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Biomedical subjects

K R Paterson

Publications and source records attributed to K R Paterson.

54 records · Page 3Linked to original sources
PubMed1988

Comparison of conventional twice daily subcutaneous insulin administration and a multiple injection regimen (using the NovoPen) in insulin-dependent diabetes mellitus.

Thirty-seven stable insulin-dependent diabetic patients receiving twice daily premixed porcine soluble and isophane insulins (Mixtard or Initard, Nordisk Laboratories) were enrolled in a trial to compare the effects of this regimen and an intensified regimen on glycaemic control and flexibility of lifestyle. After a two month run-in period patients were randomized to continue taking premixed insulin (n = 18) or to change to Human Actrapid (three times daily pre-prandial doses using a NovoPen) plus Human Ultratard (n = 19: "pen" group, Novo Laboratories). Diabetic control was assessed at monthly intervals for six months by glycosylated haemoglobin assay (HbA1), 7-point blood glucose profiles and frequency of hypoglycaemic episodes. At randomization, glycaemic control had significantly improved in the group as a whole and patients were well matched with respect to body mass index (BMI) and glycaemic control. No significant changes in BMI, HbA1, mean 7-point glucose profiles or hypoglycaemic episodes were found after six months either within or between groups. Hypoglycaemic episodes were common during the study. There were no technical problems with the NovoPen. Patients using the NovoPen felt it added greater flexibility to their lifestyle. From our study results the main indication to start a multiple injection regimen is to improve the flexibility of the patient's lifestyle and not to improve glycaemic control.

Adult↗
PubMed1986

Effect of oral verapamil on glibenclamide stimulated insulin secretion.

In order to study the effect of the calcium antagonist, verapamil, on glibenclamide stimulated insulin release, nine healthy fasted male volunteers were given 5 mg oral glibenclamide with either 120 mg oral verapamil or placebo in a double-blind crossover manner 1 week apart. Blood was withdrawn at intervals for drug, hormonal and glucose estimations. Concomitant administration of verapamil resulted in higher levels of glibenclamide at each time point (P less than 0.01) suggesting that verapamil interferes with glibenclamide metabolism. However, levels of plasma glucose, C-peptide, insulin and glucagon did not differ between the verapamil and placebo studies.

Adult↗
PubMed1986

A comparison of biosynthetic human insulin with porcine insulin in the blood glucose control of diabetic pregnancy.

Fifty insulin-dependent pregnant diabetic women were treated from presentation at the antenatal clinic with a regimen of either porcine or biosynthetic human soluble and isophane insulins. Blood glucose values, glycosylated haemoglobin, insulin requirements and outcome of pregnancy were compared in the two groups of patients. No difference was noted in blood glucose control, birth weight or neonatal complications. In the group treated with human insulin, fasting blood glucose could only be controlled by significantly greater doses of human isophane insulin injected before the evening meal. Furthermore, in two cases adequate glycaemic control required the injection of the evening human isophane insulin to be delayed until bedtime.

Adult↗
PubMed1986

Record linkage study of hypokalaemia in hospitalized patients.

Retrospective analysis of biochemical data from 58,167 hospital inpatients revealed that 21% developed hypokalaemia during hospitalization-in 5.2% the serum potassium was less than 3.0 mmol/l. Subsequent evaluation showed a positive correlation between hypokalaemia and both female sex and hospital mortality. Patients with leukaemia and lymphoid tumours, especially when receiving antibiotic or cytotoxic therapy, and patients with gastro-intestinal malignancy were amongst those most frequently experiencing hypokalaemia. There was no significant association with cardiovascular disease. Drug and intravenous fluid administration accounted for the hypokalaemia in 56% of patients. While drug-related hypokalaemia was most commonly seen with diuretics, it was also apparent following use of steroids, insulin and haematinics.

Aged↗
PubMed1986

Fatal xylenol self-poisoning.

A case of fatal xylenol ingestion by a long-stay mental hospital patient is described. The clinical course was similar to that observed in other phenolic poisonings with active bowel sounds, nausea and vomiting, severe metabolic acidosis, hypotension and cardiac and renal failure. The formulation of xylenol ingested contains alcohol which would facilitate absorption; due to the dangers of such poisonings care must be exercised as to access and exposure to xylenol sterilising agents.

Disinfectants↗
PubMed1986

Outcome of pregnancy in insulin-dependent (type 1) diabetic women between 1971 and 1984.

We have looked at the outcome of pregnancy in women with type 1 (insulin-dependent) diabetes mellitus who were confined at Glasgow Royal Maternity Hospital between 1971 and 1984. Of 134 pregnancies, 123 proceeded beyond 28 weeks' gestation and yielded 125 live infants. The perinatal mortality rate was 16/1000, due solely to congenital foetal malformation. Malformations were not related either to the severity of maternal diabetes (as graded by the White classification) or the glycaemic control in the first trimester (as judged by maternal glycosylated haemoglobin concentration). Over the period of study, there has been a marked reduction in the frequency of ketoacidosis during pregnancy and in the delivery of small-for-dates babies; more mature lecithin:sphingomyelin ratios have been obtained by amniocentesis; and better Apgar scores have been demonstrated in the infants at delivery. The Caesarean section rate has fallen from 83 to 30 per cent, and babies now spend less time separated from their mothers in paediatric units. These improvements largely reflect better diabetic treatment (improved insulin regimens and glycaemic control) and closer obstetric assessment. Foetal malformation occurred overall in 11.4 per cent of pregnancies and did not become less frequent over the period of study. Further major improvement in the outcome of diabetic pregnancy will only come from a reduction in the congenital malformation rate, which implies better diabetic control at and around the time of conception.

Adult↗
PubMed1985

Effect of sulphonylurea administration on insulin secretion and amino acid metabolism in non-insulin-dependent diabetic patients.

Sulphonylureas lower blood glucose but other metabolic effects have been little studied. In an assessment of carbohydrate and amino acid metabolism in 9 patients with non-insulin-dependent diabetes mellitus (NIDDM) before and after 3 months' therapy with gliclazide, glycaemic control was improved (mean +/- S.D. glycosylated haemoglobin 13.8 +/- 1.9% before therapy, 10.2 +/- 2.1% after therapy (p less than 0.01], but fasting amino acid levels were not altered. In contrast, postprandial levels of branched chain amino acids (BCAA) were significantly reduced: total BCAA (valine, leucine, and isoleucine) 120 mins following a standard test meal fell from 717 +/- 71 mumol/l before therapy to 600 +/- 90 mumol/l after 3 months' therapy (p less than 0.01). This finding implies an increased action of endogenous insulin on skeletal muscle to promote uptake of BCAA postprandially and, in accord with this, peripheral insulin levels were significantly increased following drug treatment (peak insulin level 55.6 +/- 20.2 mU/l before therapy, 91.3 +/- 17.9 mU/l after therapy (p less than 0.01]. Sulphonylurea drugs therefore do not simply have a hypoglycaemic action but also affect amino acid metabolism in NIDDM patients.

Adult↗
PubMed1984

Dissociation of adrenarche and gonadarche in diabetes mellitus.

Serum concentrations of testosterone and dehydroepiandrosterone sulphate (DHAS) have been measured in 10 stable insulin-dependent diabetic (IDD) males (chronological age (CA) range 13.0-17.5 years). Their results have been compared with those of a control population of 69 non-diabetic males who presented with mild constitutional growth delay and whose skeletal maturity and pubertal development were similar to the diabetic subjects. Within bone ages (BA) 11.0-14.5 years no significant difference was observed between the serum testosterone concentrations of the diabetic patients and controls: diabetic males, 8.2 (0.3-25) nmol/l (median and range); controls, 7.0 (less than 0.3-23) nmol/l. In contrast, within BA 11.0-14.5 years, the diabetic males had significantly lower serum DHAS concentrations: diabetic males, 1.1 (0.7-4.2) mumol/l; controls, 3.7 (0.7-5.6) mumol/l (P less than 0.001). The serum DHAS concentrations of the diabetic males were also significantly lower than the controls when matched separately for pubic hair and genital development, testicular volume and serum testosterone, (in each comparison P less than 0.02). Serum DHAS concentrations of the diabetic males did not correlate significantly with CA, BA, BA delay (CA-BA), age of onset of diabetes, duration of diabetes, or glycosylated haemoglobin (GHb), but significant correlation was observed between BA delay and duration of diabetes, r = 0.65, P less than 0.05. We conclude that gonadarche appears to proceed despite delayed adrenarche in IDD males. This study presents further evidence in favour of adrenarche and gonadarche being independent physiological events. The causes and clinical significance of low serum DHAS concentrations in adolescent diabetic males remain to be established.

Adolescent↗
PubMed1983

Experience of temporary cardiac pacing in a district general hospital.

Temporary cardiac pacing is widely used in the management of dysrhythmias; increasingly it is being employed in district general hospitals without specialist cardiology facilities. A retrospective study of 117 pacing procedures in a district hospital has shown that temporary pacing is both safe and effective and supports its more widespread use.

Aged↗
PubMed1983

The pre-operative electrocardiogram: an assessment.

Electrocardiography is of limited value in pre-operative screening for cardiac disease. A short questionnaire has been shown to be helpful in assessing cardiac status and could permit a 30% reduction in the number of pre-operative ECGs performed.

Adolescent↗
PubMedDate not supplied

Do different frequencies of self-monitoring of blood glucose influence control in type 1 diabetic patients?

The effect of altering the frequency of self-monitoring of blood glucose upon blood glucose control was assessed in 25 Type 1 diabetic patients. Patients entered a balanced, crossover study in which they were randomly allocated to three 12-week periods. During each period the frequency at which patients self-monitored their blood glucose was: (1) four-point profiles on 2 days per week; (2) four-point profiles on 1 day per week; (3) two-point profiles on every day of the week. There were no significant differences in mean blood glucose concentration, fructosamine or glycosylated haemoglobin concentrations during the three periods. There was no correlation between the frequency at which patients altered insulin doses and measures of metabolic control. Altering the frequency of blood glucose self-monitoring had a variable and uncertain influence upon the frequency at which patients altered insulin doses. Some patients felt unsafe monitoring blood glucose only four times per week. There was however no patient consensus on the best-liked regimen.

Adult↗