THE ENDOGENOUS URIC ACID METABOLISM IN PERNICIOUS ANEMIA.
Explore the source record for details and available documents.
Journal Article↗
Biomedical subjects
M C Riddle
Publications and source records attributed to M C Riddle.
Hyperglycemia, recognized and unrecognized, as a risk factor for stroke and transient ischemic attacks.
Glycosylated hemoglobin concentration (GHb), which is considered an indication of glycemia over the preceding several months, was examined in 50 patients hospitalized for recent stroke or transient ischemic attacks (TIA), and compared to that in several reference populations. Patients with stroke or TIA had GHb (mean %A1 +/- SD, 10.2 +/- 2.3) higher than in hospital controls without cerebrovascular disease (8.3 +/- 0.9, p less than 0.005), and equivalent to values for ambulatory diabetic patients treated with diet or diet plus oral agents (9.5 +/- 2.4) or with insulin (10.7 +/- 2.9). Twenty percent (10/50) of the stroke/TIA group were previously known to have abnormal glucose tolerance or diabetes; when this subgroup was excluded, there remained 42% of the original group (21/50) with abnormal GHb (greater than 10% A1) not previously known to have hyperglycemia, and the difference between GHb values for the stroke/TIA patients not known to have glycemic abnormality and for the hospital control group remained significant (p less than 0.005). Sixty-two percent of stroke/TIA patients (31/50) were under treatment for glycemic abnormality, or had high GHb, or both. The high prevalence of elevated GHb in this population could not be attributed to a relationship to age, sex, smoking history, hypercholesterolemia, or hypertension. We conclude that hyperglycemia commonly precedes stroke and TIA, is usually unrecognized, and has been under-appreciated as a risk factor for cerebrovascular disease.
Adult↗
Combined insulin-sulfonylurea treatment of type II diabetes.
The literature on type II (noninsulin-dependent diabetes mellitus) proposes many forms of treatment. This diversity suggests that there is no single best way to treat this condition. At Oregon Health Sciences University, we have been using the combination of insulin given in the evening and sulfonylurea drugs given during the day as an alternative to multiple-dose insulin regimens when diet or diet and oral hypoglycemic agent therapies do not achieve adequate glucose control. This approach, while effective in our experience, is not widely accepted. This paper reviews the literature on combined insulin and sulfonylurea therapy for treatment of certain stages of type II diabetes, the rationale for use of this therapy, and our experience to date.
Diabetes Mellitus, Type 2↗
Early loss of blue-sensitive color vision in patients with type I diabetes.
Existing methods for early detection of ocular injury from diabetes have serious limitations. We describe a new method, measuring visual flicker discrimination of the blue-sensitive mechanism of vision. This method is noninvasive, quantitative, and capable of distinguishing two types of impairment. Blue-flicker discrimination was measured in 10 adults with type I (insulin-dependent) diabetes for less than 5 yr. Although no evidence of diabetic changes was detected by careful ophthalmic examination by an experienced ophthalmologist, 12 of 19 eyes (63%) had flicker discrimination scores considered abnormal in comparison with those of a control group, and 8 of 10 subjects (80%) had at least 1 eye with abnormal performance. In all but 2 abnormal eyes the deficit of blue-flicker discrimination was of the "absorptive" type, suggesting increased absorbance or scattering of blue light in the optical media. These data show that a functional impairment of vision can be measured very early in the course of type I diabetes, before visible retinopathy is present, and suggest this test procedure may have both investigative and clinical applications.
Adult↗
Relief of gastrointestinal symptoms by correcting insulin excess.
Persons with diabetes mellitus often have disordered gastrointestinal function, usually attributed to autonomic neuropathy. Hypoglycemia in persons taking insulin has been considered a possible result of anorexia and gastric atony, but not a potential cause of gastrointestinal symptoms. Three patients with diabetes developing before age 30 yr and of long duration had severe gastrointestinal complaints for 1-9 mo, with symptoms suggesting nocturnal hypoglycemia. All recovered rapidly with no specific treatment other than reduction of insulin doses. Studies identified no gastrointestinal pathology. These patients may represent a subgroup of persons with diabetic enteropathy, in whom recurrent hypoglycemia provokes a reversible derangement of gut function with accompanying symptoms.
Adult↗
Traditional insulin-use practices and the incidence of bacterial contamination and infection.
While complex procedures are usually recommended to prevent infection at insulin injection sites, adherence to these procedures is imperfect and their value incompletely established. Among 254 adult insulin users in two clinic populations, the reported prevalence of complete performance of four traditional insulin-use practices (handwashing, vial prep, skin prep, discarding of plastic syringes after one use) was 29%, and none of the individual practices considered was performed regularly by more than two-thirds of the subjects. Even so, there was no infection at 2828 injection sites, and there was no significant bacterial contamination of insulin or syringes. These findings fail to support the view that traditional practices provide protection to insulin users against infection or bacterial growth in insulin or syringes. The authors suggest that modification of traditional teaching methods would do no harm, and that benefits could include financial savings, improved client success with self-care, and enhanced health care provider credibility.
Adult↗
Which patients might benefit from combining a sulfonylurea with insulin?
Explore the source record for details and available documents.
Aged↗