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Biomedical subjects

K Irsigler

Publications and source records attributed to K Irsigler.

At least 73 records · Page 4Linked to original sources
PubMed1985

Controlled drug delivery in the treatment of diabetes mellitus.

Diabetes not only requires correction of an insulin deficiency but it also demands adequate insulin delivery. A short historical review is given over the first 60 years of insulin treatment, where emphasis was mainly on the correction of insulin deficiency. Despite concerted efforts, metabolic results were often poor, and there was a high incidence of late complications, which will be described briefly. A major aim of new treatment approaches, which emphasizes better routes of insulin delivery, is the prevention or reversal of these late complications. Closed-loop systems are infusion systems located outside the body which deliver insulin according to glucose values that are measured continuously. The state of the art for such systems will be described with examples of clinical applications and results. These systems aid and stimulate research, but offer no long-term application for treatment. Open-loop systems are portable, both external and implantable, and lack an accurate glucose sensor so that the loop can be closed. A number of insulin delivery systems have been developed in this category ranging from highly complex, fully implantable units, programable from outside, to simple basal-rate infusion pumps. Various pumps are designed to be used with varying delivery routes, and the evaluation of different routes will be a vital topic in this article. Pros and cons of the intravenous, intraperitoneal, and subcutaneous routes will be discussed, with supporting research referenced. Clinical experience will be cited for both the complex and the simple infusion systems. Other topics to be covered include feasibility of long-term treatment, complications of this new treatment approach, guidelines for patient instruction and supervision, requirements for treatment of large patient groups with pumps in a modern diabetes center, requirements for the physician, the influence of improved metabolic control on late complications (prevention or regression), the possibility for a portable closed-loop system, and future outlook. The primary author is the founder of an international study group on diabetes treatment with implantable insulin delivery devices. The common goals of this study group will also be presented. Special emphasis will be placed on a differentiated approach to treatment of Type I and Type II diabetes with a family of devices. Clinical work and results from a large patient group will be included throughout.

Adolescent↗
PubMed1984

Treatment of type I diabetic with subcutaneous insulin resistance by a totally implantable insulin infusion device ("Infusaid").

A 22-yr-old diabetic female is described who developed insulin resistance due to subcutaneous (and intramuscular) "malabsorption" of insulin resulting in recurrent ketoacidosis and sepsis. Intravenous insulin sensitivity was maintained. Diverse attempts to prevent metabolic decompensation by "external" methods failed. The insulin resistance was treated successfully by a totally implantable insulin infusion device ("INFUSAID") with no episodes of ketoacidosis in the 6 months following implantation. With this constant rate insulin infusion pump, and no supplementation of insulin dose by other means, the plasma glucose control is excellent and serum lipid and glycosylated haemoglobin (HbA1) levels have returned to normal.

Adult↗
PubMed1983

[Interaction of sulfinpyrazone (Anturan) and glibenclamide (Euglucon) in type II diabetic patients].

In a randomised double blind study on 19 with glibenclamide well controlled diabetics of type II the possible interaction between sulfinpyrazone (Anturan) and glibenclamide was studied with the help of the artificial endocrine pancreas. The trial substance in a dose of 800 mg/die or placebo were used over a period of 70 days. During the trial period and at the end of it there were no significant differences in the sulfinpyrazone group as compared to the placebo group concerning the metabolic control of the diabetic condition. It is therefore justified to assume that there exists no interaction between sulfinpyrazone and glibenclamide in this regard. The dosage of sulfinpyrazone used in this trial was well tolerated by all patients and no side effects were observed.

Adult↗
PubMed1983

Implanted constant basal rate insulin infusion devices for Type 1 (insulin-dependent) diabetic patients.

A multi-phase study was undertaken to compare the metabolic effect on unstable Type 1 diabetic patients of optimized conventional treatment with that of external or implantable insulin delivery devices. External units were programmed to simulate implantable constant basal rate insulin infusion pumps with additional insulin doses given by subcutaneous injection or delivered by the pump. The study was continued using external devices with an optimal, meal-adjusted insulin profile simulating programmable, remote-controlled, implantable devices. Such good metabolic control was achieved using the constant insulin infusion, supplemented by two subcutaneous injections of insulin daily, that it justified the implantation of constant rate pumps in five Type 1 patients. Patients with the implanted devices achieved a near-normal life style, experienced significantly fewer hypoglycaemic reactions and had significantly improved glycosylated haemoglobin A1 and mean blood glucose values.

Adolescent↗
PubMed1983

The clinical use of direct calorimetry for measuring energy expenditure.

Energy output measurements are an actual problem since the 18th century. Together with the technical development very good solutions for direct calorimetry are available. Vienna Whole Body Calorimeter is a measuring system in which man can live 24 and more hours under defined activity and well known diet. Utilisation of ingested food energy is discussed and unmeasured energy shown during overfeeding. Beside increasing energy content of body mass gaining weight costs 1969 kcal/kg. Comparison of direct and indirect measurement is necessary to define energy need in different catabolic situations.

Body Temperature Regulation↗
PubMed1981

Long-term continuous intraperitoneal insulin infusion with an implanted remote-controlled insulin infusion device.

This is a report of the implantation and first 100-day operation using a remote-controlled programmable insulin infusion device in an insulin-dependent diabetic. To prevent insulin aggregation, a special surface-active polymer developed by Hoechst AG, Frankfurt, was used as an additive. Implantation was completed on April 8, 1981, and good metabolic control was reached immediately and has continued to date (July 1981), with this unit providing the only source of insulin. There have been no hypoglycemic attacks. Patient acceptance is very good. The Siemens unit, PFA 01 (external) and DFA 01 (implanted) has proved reliable and precise.

Blood Glucose↗
PubMed1981

[Diabetes and Pregnancy (author's transl)].

UNLABELLED: The article reports on the experiences collected during treatment and delivery of 316 pregnant diabetic women hospitalized in the municipal hospital of Vienna-Lainz. 1. Close co-operation between diabetologist, obstetricians and pediatricians in imperative. 2. Early diagnosis and recording - as far as possible before conception -, accurate control and intensive care by the diabetologist and obstetrician right from the beginning is most essential; the aim should be to attain normoglycaemic levels preferably during the first 3 months of pregnancy. 3. In the case of diabetic patients requiring insulin who are difficult to stabilize, it would be desirable to effect stabilization in the hospital, followed by self-control of blood sugar levels with self-adjusted insulin variation. Above all, overweight should be avoided. 4. Obstetric intensive care can be effected only in a department with modern equipment. 5. In case of complications, it will always be necessary to provide for additional hospitalization over and above the routine cases; such hospitalization must always consist of combined obstetric and internistic medical care. 6. Prognostically Bad Signs of Pregnancy (PBSP) groups must be kept as small as possible. 7. Childbirth should be approximated as closely as possible to the calculated date of birth (in While A cases up to the 40th week of pregnancy, with the other patients at least up to the 38th week of pregnancy). The necessary controls which can justify postponing the time of birth, are explained. The approximation to the calculated data of birth depends largely on optimal stabilization of the diabetes to normoglycaemic levels during the entire pregnancy period. This is documented, inter alia, by normal weight of the newborn at the time of birth, corresponding to the duration of pregnancy. 8. Vaginal delivery should be aimed at. 9. Newborn are always high-risk infants; the first few minutes of live are absolutely decisive. The infants should be placed in the care of a team of pediatricians as early as possible, combined with transfer to a children's hospital with intensive-care ward, using an intensive-care ambulance for effecting the transfer. 10. RESULTS: These measures led to a reduction of the mortality rate (reduced to the corrected values), the average of which had been 12.5% during 1970-1971, to 1.85% during 1972-1979. The proportion of PBSP groups, which was originally 32.42%, dropped during the same period to 20.79%, the perinatal mortality in this group being reduced from 50% to 17.24%.

Blood Glucose↗
PubMed1981

Lipid-lowering effect of the new drugs eniclobrate and beclobrate in patients with hyperlipidemia type II a and type II b.

First clinical results are presented for two newly developed drugs. Both are diphenylmethane derivatives named ethyl-(+/-)-2-([alpha-(p-chlorophenyl)-p-tolyl]-oxy)-2-methylbutyrate (beclobrate, B) and (+/-)-2-(4-[(4-chlorophenyl)methyl]phenoxy)-2-methyl-butanacid-3-pyridinylmethylester (eniclobrate, E). These drugs were given in a doubleblind crossover trial with placebo periods before, in between and afterwards to 6 patients with type IIb and 13 patients with type IIa hyperlipidemia. Beclobrate was given in a dosage of 100 mg twice daily and eniclobrate in a dosage of 130 mg twice daily. Besides effectively reducing LDL-cholesterol in type IIa there was a remarkable increase in HDL-cholesterol in both types of hyperlipidemia especially for beclobrate.

Benzhydryl Compounds↗
PubMed1980

[A comparison of the blood glucose increase and insulin requirement after oral sucrose, fructose and sorbitol alone or in combination (author's transl)].

The artificial pancreas allows a new means of quantification of the behaviour of blood glucose (BG) and insulin requirement after the administration of nutrient sweeteners such as fructose and sorbitol as compared to sucrose. The purpose of the present study was to compare the effects of these substances, plus a combination of fructose and sorbitol (70:30) in a group of maturity-onset diabetics. Sucrose produced the steepest BG increase and the greatest insulin requirement in order to return to baseline BG levels. Sorbitol at a dosage of 20 g did not act as a laxative, produced the smallest BG increase, and required the least amount of insulin to return to baseline. The combination of 70% fructose and 30% sorbitol achieved similar results to those of sorbitol alone, regarding both BG increase and amount of insulin required to return to baseline. Since this mixture has the same sweetening ability as sucrose, and shows no laxative effect, it was concluded that it is superior to fructose or sorbitol alone.

Aged↗
PubMed1980

[Regression of florid proliferative diabetic retinopathy through achievement of normoglycaemic over five months by means of a portable insulin-dosage apparatus (author's transl)].

A portable insulin-infusion device (Siemens-Erlangen) was used by 24-year-old juvenile onset-type diabetic woman for a period of 5 months in order to achieve normoglycaemic conditions. The patient suffered from rapidly deteriorating florid proliferative retinopathy and was practically blind. Kidney function was serioudly impaired and severe neuropathy also existed. Insulin was infused through a polyethylene catheter inserted through the subclavian vein into a central vein. A continuous basal rate which was varied from day to night was infused with additional supplementary rectangular profiles of insulin at meals. Blood glucose was self-monitored with strip test apparatus in order to adjust insulin dosage to diet. HbA1 decreased from 16% during the pre-therapy phase to 8% (= normal range) at the end of the last phase. MBG decreased from 238 during the pre-therapy phase (6 24 hr profiles at 5 to 7 time points) to 97 during the latter phase (daily profiles from day 103 to day 150). After 3 weeks of this treatment the retinal bleeding had disappeared. During further treatment regression of the massive vascular proliferation was observed with fluorescein angiography, and perfusion of the retina improved. Vision also improved, so that the patient has now been able to resume her work as a bank employee. Albuminuria decreased and the neuropathic symptoms also disappeared. The originally planned hypophysectomy was, therefore, considered to be unnecessary.

Adult↗