of administration of lispro is preprandial. However, for meals with a high solid fat content, postprandial administration of lispro may be preferable.

Adult↗
PubMed1997

Hypoglycaemia and non-cognitive aspects of psychological function in insulin-dependent (type 1) diabetes mellitus (IDDM).

Hypoglycaemia provokes unpleasant symptoms and sensations in patients with insulin-dependent (Type 1) diabetes mellitus (IDDM). There is much interest in, and information on, the cognitive effects of acute insulin-induced hypoglycaemia. However, the effects of hypoglycaemia on brain function extend to important, non-cognitive aspects of psychological functioning, which are reviewed here. Acute hypoglycaemia induces changes in mood which result in a transient state of 'tense tiredness', a decrease in happiness, an increase in tense arousal, and decreased energetic arousal. Appraisals of life problems are affected adversely. Frequent exposure to hypoglycaemia is associated with heightened fear of hypoglycaemia, which can be quantitated in individuals. Personality may also influence behavioural responses to hypoglycaemia and the ability of an individual to cope with diabetes. The adverse effects of hypoglycaemia on mood, behaviour, personality, social function and management of diabetes in individual patients may be profound and need to be identified and addressed appropriately.

Diabetes Mellitus, Type 1↗
PubMed1997

A structural equation model for predictors of severe hypoglycaemia in patients with insulin-dependent diabetes mellitus.

There are several predictors of severe hypoglycaemia in patients with insulin-dependent diabetes mellitus (IDDM), many of which are correlated. To assess factors which may be predictive of severe hypoglycaemia, structural equation modelling was used to test specific hypotheses using prospective data. Sixty patients with insulin-dependent diabetes mellitus (IDDM) were studied prospectively for one year during which any episodes of severe hypoglycaemia, asymptomatic biochemical hypoglycaemia, and glycaemic control were documented. Half the patients reported hypoglycaemia unawareness and they were matched for HbA1 with the rest. Baseline measurements included symptomatic awareness of hypoglycaemia, fear of hypoglycaemia, previous history of hypoglycaemia, glycaemic control, and peripheral autonomic function. Formal structural equation modelling was performed on these variables and a model was constructed that expressed the putative causal associations among the variables. The frequency of severe hypoglycaemia (measured prospectively) correlated significantly with duration of diabetes, awareness of hypoglycaemia, patient's age, history of previous severe hypoglycaemia and autonomic function scores. HbA1 did not show significant correlation, possibly because of the narrow range in the subject population. In the structural equation modelling exercise, at least 18% of the variance of severe hypoglycaemia, measured prospectively, was accounted for by a history of severe hypoglycaemia, the state of awareness of hypoglycaemia, and the autonomic function score. Over 25% of the variance of 'worry' on the hypoglycaemia fear scale was accounted for by a history of previous severe hypoglycaemia. An assessment of multiple risk factors for hypoglycaemia may be of value in advising individual patients about their diabetes care.

Adult↗
PubMed1997

Hospital management of diabetic ketoacidosis: are clinical guidelines implemented effectively?

A study was undertaken in order to examine the quality of management of diabetic ketoacidosis (DKA) in a teaching hospital and to assess whether the introduction of clinical guidelines contributed to a satisfactory outcome. Data on presentation and management of 71 cases of DKA admitted in one calendar year (1994) were collected and analysed. Comparing the data to standards set in guidelines, inadequacies of clinical management were identified including delay in initiation of intravenous fluid replacement (greater than 30 min) and intravenous insulin (greater than 60 min) in 70% and 69% of cases, respectively; under-replacement with intravenous fluid in the first 24 h (less than 6.5 l) in 70% of cases, and insufficient intravenous potassium replacement (less than 70 mmol) in the first 24 h in 70% of cases. Suboptimal management of DKA may have contributed towards death in one of the three fatalities, and to morbidity in other patients. In 22.5% of cases (group 1) in whom the guidelines were alleged to have been followed, intravenous fluid, potassium, and insulin had been administered earlier and in larger quantities compared to the remaining cases (group 2). However, in most cases in group 1 the standards set by the guidelines were unfulfilled and the incidence of hypokalaemia, hypoglycaemia, and duration of in-patient stay did not differ from group 2. The treatment of DKA by non-specialist general medical staff in a large teaching hospital was frequently inadequate and was associated with significant mortality and morbidity. The introduction of guidelines had moderately influenced the process of managing DKA but not the outcome, probably because of the low rate of their implementation by junior doctors.

Adolescent↗