Search PubMed⌕ Search

Biomedical subjects

C R Shuman

Publications and source records attributed to C R Shuman.

At least 19 recordsLinked to original sources
PubMed1998

Control of vascular disease in patients with diabetes mellitus.

To achieve the optimal management program for the diabetic vasculopathic patient, a multidisciplinary approach incorporating the necessary major elements is required. The endocrinologist is essential in tight metabolic control of blood sugars and diet modifications. The podiatrist is indispensable in the early detection of foot ulcerations and preventive care. Visiting nurses function as a vital component in outpatient wound assessment and daily care. With this approach, the vascular surgeon is ensured of the most favorable outcome with conservative measures.

Blood Glucose↗
PubMed1996

Managed psychiatric care: a suburban medical department activity model.

Munson Army Community Hospital has successfully realized substantial cost savings by instituting psychiatric managed care. The development of an external partnership with a civilian psychiatric facility is a unique aspect of the psychiatric managed care initiative and has resulted in most of the savings. We staff this partnership hospital with one-half full-time-equivalent psychiatrist. Other psychiatric managed care program elements include: (1) using CHAMPUS "recapture" funds to hire additional personnel; (2) maximizing personnel utilization by combining mental health staff from the social work and psychiatry services; (3) working closely with the community to identify local mental health needs; (4) offering additional therapeutic modalities; and (5) reducing rehospitalization rates through improved discharge planning. We reduced our financial-year first quarter costs by 76% from 1993 to 1995. We attributed much of these savings to reduced residential treatment admissions. Although the total number of outpatient visits increased, Munson's psychiatric services reduced outpatient costs by increasing clinic access. We have used the Gateway to Care program to prepare for the initiation of Tri-Care in our region.

Community Mental Health Services↗
PubMed1986

Infection in diabetic osteoarthropathy: use of indium-labeled leukocytes for diagnosis.

Indium-111 labeled leukocyte imaging was compared with three-phase skeletal scintigraphy as a means of determining whether osteomyelitis was complicating diabetic osteoarthropathy. Three-phase scintigraphy demonstrated increased activity in both infected and noninfected osteopathic bone, with a sensitivity of 75% and a specificity of 56% for osteomyelitis. Leukocyte imaging had the same sensitivity but was most helpful for excluding infection (specificity, 89%) when three-phase imaging could not. Abnormal leukocyte localization was seen at the primary site of infection in all cases within 4 hours after injection. Disadvantages of leukocyte imaging included long preparation time, low count rates resulting in poor spatial resolution, and absence of bone landmarks, which made it difficult to differentiate soft tissue from bone infection.

Adult↗
PubMed1984

Improvement of metabolic control in diabetic patients during mebendazole administration: preliminary studies.

After the observation of decreasing insulin resistance in a diabetic patient during treatment with mebendazole for nematosis, we investigated the effect of mebendazole on metabolic control in six Type 1 (insulin-dependent) and six Type 2 (non-insulin-dependent) diabetic patients, eight of whom were chronically resistant to conventional treatment. Before and after mebendazole treatment for 1 month, plasma glucose and serum C-peptide concentrations were determined both fasting and 4 h after a mixed breakfast. Improvements in fasting blood glucose concentrations occurred in Type 1 (12.83 +/- 1.11 versus 6.56 +/- 0.56 mmol/l; p less than 0.05) and Type 2 (10.22 +/- 0.56 versus 7.56 +/- 0.67 mmol/l; p less than 0.05) diabetic patients and were associated with increases in post-cibal C-peptide responses in Type 1 and Type 2 diabetic patients. Following discontinuation of mebendazole, metabolic control deteriorated in five out of the six Type 1 diabetic patients and in all the Type 2 diabetic patients. We conclude that mebendazole increases insulin secretion, and decreases plasma glucose concentration in Type 1 and Type 2 diabetic patients. However, these beneficial effects may be transient.

Adult↗
PubMed1984

Optimum insulin use in older diabetics.

Insulin treatment of the elderly diabetic patient differs little from that advocated for the younger adult population, although in general the standards for blood glucose control are raised in the elderly by 10 mg/dl per decade, starting at age 60. These higher standards are recommended primarily to minimize the risk of hypoglycemia. Within these limits, control of diabetes will retain the older patient's vigor, alertness, and health. Insulin therapy can also be flexible to suit the requirements of individual patients. For those with residual endogenous insulin secretory capacity, a single dose of modified insulin may suffice. For those with greater insulin needs, split-dose schedules supplemented with regular insulin can be instituted, depending on the severity of the deficiency. Most important, the program for the aging diabetic should be simple and practical, and family members or community health personnel can be enlisted to assist in diabetic care and monitoring.

Aged↗
PubMed1983

Glipizide: an overview.

This is a brief summary of the extensive clinical experience with glipizide in the treatment of noninsulin-dependent diabetes mellitus. The data demonstrate that this agent, one of the newest oral hypoglycemics, is an effective and safe compound with unique properties. Among its other qualities, it has been shown (1) to stimulate insulin action through extrapancreatic effects that affect insulin-receptor binding and enhance tissue responsiveness to insulin; (2) to favorably influence the principal pathophysiologic abnormalities, defective secretory dynamics, and target-cell resistance to insulin observed in noninsulin-dependent diabetes; (3) to improve control of blood glucose, and when used in conjunction with insulin, to achieve glycemic control with reductions in insulin dosage; (4) to lower the level of plasma glucose and to maintain this effect despite a short half-life; (5) to stimulate insulin secretion following its oral administration; (6) to be more effective than tolbutamide in elderly patients with long-standing diabetes; and (7) to be well tolerated with few side effects. The occurrence of hypoglycemia with its use is uncommon and can be avoided by appropriate precautions and correct usage. These factors seem to recommend its use for the management of noninsulin-dependent diabetes mellitus.

Blood Glucose↗
PubMed1983

Foot disorders in diabetics. Source of serious morbidity.

In the diabetic patient, the foot is particularly vulnerable to disorders resulting from vascular insufficiency, neuropathy, and infection. Without proper treatment, these disorders can lead to serious disability or amputation. Hyperglycemia, smoking, hypertension, and obesity contribute to the development of foot lesions. Early recognition of pedal lesions allows institution of measures (eg, special shoes, fitted inserts) that reduce risks of serious disorders. Patient education regarding foot care also plays an important role in prevention and management of disease. Aggressive treatment of infection and local care of lesions prevent extension of disease to adjacent areas. In cases of established infection or occlusive vascular disease amenable to bypass procedures, surgical intervention is frequently necessary. When amputation is required, rehabilitation professionals can assist the physician in patient education regarding personal care and readjustment.

Amputation, Surgical↗
PubMed1982

Reduced epinephrine secretion and hypoglycemia unawareness in diabetic autonomic neuropathy.

The cause of susceptibbility of certain diabetic patients to severe hypoglycemia is not known. Because the awareness of hypoglycemia is heightened by catecholamine-mediated physiologic responses, deficient catecholamine secretion may cause frequent and severe hypoglycemia. Plasma epinephrine and norepinephrine were measured after insulin-induced hypoglycemia in 18 diabetic patients, nine with autonomic neuropathy, and in nine normal volunteers. Our results show that two thirds of patients with diabetic autonomic neuropathy have moderate to severe deficits in epinephrine secretion and that these patients have diminished or delayed subjective responses to low blood sugar and are at risk for developing severe hypoglycemia and its neurologic consequences.

Autonomic Nervous System Diseases↗
PubMed1982

Surgery in the diabetic patient.

The condition of the diabetic patient--reduced availability of insulin and an enhanced reaction to the counter-regulatory hormones elicited during major surgical stress--necessitates the administration of insulin to prevent hyperglycemia, fat mobilization and ketosis, and wastage of body protein. Crucial items in management are the maintenance of fluid and electrolyte balance and prevention of infection. The recognition of diabetes-related complications, particularly those involving the cardiovascular system, will forestall problems related to these conditions during the perioperative period. For both type I and type II diabetes the use of intravenous glucose-insulin infusion provides a safe and effective method for management during surgery. During surgery, monitoring of blood glucose concentration determines the adequacy of insulin dosage, which can be adjusted to maintain glucose concentrations within the desired range. With this system, the hazards of hyperglycemia are avoided and significant hypoglycemia is rarely encountered. For elective operations as well as for emergency surgical procedures, this method can provide a simple and effective regimen for use in most hospitals.

Anesthesia↗
PubMed1980

Substrate, hormone, and temperature responses in males and females to a common breakfast.

To evaluate the response to a mixed meal we studied oral temperature, metabolite, and hormonal responses to a common American breakfast containing 11 kcal/kg body weight (carbohydrate 43%, fat 42%, and protein 15%) in 12 normal volunteers (6 males and 6 females). There was a significant rise in oral temperature during the postcibal period. This change in oral temperature did not depend upon food consumption in males but was meal-dependent in females. Food ingestion caused increases in the peripheral circulating concentrations of glucose, lactate, pyruvate, and amino acids and reciprocal decreases in the concentrations of free fatty acids, glycerol, and urea nitrogen. Acetoacetate and beta-hydroxybutyrate decreased during the postcibal period but the changes were not statistically significant. Although peripheral venous serum insulin and plasma glucagon concentrations were indistinguishable between the sexes, males had higher concentrations of plasma triglycerides, plasma amino acids, and serum urea nitrogen. Peripheral venous plasma somatostatin and secretin remained unchanged, but pancreatic polypeptide hormone showed a large biphasic response to the meal. After breakfast the blood glucose concentration tended to be greater in males than in females and this difference was significant at 60 and 120 min postcibal. Furthermore, every female had a 120 min postcibal glucose concentration that was lower than her basal fasting glucose concentration. This suggests that postcibal glucose concentrations should be related to gender in making the diagnosis of carbohydrate intolerance or reactive hypoglycemia.

Adult↗
PubMed1980

Monitoring metabolic control in diabetic outpatients with glycosylated hemoglobin.

The usefulness of HbA, as a monitor of metabolic control was studied in 15 diabetic outpatients during periods of stable, deteriorating, and improving control. Mean fasting concentrations of HbA, and plasma glucose during a 3-month period of stable control were 12.6% +/- 0.8% and 120 +/- 8 mg/dL, respectively. One week after discontinuation of oral hypoglycemic therapy, blood glucose had risen to 172 +/- 23 mg/dL and HbA, to 14.1% +/- 0.7% (P less than 0.025). Reinstitution of therapy resulted in a significant fall of blood glucose within 2 weeks. A significant decline in HbA1 (from 15.3% +/- 0.8% to 14.1% +/- 0.9%, P less than 0.025) occurred 2 weeks later. The data show that the rate of formation of HbA1 is considerably faster than its rate of disappearance. Thus, HbA1 is likely to reflect disproportionally recent episodes of poor control. We conclude that HbA1 is useful to monitor diabetic outpatients during periods of stable and rapidly deteriorating control but is not suited to detect rapid metabolic improvements.

Administration, Oral↗