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Biomedical subjects

K Irsigler

Publications and source records attributed to K Irsigler.

At least 19 recordsLinked to original sources
PubMed1992

[Morbidity and mortality in type 1 and type 2 diabetes mellitus after the diagnosis of diabetic retinopathy].

One to ten years after laser coagulation for diabetic retinopathy, 229 type I diabetics (mean age 44.3 years) and 157 type II diabetics (mean age 65 years) were re-studied for morbidity and mortality (progression of late damage, duration of survival, cause of death). The duration of diabetes at the first laser coagulation averaged 23.1 years for type I diabetics (15.9 years for type II). Average period from the first laser coagulation to the re-examination was 6.5 years for type I, 5.1 for type II diabetics. Of those patients still alive 6.7% had gone blind (type II: 7.3%). 2.1% and 4.6%, respectively, were receiving dialysis treatment, while renal transplantation had been performed in 3.1 and 1.8%, respectively. Stroke was the most frequent macrovascular complications (8.4 and 16.5%), followed by leg amputation (3.6 and 14.7%) and myocardial infarction (3.7 and 18.3%). 83 patients had died: 35 (15.3%) type I and 48 (30.6%) type II diabetics. Causes of death were septicaemia 14.3% (0%), uraemia 11.4% (8.3%), myocardial infarction 14.3% (33.3%), heart failure 8.6% (29.2%) and stroke 5.7% (6.3%). 10.7% (24.2%) had died within the first 5 years after laser coagulation. Despite a lower incidence of blindness in patients with diabetic retinopathy, the vascular disease progresses in other vascular regions so that a large proportion of diabetics will develop renal failure or die early from macrovascular complications.

Adult↗
PubMed1992

Mechanical load on the inspiratory muscles during exercise hyperpnea in patients with type 1 (insulin-dependent) diabetes mellitus.

The aim of this study was to evaluate the difference between Type 1 (insulin-dependent) diabetic patients and healthy control subjects regarding inspiratory muscle load during exercise hypernea. For this purpose an incremental progressive exercise test on a cycle ergometer was performed by 36 Type 1 diabetic patients and 40 healthy subjects. In order to determine the mechanical load on the inspiratory muscles breath by breath, we selected the following two parameters, which represent the pressure generated by the inspiratory muscles as well as the duration and velocity of their contraction: (1) the oesophageal tension time index, which is the product of the duty cycle (ratio of inspiratory time to total breath cycle duration) and the mean oesophageal pressure expressed as a percentage of the maximal oesophageal pressure and (2) the mean oesophageal pressure change per time unit during the inspiratory phase of each breathing manoeuver, which is expressed as a fraction of the subject's maximal oesophageal pressure. Comparison of the two groups revealed that at similar levels of ventilation the mechanical load on the inspiratory muscles was significantly higher in the Type 1 diabetic patients than in the control subjects. When the loading was stopped the maximal ventilation was lower in the patients. Nevertheless, they reported a degree of respiratory effort sensation comparable to the control group, which seems to have been caused by an increase of the mechanical load on the ventilatory muscles.

Adult↗
PubMed1992

Pulmonary gas exchange and oxygen uptake during exercise in patients with type 1 diabetes mellitus.

In order to investigate pulmonary gas exchange and cardiopulmonary performance in Type 1 diabetes, 36 patients underwent a progressive incremental exercise test on a cycle ergometer. Cardiopulmonary variables were measured, and arterial blood gases determined on samples obtained from an indwelling catheter in the radial artery. The results were compared with those from 40 control subjects. In the patients, the maximum power (Wmax) and maximum oxygen uptake (VO2max) were lower than in the control subjects (Wmax 186 +/- 52 (+/- SD) vs 233 +/- 48 W, p less than 0.05; VO2max 2.56 +/- 0.71 vs 3.17 + 0.77 l min-1, p less than 0.05). At comparable levels of power output, however, no significant abnormality was observed in the difference between alveolar and arterial oxygen pressure (P(A-a)O2), and the ratio of physiological dead space to tidal volume (VD/VT ratio). These data indicate that in Type 1 diabetic patients, despite their reduced maximum oxygen uptake, gas transfer during exercise is not limited and thus does not contribute to the impairment of exercise capacity.

Adult↗
PubMed1992

Phrenic nerve function in type 1 diabetic patients with diaphragm weakness and peripheral neuropathy.

Phrenic nerve latency was studied in 14 male type 1 diabetic patients with impaired diaphragm function and in 14 healthy control subjects. The diabetics showed significantly decreased values regarding inspiratory vital capacity and forced volume in 1 s compared with the control subjects. All other lung function parameters were similar in both groups. Although motor and sensory nerve conduction studies provided evidence for peripheral neuropathy in all patients, phrenic nerve latencies turned out to be normal. These results rule out a neuropathic disorder of the phrenic nerve. Thus, impaired diaphragm function in type 1 diabetic patients is not caused by phrenic neuropathy.

Adult↗
PubMed1992

[Hypoglycemia in diabetes mellitus].

Type 1 diabetic patients experience symptomatic hypoglycemia once or twice a week. 30% of insulin-treated patients suffer from hypoglycemic coma at least once during their life, 10% at least once a year. 3% are incapacitated by frequent and severe attacks, 3 to 4% die from hypoglycemia. In contrast the incidence of symptomatic hypoglycemia in sulfonylurea-treated patients is about 0.2 per 1000 patients' years, the mortality of severe attacks being about 8%. The cause of hypoglycemia is always an excess of insulin, in absolute or relative terms. Additional precipitating factors are defective counterregulation after longer duration of diabetes, as well as a lowered threshold for counterregulation and/or for perception of warning symptoms, as seen under strict glycemic control. Considering the risks associated with hypoglycemia, preventive measures must be emphasized.

Blood Glucose↗
PubMed1992

[Alcoholic ketoacidosis--3 episodes in one patient].

3 episodes of alcoholic ketoacidosis were observed in one female patient over a period of 19 months. The clinical picture consisted of vomiting, dehydration, hyperventilation and abdominal pain. Predominant laboratory findings were acidosis (pH less than 7) and hyperglycaemia, with blood glucose values of 354, 330 and 147 mg/dl. This disorder is an important cause of metabolic acidosis, but especially in the German literature there are only rare reports on this issue. The picture of ketoacidosis in mostly chronically malnourished alcoholics reflects not only the complex abnormalities of acid-base balance caused by excessive cumulation of ketoacids, but also the related severe depletion of electrolytes and extracellular volume. Adequate acute therapy (as for diabetic ketoacidosis) and thorough follow-up treatment of any concurrent conditions result in rapid reversal of the syndrome in most cases. Since there are few reports of repeated episodes in one patient, an overview of this disorder is presented concerning management and differential diagnosis of the basis of our case report.

Acidosis↗
PubMed1992

[4-years experience with quality control of decentralized reflectometry blood glucose measurement in the Vienna-Lainz hospital].

Since 1987 a quality control programme for ward-based blood glucose assays has been established in Lainz Hospital, Vienna. In 1991 following a decision to standardise the type of reflectometer used in the ward, 62 Reflolux IIS reflectance meters (Boehringer Mannheim) were assessed in a quality control consisting of 4 ring trials a year (blood glucose determination in two "unknown" samples) and in daily measurements of control solutions of known glucose concentrations. Experience with this quality control procedure is reported in this presentation of the relevant results of the ring trials. The most frequent errors in performing the test are discussed and the importance of instructing and training the nursing staff in the proper use and maintenance of the meters is pointed out.

Austria↗
PubMed1991

[Dynamic measurement of pressure distribution on the foot sole of diabetic patients and a comparison group].

A new method known as pedography enables the measurement of plantar pressure while walking. Different areas on the sole can be separately analyzed by means of a personal computer. We studied plantar pressure in 20 patients walking normally on a horizontal platform. Four different stages of weight bearing were investigated, namely 0, 10, 20, and 30 kg, in the ten diabetics and ten non-diabetics. All diabetic suffered from peripheral neuropathy, which was clinically proven as well as a reduction in nerve conduction velocity in the peroneal nerve. Non-diabetics showed no abnormal clinical findings on the lower extremities and nerve conduction velocity was within the normal range. The mean age and size differed between the diabetics and non-diabetics 52 +/- 5 versus 37 +/- 7 and 178 +/- 5 versus 185 +/- 4. Body weight was equal (84 +/- 6 versus 85 +/- 5 kg). We found no significant difference in maximum pressure on the heel, though there were differences on the fore-foot. Diabetics showed a higher maximum pressure already without weight bearing and reached a plateau at the 10 kg level, which was not exceeded at the higher stages of weight bearing. In summary, diabetic patients with neuropathy are subjected to very high plantar pressures at relatively low stages of weight bearing. Pedography enables preventive measures to be undertaken in time, e.g. prescription of orthopaedic insoles.

Body Weight↗
PubMed1979

[Comparison of glibenclamide, gliquidone, glisoxepide and placebo in maturity onset diabetics of differing degrees of severity (author's transl)].

The purpose of the study was to investigate whether the potency of effect on the beta cell differs with type of sulfonylurea (SU) and with degree of severity of diabetes. 12 maturity onset diabetics were classed according to fasting blood glucose (FBG) in three groups of 4 patients each. Each patient served as his own control. Glibenclamide, Gliquidone, Glusoxepide and placebo were administered in random order with degree dosage adjusted according to degree of severity of diabetes. All patients were given a standardized diet with 150 g carbohydrates per day. Fullday profiles of blood glucose, insulin, C-peptide and sulfonylurea level in serum were made on the third day under each preparation. Results showed that with proper nutrition and sufficient weight reduction, patients in group I (FBG 80--130 mg/dl) needed no oral medication and in fact showed a tendency towards hypoglycaemic episodes under oral therapy. In group II (FBG 130--200 mg/dl) the effect of nutrients on beta cell secretion appeared to be both enhanced and accelerated by SU administration. Satisfactory metabolic control was achieved with SU, but not with placebo. This group seems to represent the type of patient most likely to benefit from SU therapy. In spite of high dosage levels, satisfactory control was not achieved with SU in any patient in group III (FBG greater than 200 mg/dl). Depending on individual factors such as ketosis-proneness, vascular complications, age and psycho-social aspects, insulin administration should be considered for these patients. There were not differences between the individual SU preparations in the parameters studied. There was insufficient evidence for a pharmacokinetic differential diagnosis.

Blood Glucose↗
PubMed1979

[Diabetic coma].

Explore the source record for details and available documents.

Adult↗
PubMed1979

[Blood sugar self-profiles. Improvement in diabetes control in outpatients (author's transl)].

15 insulin-dependent diabetics who had been hospitalised for evaluation and modification of their treatment regimen were trained to take their own blood samples with 10 microliter glass capillaries. Blood sugar self-profiles were analysed from each patient twice in hospital and afterwards at home. Urine samples were also self-tested for sugar. The profiles were carried out reliably and seem to cause a minimum of trouble to the patient. This method of feedback, with comparison of blood and urine sugar values, increased the patient's understanding and ability to vary his own insulin dosis. The analysis of 3 daily profiles for each patient showed increasing improvement in metabolic control. This also increased motivation to keep to a regimen in which insulin dosage, physical activity, and nutrition are in balance. For the first time daily profiles were introduced which could be carried out under the normal conditions of the patient's daily life.

Ambulatory Care↗
PubMed1979

[Biguanide-induced and - associated lactic acidosis: serum and tissue biguanide levels in hyperlactaemia and lactic acidosis (author's transl)].

An investigation was carried out on 30 diabetic patients in an attempt to clarify the relationship between serum biguanide levels and raised lactate. No consistent relationship was demonstrable between the serum biguanide level, administered dosage and time of administration. There was also no correlation between biguanide and lactate increase. It is not justifiable to quote a specific serum level of biguanides in defining lactic acidosis. A causal association between biguanide medication and lactic acidosis seems to be possible only by determination of serum and tissue levels. Determination of biguanide levels was carried out in the serum and tissue of a patient who had died as a result of lactic acidosis after phenformin administration. While the serum levels were only slightly higher than the therapeutic range, both liver and kidney tissue showed highly toxic levels. Furthermore, the amount of biguanides in the body was calculated in another patient successfully treated for lactic acidosis after buformin therapy. A differentiation should be made between biguanide-induced and biguanide-associated lactic acidosis. In both forms serum levels can be within relatively low ranges. In the former condition, the biguanides alone are responsible for the development of lactic acidosis by blocking the respiratory chain. In the latter condition they aggravate an already existing pathological condition, and can, therefore, represent a lethal factor.

Acidosis↗
PubMed1979

Calorimetric results in man: energy output in normal and overweight subjects.

In order to test the practicability of 24-hr investigations with the gradient-free Vienna Whole-Body Calorimeter, energy output was measured over 24-hr periods in 18 human subjects. Heat loss was partitioned into dry and evaporative components. Sixteen female subjects were divided into normal-weight (less than 100% according to the Broca index), overweight (100%--120%), and obese (over 120%) groups. A male with severe hypothyroidism, and a female with no signs of impairment of thyroid function who had weight problems that were suspected to be due to low energy expenditure, were studied separately. Subjects reported that the calorimeter chamber was sufficiently comfortable for at least a 24-hour investigation. Overweight and obese subjects showed both greater total heat output and greater inter-individual variability than the normal weight group. Normal and overweight subjects were on steady levels of food intake that were representative of usual intake. For normal subjects there was a relatively close correspondence between energy intake and output, but not for overweight subjects. Thyroid hormone therapy produced a large increase in energy output in the hypothyroid patient. Energy expenditure was found to be unusually low in the patient with weight problems and was increased by about 50% after thyroid hormone administration.

Adult↗
PubMed1979

Long-term continuous intravenous insulin therapy with a portable insulin dosage-regulating apparatus.

A portable insulin dosage-regulating apparatus (PIDRA) was used with five volunteer diabetic subjects for periods ranging from 1 wk to more than 3 months to explore the possibilities of achieving near normoglycemic control over long time periods with such an apparatus. PIDRA consists of a matchbox size pump with insulin reservoir and a pocket size electronic control box. It can infuse a preprogrammed basal rate of insulin plus externally manipulated supplementary doses in rectangular profiles. The quality of blood glucose control was monitored with the Miles Biostator and through self-testing by the patient in the outpatient phases. Under inpatient conditions, the relatively simple PIDRA insulin administration profile was almost as effective in achieving normoglycemia as the Biostator, and good control could be maintained over long periods of time. The apparatus allows considerably greater ease in variation of insulin dosage with less risk of hypoglycemic epidoses as compared with conventional subcutaneous injections. Several technical problems remain to be solved, but it is concluded that PIDRA represents a viable alternative as a means of achieving tight control, at least as a step toward the goal of an implanted glucose-contingent insulin infusion system.

Adolescent↗
PubMed1979

Preprogrammed insulin infusion with a portable pump system.

A glucose-controlled insulin infusion system (Biostator) was used to determine patient insulin requirement for clinical evaluation of a portable pump system (technical development by Siemens AG). Results from 6 insulin-dependent diabetics with respect to quality of control, carbohydrate/insulin ratio, and insulin requirement are shown. Preprogrammed insulin infusion with the portable system was carried out for up to 117 days.

Adolescent↗