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Biomedical subjects

H Mehnert

Publications and source records attributed to H Mehnert.

At least 55 records · Page 3Linked to original sources
PubMed1990

[ACE-inhibitors and glucose metabolism].

ACE-inhibitors exhibit their blood pressure-lowering activity not only via a reduction of angiotensin II but also via on increase of kinin levels. The latter are known to improve insulin action and hence carbohydrate metabolism in normal volunteers and diabetics. Accordingly, ACE-inhibitors display the same effects. As clinical trials show they are especially useful for the treatment of hypertension in diabetes mellitus.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1990

Risk of progression to diabetes of low titer ICA-positive first-degree relatives of type I diabetics in southern Germany.

In a prospective study to evaluate the prevalence and predictive potential of circulating cytoplasmatic islet cell antibodies (ICA) and competitive insulin autoantibodies (CIAA), we screened 406 non-diabetic first-degree relatives of patients with Type I diabetes mellitus (n = 154 for CIAA). The prevalence of ICA was 2.5% (10/406) and of CIAA 0.6% (1/154) in ICA- and 10% (1/10) in ICA+ relatives at initial screening. The titer of ICA positivity in all relatives varied between 1:1 and 1:4. Values of elevated CIAA were 256 nU/ml of the CIAA+/ICA+, and 97 nU/ml of the CIAA+/ICA- relatives (normal range less than or equal to 39 nU/ml). Sera for repeat ICA and CIAA determination was obtained, and 70% of relatives were found to be again ICA+ after 1.5 years, 40% after 3 years, and 10% after 5.7 years. Both CIAA+ relatives were found to be again CIAA+ on follow-up. Intravenous glucose tolerance tests (IVGTT) were performed in all antibody-positive relatives. No decrease in first-phase insulin secretion (1 + 3 min) below the 1st percentile was observed in any of the ICA+ relatives during follow-up. No ICA+, but one CIAA+/ICA- relative had developed Type I diabetes after 5.6 years of follow-up. In summary, these results indicate that low titer ICA (less than 40 JDF units) are often transient and relatives with low titer ICA rarely progress to Type I diabetes. Elevated CIAA appear to be constant over time and associated with increased progression to overt diabetes.

Adolescent↗
PubMed1990

Effects of beta-blocking agents on insulin secretion and glucose disposal.

Non-selective and to a lesser extent selective beta-blockers are known to slightly deteriorate glucose metabolism. This may be of clinical relevance, since patients with essential hypertension suffer from reduced insulin-sensitivity and some studies showed an increased incidence of diabetes type II with beta-blocker-treated hypertensive patients. However, it is not clear whether this effect is due to hypertension per se or in addition by antihypertensive treatment. The possible mechanisms by which beta-blockers influence carbohydrate metabolism are discussed. Insulin secretion is inhibited by beta-blockers in vitro. However, no effect is seen in vivo in man. Hepatic glucose production in theory may be influenced, but no effect is demonstrable. Muscular glucose uptake could be reduced; some data exist showing reduced peripheral insulin sensitivity, although there are controversial results. In conclusion, a deterioration of carbohydrate metabolism by beta-blockers is established, the mechanism whereby remains obscure.

Adrenergic beta-Antagonists↗
PubMed1990

[Antihypertensive therapy with co-dergocrine mesilate/nifedipine in comparison with nifedipine in type II diabetes].

In a randomized cross-over study the antihypertensive effects of nifedipine and the combination of co-dergocrine and nifedipine (Pontuc) respectively as well as the influence of both preparations on the glucose metabolism was tested in 22 hypertensive patients with diabetes type II over a period of 4 weeks. During treatment with the combination a significantly more pronounced blood pressure reduction was achieved compared to monotherapy with nifedipine, whereas the heart rate was significantly increased only by nifedipine. Both drugs--nifedipine and co-dergocrine/nifedipine--did not change the concentrations of glucose in the blood or urine or of HbA1.

Aged↗
PubMed1990

Stabilized human insulin prevents catheter occlusion during continuous subcutaneous insulin infusion.

Obstruction of infusion sets is a major cause of metabolic deterioration or even ketoacidosis during continuous subcutaneous insulin infusion (CSII). 21 type I, CSII-treated patients were studied in a prospective, randomized cross over design during two periods of three months to assess the effects of Genapol stabilized human insulin (HOE 21 PH H-TRONIN) on obstruction frequency of PVC catheters in comparison with a neutral preparation of biosynthetic human insulin (BHI). In a total observation time of 9.5 patient-years 79 catheter obstructions by precipitated insulin occurred with an incidence of 0.67 episodes per patient-month for BHI and 0.026 for HOE 21 PH. Improvement of metabolic control paralleled the reduction of obstruction frequency by HOE 21 PH. Thus, a stabilized insulin preparation is recommended for use in CSII to reduce the therapeutic risk.

Adult↗
PubMed1990

Metabolic effects of ramipril treatment in hypertensive subjects with non-insulin-dependent diabetes mellitus.

The antihypertensive and metabolic effects of the new long-acting angiotensin converting enzyme (ACE) inhibitor, ramipril (Hoe 498), were assessed in 21 patients with non-insulin-dependent diabetes mellitus (NIDDM) over a 12-week treatment period. In an average dose of 5 mg given once daily, ramipril effectively reduced the elevated blood pressure. In 74% of the cases systolic and diastolic blood pressure was normalised during monotherapy. Mean blood glucose and glycosylated hemoglobin (HbAI) values showed a slight but significant (p less than 0.05) decrease at the end of the ramipril treatment period (glucose: 8.5 +/- 1.4 mmol/l vs 8.0 +/- 0.9 mmol/l; HbAI: 10.0 +/- 1.3% vs 9.7 +/- 1.1%). C-peptide levels did not change. Since there was also a small reduction of body weight during treatment, the observed hypoglycemic response could not be fully ascribed to ramipril. Also, a reduction in total cholesterol and an increase of HDL cholesterol could be documented during treatment with ramipril. The reduction in body weight could also be made partly responsible for this positive effect on lipid metabolism. No serious side effects were reported during the entire study period. Due to these beneficial effects, ramipril can be recommended as first-line drug in the management of hypertensive subjects with NIDDM.

Aged↗
PubMed1990

Clinical studies with CE-inhibitors in diabetes.

Early antihypertensive intervention in diabetes often means intervention in a cluster of cardiovascular risk factors including glucose intolerance per se, hyperlipidemia, obesity and hypertension, which are not just coexistent but may be causally linked together by the resistance of peripheral tissues to the action of insulin. Blood pressure lowering treatment should therefore be metabolically neutral in order to avoid aggravation of this risk factor syndrome. Clinical studies applying CE-inhibitors in type II diabetes are critically reviewed under this aspect. The majority of the available studies in type II diabetes report a reduction of insulin resistance and a marginal improvement of metabolic control. The order of magnitude in HbA1 reduction is nearly 10% of the glycosylated haemoglobin, reduction of fasting and postprandial blood glucose approximates 1 mmol/l. From a more extended view, considering essential hypertension as insulin resistant and thus possibly "prediabetic" state, this marginal metabolic effect gets further support from recent studies in essential hypertension consistently reporting an improvement of metabolic parameters of similar magnitude. This might become a central argument in the discussion about individualized and metabolically neutral antihypertensive treatment in essential hypertension.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

[Ketoacidosis in long-term therapy with insulin pumps. Incidence, causes, circumstances].

110 type I diabetic patients were treated with CSII from 1980 to the end of 1988 on a routine basis over a total of 337 patient years and a mean of 36.7 months per patient. 14 cases of severe diabetic ketoacidosis (DKA) were seen in 14 patients representing an accumulated incidence of one episode of DKA per 209 patients months. DKA occurred on an average of 25 months after start of CSII therapy. The main causes of DKA were undetected leakage of the infusion system in nine, infection in three and mismanagement of the pump in two cases. Technical or electronic failures could be excluded in each case. The lack of checking urine for ketones, the wrong feeling of safety after long-term successful pump treatment, and a concomitant psychological stress situation favoured the misjudgement of the clinical symptoms of ketosis and the delay of hospital admission.

Adolescent↗
PubMed1989

Implantation of programmable infusion pumps for insulin delivery in type I diabetic patients.

Five type I diabetic patients were followed prospectively during treatment with continuous subcutaneous insulin infusion by externally worn pumps and during the first 12 months after implantation of a remote-controlled insulin infusion device (ID1, Siemens AG). Stabilized insulin (Hoe 21 GH, Hoechst AG) was infused intravenously in two and intraperitoneally in three patients. Total observation time was 47.2 patient-months after implantation. Two devices had to be explanted prematurely, one because of a technical failure after 101 days, one due to a skin necrosis over the implant after 236 days. HbA1, frequency of hypoglycemia, total insulin dose, and basal rate infusion did not change after implantation. There was a reduction in the insulin antibodies 6 months after start of intravenous or intraperitoneal insulin delivery. Fasting plasma free insulin levels could be normalized only by intraperitoneal insulin infusion. Although a technical and a surgical problem was observed, our data show the successful implantation and clinical use of programmable dosing devices and stabilized insulin.

Adult↗
PubMed1989

[Diabetic ketoacidosis during insulin pump therapy].

During treatment of four type-1 diabetics (aged 20-46 years) by continuous subcutaneous insulin infusion (CSII) a leak developed in the system which caused severe ketoacidosis. The gastrointestinal symptoms (nausea, vomiting and abdominal pain) were misdiagnosed by both the patients and their doctors because there was only mild hyperglycaemia. These observations highlight the importance of carefully instructing and supervising patients at the beginning of CSII and point to the need of frequent urine testing by the patients, also for urinary keto bodies.

Adult↗
PubMed1989

[Treatment of diabetes with insulin pumps. Current status and insurance medicine aspects].

The continuous subcutaneous insulin infusion (CSII) by means of portable dosing devices ("insulin pumps") represents a new therapeutical principle in the treatment of type I diabetics. Developed in 1978/79, subcutaneous infusion is being used increasingly in today's routine therapy. It achieves an almost physiological distribution of insulin between a basal rate (basic insulin requirement) and additional rates (insulin requirement depending on food-intake), leading to an improvement not only in metabolism but also in the quality of patient's life (increased flexibility in everyday life). The prerequisites for successful therapy are stated and therapy-specific complications are analysed on the basis of the experience of the III. Medical Department of the City Hospital Munich-Schwabing with 104 patients over an accumulated period of 283 treatment years. An outline is given of future advancements in the field of controlled insulin dosage with the help of infusion systems. Important aspects of insurance medicine are pointed out, such as the registration of substandard risks by means of a questionnaire especially developed for that purpose and the prognostic evaluation as compared to forms of therapy applied so far. The reasons for the current classification of this new therapeutical method as prognostic/experimental are indicated and the procedure for selecting favourable risks is described.

Diabetes Mellitus, Type 1↗