Biomedical subjects
Jerzy Loba
Publications and source records attributed to Jerzy Loba.
[Effect of short-term intensive insulin therapy on daily insulin requirement in poorly controlled type 2 diabetes patients].
Prompt metabolic control improvement and daily insulin requirement assessment are indications for short-term intensive insulin therapy in type 2 diabetes, applied as multiple daily subcutaneous insulin injections (MDI), continuous subcutaneous (CSII) and intravenous insulin infusion (IVII). The study aimed at assessing the mean daily insulin dosage before beginning and after finishing three methods of short-term intensive insulin therapy, discontinued upon achievement of good glycemic control. 90 poorly controlled type 2 diabetes patients, hospitalized in Diabetology Department of Medical University in Lódź, treated with insulin twice daily were enrolled into the study (age 52.8 +/- 6.7 years, mean daily insulin dosage 0.76 +/- 0.28 U.I./kg. of body weight, daily blood glucose profile values 271 +/- 76 mg/dl). The patients were randomized into three groups: the first group treated with MDI, the second with IVII and the third with CSII. Insulin dosage increased significantly after MDI therapy comparing with prehospital values (0.72 U.I./ kg-->0.84 U.I./kg, p = 0.007). No change in daily insulin requirement was noted in CSII and IVII groups. We concluded that CSII and IVII comparing with MDI are more efficient methods of achieving prompt glucose control improvement and they do not lead to the increase in the insulin dosage.
Drug-eluting coronary stents.
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Circadian blood pressure variation in morbidly obese hypertensive patients undergoing gastric bypass surgery.
BACKGROUND: Impaired blood pressure (BP) variation, often found in obesity and hypertension, is associated with increased cardiovascular risk. The effect of obesity surgery on BP variation is unknown. We performed this study to investigate the effect of gastric bypass surgery on circadian BP variation in morbidly obese hypertensive subjects. METHODS: The study group consisted of eight patients (mean age 35.0 +/- 9.1 years), with impaired circadian BP rhythm. Controls were eight well-matched subjects (34.6 +/- 9.8 years) with normal BP rhythm. All patients underwent gastric bypass surgery. The 24-h ambulatory BP measurements were performed before (baseline) and 8 weeks after gastric bypass surgery. RESULTS: Mean body weight in the study group and controls decreased from baseline of 129.0 +/- 21.9 kg and 134.1 +/- 27.2 kg to 116.7 +/- 21.1 kg (by 9.5% +/- 2.1%) and 121.6 +/- 25.7 kg (by 9.3% +/- 1.7%) after the surgery, respectively (P < .0001 v baseline). Mean 24-h, daytime, and night-time BP values decreased significantly and similarly in both groups. In the study group mean 24-h systolic and diastolic BP decreased from 154.7 +/- 12.3 mm Hg and 105.6 +/- 8.1 mm Hg to 138.5 +/- 9.3 mm Hg and 90.8 +/- 6.7 mm Hg and in controls from 158.2 +/- 16.5 mm Hg and 106.2 +/- 10.0 mm Hg to 136.3 +/- 10.8 mm Hg and 92.9 +/- 6.3 mm Hg (P < .0001 v baseline), respectively. Circadian BP rhythm in the study group returned to the normal profile (mean systolic nocturnal fall increased from 4.0% +/- 2.4% to 16.4% +/- 4.0% and diastolic, from 5.1% +/- 3.0% to 17.3% +/- 5.5%; P < .0001 v baseline), whereas it remained normal in the controls. CONCLUSIONS: Surgery-induced body weight loss in morbidly obese hypertensive subjects with impaired circadian BP variation is not only associated with BP reduction, but also with the restoration of normal BP rhythm.
Treatment of diabetic ketoacidosis with subcutaneous insulin lispro.
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Treatment with continuous positive airway pressure may affect blood glucose levels in nondiabetic patients with obstructive sleep apnea syndrome.
STUDY OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) is often associated with impaired glucose metabolism. Data on the effects of OSAS treatment with continuous positive airway pressure (CPAP) on blood glucose and insulin resistance are conflicting. The study aimed at assessing the immediate effect of CPAP on glucose control measured with a continuous glucose monitoring system (CGMS). PARTICIPANTS AND MEASUREMENTS: Nine non-diabetes subjects with OSAS (mean age 53.0 +/- 8.0 years; body mass index 34.8 +/- 5.3 kg/m2) underwent 2 overnight polysomnographic examinations: a diagnostic study and one with CPAP treatment. Continuous glucose monitoring system (CGMS) was applied overnight on both occasions. Glucose metabolism was assessed with a 75-g oral glucose tolerance test, plasma insulin and homeostatic model assessment of insulin resistance (HOMA-IR) index. RESULTS: The mean (+/- SD) apnoea-hypopnea index (AHI) at diagnostic polysomnography was 54.3 +/- 29.3 (range 16-81). Fasting plasma insulin levels in patients with OSAS was 84.3 +/- 43.4 pM at baseline, and the HOMA-IR was 3.6 +/- 2.2. CPAP treatment in the subjects with OSAS resulted in a significant reduction in the AHI to 4.5 +/- 7.1. All of the major saturation parameters improved significantly on CPAP. CGMS showed mean glucose values significantly higher during the CPAP night than during the diagnostic night: 80 +/- 11 mg/dL versus 63 +/- 7 mg/dL (P < .01). Fasting insulin and HOMA-IR measured after the CPAP night tended to be higher than at baseline (98.4 +/- 51.0 pmol vs 84.3 +/- 43.4 pmol and 3.9 pmol +/- 2.6 vs 3.6 +/- 2.2 pmol, respectively, P > .05). CONCLUSION: CPAP treatment in nondiabetic obese patients with OSAS may have an immediate elevating effect on blood glucose.
[Ghrelin--role in energy homeostasis and glucose metabolism].
Ghrelin is a 28 aminoacids peptide secreted from the stomach that stimulates the release of growth hormone (GH) from the anterior pituitary cells and is the strongest orexigenic hormone discovered so far. Ghrelin seems to be involved in the pathogenesis of obesity, anorexia nervosa and cachexia. Furthermore, low levels of ghrelin are negatively correlated with the degree of insulin resistance, blood pressure and the prevalence of type 2 diabetes. The role of ghrelin in the energy homeostasis and carbohydrate metabolism is discussed.
[Personal insulin pumps--from experiment research till recommended method of diabetes treatment].
Diabetes treatment with continuous insulin infusion with the use of personal insulin pumps secures strict metabolic control in diabetes--patients and can minimize a number of complications of diabetes. According to American Diabetes Association (2001), diabetes therapy with continuous insulin infusion is recommended for each person, who accept this therapy method. Personal insulin pump is well tolerated device, which enables to conduct a comfortable continuous insulin infusion. The patients, who comply with medical instruction and perform self-monitoring are fit for diabetes treatment with personal insulin pump. According to present recommendation, there is not necessary to hospitalize patients to initiate continuous insulin infusion. Treatment with personal insulin pump takes up in Poland only in wards of Diabetology and Diabetes outpatient clinics. The main indications of personal insulin pump use are: unstable course of diabetes despite of the another intensive insulin methods used before, often hypoglycemic episodes in anamnesis, active, changing patient's life-style. Little daily insulin requirement < 20 U.l./24 hours, pregnancy. The essential advantages in personal insulin pump use are: prompt metabolic control improvement, a considerable liberty in meal consumption (in its time and amount) and intensity of effort, decrease in number of hypoglycemia and exactly insulin dosage establishment.
[The picture of visual evoked potentials in type 1 diabetes mellitus].
The aim of this study was to assess frequency of abnormal visual evoked potentials in type 1 diabetic patients and the correlation between patients' age, duration of the disease, metabolic control and coexisting clinical complications on the abnormal recordings. The investigation was carried out in a group of 50 diabetic patients, aged from 16 to 55 years. The VEP recordings were performed four times, each time using a pattern made up of elements of another size (18, 36, 72 and 144 angular minutes). With this method the abnormal VEP were recorded in 26% of the cases and it was possible to find 10% patients who had more than one abnormal test. In VEP recorded with stimulation with a single size pattern, abnormal results were recorded from 8% to 14% of the cases. The pathological VEP were recorded as elongation of P100 latency in 86% type 1 diabetic patients, and as significant difference between the latencies from both eyes in 14% cases. There was no statistically significant correlation between the age, duration of the disease, coexisting clinical complications or metabolic compensation and the abnormal recordings.
[The picture of visual evoked potentials in type 2 diabetes mellitus].
The aim of this study was to assess frequency of abnormal visual evoked potentials in type 2 diabetic patients and the correlation between patients' age, duration of the disease, metabolic control and coexisting clinical complications on the abnormal recordings. 41 diabetic patients, aged 35 to 62 years were examined. The VEP recordings were performed four times, each time using a pattern made up of elements of another size (18, 36, 72 and 144 angular minutes). With this method the abnormal VEP were recorded in 22% of the cases. The abnormal VEP recordings with a single size pattern were in 8% to 14% of the cases. The P100 latency increased in 33% of the pathological recordings and in about 66% of the cases there was a significant difference between the latencies from both eyes. There was no statistically significant correlation between the age, duration of the disease, coexisting clinical complications or metabolic compensation and the abnormal recordings.
[Recent discoveries of the early history of insulin production in Poland].
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[Accuracy of blood glucose concentration values outcome performed at various skin sites with personal glucose meters].
AIM: The aim of this study was the comparison of capillary blood glucose values performed at different skin sites with various glucose meters. PATIENTS AND METHODS: 50 type 2 - diabetic patients were enrolled into the study. At the first part of study - in stable glucose phase, measurements were performed with four various glucose meters at four skin sites: finger, forearm, abdomen, big toe. At the second part of the study all the subjects underwent one hyperglycemic challenge (after intravenous 40% glucose load) and hypoglycemic challenge (after intravenous 6 I.U.dose of short-acting human insulin). All of those capillary glucose values were compared between the venous blood and the interstitial glucose values. RESULTS: No significant differences in performed glucose values were observed between the four types of glucose meters (p>0.05). Only the glucose values at finger were similar to the venous and the interstitial glucose levels in stable glycaemic and rapid glucose change phase as well (p>0.05). CONCLUSION: 1. Glucose meters are precise and reliable tool for capillary glucose measurement. 2. Capillary glucose measurements can differ depend on various skin sites. 3. Capillary glucose measurements at finger are reliable and comparable with the suitable venous and the interstitial glucose levels.
[Usefulness of continuous glucose monitoring system in detection of hypoglycaemic episodes in patients with diabetes in course of chronic pancreatitis].
BACKGROUND: Recently introduced method of glucose monitoring--Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed) now offers new possibilities of assessing metabolic control of diabetes as it records blood glucose values 288 times per day. CGMS is particularly helpful in pancreatogenic diabetes, which is associated with essentially poor metabolic control and higher number of hypoglycemic events. AIM: The study aimed at assessing number of hypoglycemic episodes, including symptom-free hypoglycemic episodes detected with CGMS and glucose meter (GM). TURESTIGALED GROUP AND METHODS: The study comprised 60 diabetic out-patients, treated with insulin in age mean 53.8 +/- 5.1 years, with chronic pancreatitis lasting mean 10.6 +/- 4.6 years and diabetes mellitus-- 4.9 +/- 2.4 years. Serum glucose concentration values were measured with the use of CGMS. Ten measurements of capillary blood glucose concentration with GM were performed daily during the period of CGMS use. Observation period of hypoglycemic episodes lasted 3 days. Hypoglycemic event was detected when glucose value decreased below 60 mg/dl. The number of hypoglycemic episodes, including symptom-free hypoglycemic episodes detected with CGMS and GM was compared. RESULTS: Number of hypoglycemic events detected with CGMS was five times higher than in GM measurements (p < 0.001). Episodes of symptom--free hypoglycemia were noted in CGMS six times higher than in GM measurements (p < 0.001). Hypoglycemia was found in twice as many patients when diagnosed upon CGMS results as when found upon GM results (p < 0.01). Episodes of symptom-free hypoglycemia were detected in six times as many patients when diagnosed upon CGMS as when analysed upon GM measurements (p < 0.001). CONCLUSION: CGMS offers more complete data on low blood glucose incidents, including symptom-free hypoglycemia, than intensive blood glucose monitoring with the use of glucose meter.
Gastric bypass surgery in severely obese type 1 diabetic patients.
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Botulinum toxin A in the early treatment of sixth nerve palsy-induced diplopia in type 2 diabetes.
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[Effectiveness of selected methods of the short-term intensive insulin therapy in patients with poorly controlled type 2 diabetes mellitus].
Poorly controlled type 2 diabetes mellitus can be an indication for hospitalisation and short-term intensive insulin therapy. There are different forms of such therapy i.e. multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) or continuous intravenous insulin infusion (IVII). The aim of our study was to compare the efficacy of these methods of intensive insulin therapy. The following parameters were measured: 1) time period needed for "near normoglycaemia" establishment and 2) mean daily glucose values reduction as a result of the treatment applied. 60 patients with poorly controlled type 2 diabetes (daily blood glucose profile values > 250 mg/dl) treated with insulin twice daily were enrolled into the study. Patients were randomly divided into three groups: CSII, IVII and MDI. CSII as realized through subcutaneous insulin pump model MiniMed 508, IVII through intravenous pump model Duet standard 50-Kwapisz and MDI was based on four insulin injections per day in bolus--basal fashion. Intensive insulin therapy was continued until satisfying daily glucose profile achievement (80-180 mg/dl). After "near normoglycaemia" attainment, a conventional insulin therapy was introduced through subcutaneous insulin dosage. Significant reduction of mean daily glucose values as result of applied treatment was observed in all the groups examined. The degree of glycaemia reduction amounted 60 mg/dl for CSII and 85 mg/dl for IVII. There was no statistical significant difference between treated groups. Mean duration of intensive insulin therapy until "near normoglycaemia" establishment was significantly longer in MDI as compared to CSII and IVII groups (6 days vs. 4.45 and 5.2 respectively). Short-term intensive insulin therapy by MDI, CSII and IVII gives good glycemic control and significantly reduces mean daily glucose values, but this aim can be achieved most quickly using CSII and IVII.
Long-term discontinuation of insulin treatment in a type 1 diabetic patient: a case for late autoimmune diabetes of the adult?
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The use of polypropylene mesh in midline incision closure following gastric by-pass surgery reduces the risk of postoperative hernia.
BACKGROUND: Incisional hernia is a common problem following Roux-en-Y gastric bypass for morbid obesity. PATIENTS AND MATERIALS: We report the preliminary results of nonrandomized prophylactic use of polypropylene mesh in a group of 60 consecutive patients. The patients with highest body mass index, and/or history of abdominal hernias and profound liver damage had abdominal wall reinforced with mesh during an operation. A year later the wound was assessed in all patients. RESULTS: In standard wound closure group (n=48) incisional hernia was found in 9 cases (20%). None of the patients with inserted mesh (n=12) developed hernia. The length of hospital stay in mesh group was similar to that in the nonmesh group and shorter than in patients with hernia occurrence. Mesh insertion was complicated with wound discharge in three patients. CONCLUSIONS: In our opinion prophylactic use of polypropylene mesh in bariatric patients is highly effective in postoperative hernia prevention.