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Biomedical subjects

L Jovanovic

Publications and source records attributed to L Jovanovic.

81 records · Page 5Linked to original sources
PubMedDate not supplied

Management of the pregnant, insulin-dependent diabetic woman.

An intensive care program was offered to all insulin-dependent, pregnant diabetic women who presented to The New York Hospital Obstetrical Clinic in their eighth week or less of gestation. The patients were hospitalized for 1 wk to normalize their blood glucose and to teach the technique of self-monitored glucose determination, diet and exchange lists, and the method to titrate insulin according to the blood glucose determination. The mean blood glucose for the first 10 patients accepted to the program was 169 mg/dl at the start of the program with a mean hemoglobin A1c of 9.4% for the group (normal < 5.5%) and glucosuria up to 50 g/24 h. After discharge, mean glucose was 91 mg/dl, and urinary glucose excretion was 1.4 g/24 h. HbA1c fell into the normal range 5 wk after normoglycemia was achieved (3.4%) (nl < 5.5%). Normoglycemia was maintained as outpatients until 3 wk before delivery when the patients were readmitted for tests of fetal well-being. Mean weight gain for the mothers was 12.2 kg. Mean glucose at delivery was 87 mg/dl and HbA1c was 3%. Hormonal profiles (hCG, hPRL, estrogens, progesterone, hPL) normalized after normoglycemia was achieved and remained normal until delivery. Mean gestational age at time of delivery was 38.8 wk with a mean infant birth weight of 2988 g. No infant manifested hypoglycemia, hypocalcemia, erythremia, or respiratory disease. The use of self-monitored blood glucose allows for optimal care of the insulin-dependent, pregnant diabetic woman while she remains at home with her family.

Adult↗
PubMedDate not supplied

The evaluation of a pocket computer as an aid to insulin dose determination by patients.

A small and inexpensive computer was programmed to assist patients in making decisions regarding insulin delivery using constant subcutaneous infusion systems. Insulin dosage was based on gender, pre- and postprandial blood glucose, between-meal blood glucose, patient weight, time of day, and when appropriate, the carbohydrate content of food ingested. The system was self-adjusting based on postprandial and fasting blood glucose levels. A developmental phase in which the computer program was refined was undertaken with five highly trained type I patients using an insulin infusion pump. Then, based on the suggestions made by these patients, a final program was used by these same five patients for 1 mo. Computer-assisted insulin delivery resulted in lower mean blood glucose (162 versus 130 mg/dl) and hemoglobin A1c (7.2% versus 5.8%) values when compared with precomputer values. In addition, there was a significant increase in the frequency of blood glucose testing during the computer-assisted periods in that patients monitored their blood glucose 4.9 times per day during the physician-alone period whereas a mean of 7.5 glucose tests were performed during the computer-assisted periods. Patient response to the concept was overwhelmingly favorable. These studies demonstrate that computer-assisted insulin-delivery decision making is feasible, acceptable to patients already accustomed to pump use, safe, effective, and may provide a savings in terms of professional time.

Adult↗
PubMedDate not supplied

Effect of normoglycemia before conception on early pregnancy hormone profiles.

Insulin-dependent diabetic women have been shown to have subnormal hormone levels in the first trimester of pregnancy. To determine whether these abnormalities were the result of poor diabetes control, testosterone, androstenedione, human chorionic gonadotropin (HCG), and prolactin were studied longitudinally in diabetic women made normoglycemic before conception (N = 11) and normal (N = 6) control subjects beginning at the fifth week of gestation. HCG levels rose normally in all 11 diabetic and six control subjects and then declined as expected, with peak levels between 8 and 12 wk of gestation. Prolactin levels similarly rose significantly (P less than 0.00001) during the period studied. Plasma androstenedione did not increase during the course of this study, but testosterone levels increased significantly (P = 0.0001). Androgen levels were consistently higher in diabetic subjects despite the normoglycemic state, although the differences reached statistical significance at only one point. This study demonstrates that when normoglycemia is achieved before conception, HCG and prolactin are normal at 5 wk after the last menstrual period. The possibility that androgen levels may be higher in insulin-requiring diabetic women, perhaps due to peripheral hyperinsulinemia, should be explored.

Adult↗
PubMedDate not supplied

Optimization of insulin therapy in patients with gestational diabetes.

OBJECTIVE: To discuss the new criteria for screening and diagnosis of gestational diabetes and present recommendations for patient management. METHODS: Various strategies for detecting gestational diabetes historically and currently are reviewed, and approaches for optimizing patient and neonatal outcome are discussed. RESULTS: Rather than testing for gestational diabetes selectively, universal screening of pregnant women between 24 and 28 weeks of gestation with use of a glucose challenge test and 1-hour assessment has been shown to decrease the rate of occurrence of neonatal macrosomia. Performance of both preprandial and postprandial self-monitoring of blood glucose levels helps to prevent pronounced postprandial glucose excursions and minimize the risk of neonatal macrosomia. In comparison with regular human insulin, insulin lispro has yielded significantly better metabolic control and a reduction in hypoglycemic episodes before breakfast in patients with gestational diabetes. CONCLUSION: Women with gestational diabetes who are not optimally managed with diet and exercise need insulin therapy. Insulin lispro is associated with fewer hypoglycemic events and attenuates the postprandial response greater than does regular human insulin.

Diabetes, Gestational↗
PubMedDate not supplied

Type 2 diabetes: the epidemic of the new millennium.

The increasing prevalence of obesity, which has reached epidemic proportions, raises the likelihood that a similar increase in diabetes will follow. Linkage between the two conditions is clear. Overweight is not only an important risk factor for the development of diabetes, but also has a significant impact on progression and complications. Diagnostic criteria for the recognition of diabetes and for monitoring of the disease process will become increasingly important. The role of laboratory evaluation needs to be reassessed in light of new concepts regarding classification and diagnostic criteria. The relative utility of glucose and glycosylated protein measurements should be addressed, particularly the relationship between laboratory findings and clinical guidelines. Blood glucose monitoring depends on establishment of the threshold for diagnosis. Additional issues are bedside monitoring, the goal of noninvasive glucose sensors and targeting of therapy. The laboratory scientist is likely to play a key role in the application of advances in the detection and management of diabetes.

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

Optimal insulin delivery for the pregnant diabetic patient.

It is now possible to virtually normalize ambient blood glucose levels in insulin-dependent diabetic women during pregnancy. Successful programs have been developed that utilize home blood glucose monitoring, physiologic delivery of insulin, and quantitation of caloric intake carefully matched to insulin dosage. The results of establishing normoglycemia throughout gestation appear to be a normalization of mortality and morbidity for both infant and mother. Pregnancy provides a need for continuous upward adjustment of insulin dose concomitant with the ongoing fetal and hormonal changes associated with gestation.

Blood Glucose↗
PubMedDate not supplied

Effect of increasing glucose concentrations on Sertoli cell viability in the nonobese diabetic mouse.

Spermatogenesis is severely altered in the nonobese diabetic (NOD) mouse in the presence of diabetes. When insulin is administered early in the development of diabetic changes, blunting of the testicular damage results, suggesting a direct causal effect of hyperglycemia on the testicular alterations. In view of the key role of Sertoli cells in supporting spermatogenic maturation, it has been speculated that the testicular damage may be mediated via Sertoli cell effects. The present study utilized Sertoli cell cultures to test the effects of different glucose levels on cellular viability. Sertoli cells from NOD and control mice were able to survive at glucose concentrations up to 38 mM, when maintained in culture at constant pH. With higher concentrations, there was a progressive loss of viability, comparable in the test and control animals. Further studies will be needed to determine the specific effect of hyperglycemia on Sertoli cells and the association with spermatogenic alterations in the NOD mouse.

Animals↗