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Biomedical subjects

R S Scott

Publications and source records attributed to R S Scott.

126 records · Page 7Linked to original sources
PubMed1978

Hormonal responses during treatment of acute diabetic ketoacidosis with constant insulin infusions.

Changes in glucagon, growth hormone (GH), cortisol, renin and aldosterone accompanying the metabolic disturbances and dehydration of severe diabetic ketoacidosis were studied over a 24 h period in eight patients treated with a constant intravenous insulin infusion. Mean steady state plasma-free insulin levels achieved were 28.6--49 mu/1 in patients receiving 2 u/h but a satisfactory rate of fall of glucose was not always obtained until the infusion dose was increased to 4 u/h or more. The total insulin dose administered was positively correlated with the level of plasma glucagon and cortisol on admission. During insulin infusion, both glucagon and cortisol fell but the rate of fall was not related to dose or plasma level of free insulin achieved. In six of eight patients studied increments in plasma GH above admission levels were observed during insulin treatment. Admission values of both plasma renin activity and plasma aldosterone were raised. The renin levels were highest in newly diagnosed diabetics, and two patients with long-established diabetes showed only small increments despite profound dehydration. Plasma renin activity, but not plasma aldosterone correlated with the fluid and sodium retention over the initial 24 h treatment period, but not with potassium requirements. The urinary excretion rates of the small molecular weight proteins GH and insulin, were considerably elevated over the treatment and convalescent periods.

Acute Disease↗
PubMed1978

Toxic autonomous thyroid nodule following neck irradiation.

A 37-year-old male with a history of neck irradiation in childhood presented with thyrotoxicosis due to an autonomous thyroid nodule. Adjacent to the nodule was a radiation scar from radiotherapy administered 35 years previously. Hemithyroidectomy was performed and histological examination excluded malignant change. Long term follow-up should continue to detect possible nodule formation in the contralateral lobe.

Adult↗
PubMed1978

Antibody binding of insulin in diabetic ketoacidosis.

This study investigates the effects of insulin antibody binding on free insulin levels measured in patients with acute diabetic ketoacidosis receiving insulin by constant infusion. In spite of antibody binding ranging from 10 to 90 per cent of the total circulating insulin, the steady state concentrations of free insulin were similar to those observed in individuals on identical infusion rates but without insulin-binding antibodies. However, the levels of free insulin in two patients were substantially lower than expected for the rate of insulin infusion, even though levels of bound insulin were not greatly elevated. An infusion rate of at least 4 U. per hour produced satisfactory rate of fall of plasma glucose, whereas lower dose regimens (2 U. per hour)--producing steady state free insulin concentrations ranging from 28 to 49 mU. per liter in different subjects--were unreliable in controlling the metabolic abnormalities of diabetic ketoacidosis.

Adolescent↗
PubMedDate not supplied

Insulin deficiency in non-insulin-dependent diabetics.

In this study, the prevalence of severe insulin deprivation amongst 104 non-insulin-dependent diabetes mellitus (NIDDM) patients was determined using a mixed meal pancreatic stimulation test (2.4 MJ). Of the 104 patients, 62 were recently diagnosed and 42 had been diabetic for between 1 and 40 years, but were not adequately controlled on diet and oral hypoglycaemic agents. Twenty-one (34%) of the recently diagnosed patients and 13 (31%) of the poorly controlled patients had peak post-testmeal insulin responses less than 160 pmol/l (less than 23 mU/l)--values 3 SD below normal--and were therefore considered to have severe blunting of beta cell response to nutrient secretagogues. Amongst recently diagnosed diabetics, these patients, as a group, had higher blood glucose levels (P less than 0.05) and lower body weights (P less than 0.01) but overall these parameters correlated poorly with insulin responses. Islet cell antibodies were positive in only one patient, whereas they were present in three others with less severe insulin secretory defects. For the treated diabetics, insulin release showed very low non-significant correlations with duration of diabetes, age, weight and glycaemic control. Islet cell antibodies were present in five patients, one only showing peak insulin values less than 160 pmol/l. These data suggest that about one-third of new diabetics and one-third of treated diabetics with poor glycaemic control are insulin deficient. Clinical and biochemical parameters, including islet cell antibodies, appear to be of no value in identifying this sub-group requiring insulin therapy. Their early recognition is best facilitated by routine pancreatic function tests.

C-Peptide↗
PubMedDate not supplied

Epidemiology of insulin-dependent diabetes mellitus in Canterbury, New Zealand.

A prospective study of incidence and prevalence of insulin-dependent diabetes mellitus in persons under 20 years was conducted over a 4-year period (1 February 1982-1 February 1986) for the Canterbury Hospital Board (total population 342,000) area in New Zealand. A central register for the area was established at the beginning of the study period. Degree of ascertainment was close to 100%. Average annual incidence was 11.7 persons per 100,000 (females: 10.6 per 100,000; males: 12.7 per 100,000) with no significant sex difference or temporal trends. Incidence peaks were seen for both sexes in the pubertal ages (females: 11 years; males: 13 years), with minor peaks occurring for both sexes in the pre-school ages. Age of onset was significantly younger in females than males. A seasonal variation in incidence was seen for males, with peaks in late autumn and mid-winter. 5.7% of the new diabetics had a first-degree relative with insulin-dependent diabetes mellitus. Islet cell cytoplasmic antibodies were detected in 68% of new diabetics and in 0% of age- and sex-matched healthy controls. Thyroid, gastric and adrenal auto-antibodies were seen more frequently in diabetics than in controls, but this difference was not significant. Prevalence of insulin-dependent diabetes on 1 February 1982 was 1.00 per 1000 and 1.05 per 1000 on 1 February 1986. The insulin-dependent diabetes mellitus incidence characteristics noted for the Canterbury Hospital Board area are similar to those reported for European and North American populations.

Adolescent↗
PubMedDate not supplied

No effect of gliclazide on gastric inhibitory polypeptide (GIP) in type II diabetes.

Seven subjects with non-insulin-dependent diabetes mellitus were studied prior to and after 1 month of treatment with gliclazide, 80 mg twice daily. Individuals attended for a standard breakfast test meal (10 kcal/kg) on three occasions--prior to therapy, first day of therapy, and 30th day of therapy. Blood samples were collected between 0 and 240 min post-prandially and assayed for glucose, insulin, C-peptide, glucagon, pancreatic polypeptide, gastric inhibitory polypeptide (GIP), and gastrin. Following gliclazide, fasting and post-prandial glucose levels were significantly improved. An increase in post-prandial insulin and C-peptide levels was noted on the first treatment day and values remained elevated for the study period. GIP and other measured peptide hormones were unchanged. These data suggest that gliclazide asserts its hypoglycaemic effects by promoting insulin release, and has no detectable effect on other enteropancreatic hormones.

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

HMG-CoA reductase inhibitor use in the aged. A review of clinical experience.

While the benefit of cholesterol-lowering in the elderly has yet to be proven in clinical trials, individuals at high risk of coronary events who otherwise enjoy a good quality of life, should not be denied cholesterol-lowering therapy on the basis of age alone. Moreover, hypolipidaemic drugs are already extensively used in the aged. The HMG-CoA reductase inhibitors lovastatin, simvastatin and pravastatin are potent well tolerated hypolipidaemic therapies in young subjects. Although there have been few studies on their use in elderly subjects, the available data suggest the efficacy and safety of HMG-CoA reductase inhibitors in similar to that established for younger age groups.

Age Factors↗
PubMedDate not supplied

Nocturnal cortisol release during hypoglycemia in diabetes.

Nocturnal hypoglycemia in insulin-treated diabetic persons is often difficult to recognize clinically. It has been suggested that a useful biochemical test to demonstrate this would be the increased excretion of cortisol in the urine during the overnight period. However, of six diabetic persons who had nocturnal hypoglycemia (less than or equal to 2.5 mmol/L), plasma cortisol profiles and overnight urinary cortisol-creatinine ratios were abnormal in only one. In four others the plasma cortisol levels and cortisol excretion indices were indistinguishable from either a normal control group or a group of five diabetic subjects who did not develop nocturnal hypoglycemia. The remaining patient had a raised urinary cortisol-creatinine ratio, but did not show increased plasma levels of cortisol, growth hormone, or glucagon during the hypoglycemic phase. These data do not support the usefulness of the urinary cortisol-creatinine index as a marker of nocturnal hypoglycemia in diabetes.

Adolescent↗
PubMedDate not supplied

Use and abuse of glucose reflectance meters.

All diabetic patients who had been using home glucose monitoring devices during the last 2 yr in the area served by the specialist Diabetes Unit in Christchurch, New Zealand were invited to complete a questionnaire designed to provide information on glycemic control, treatment regimen, and patterns of glucose recording. Questionnaires were completed by 111 of 152 patients, of whom 99% were using insulin. The period of use of reflectance meters was between 1 and 18 mo. Forty-three percent used their meters in a manner considered unsatisfactory and 15% failed to write down results. Those patients recording for the longest periods showed a significant trend to more inefficient use of devices. Forty-four percent still relied on their medical supervisor for treatment changes, but most attended infrequently (mode 12 wk; range 1-52 wk). Most frequently, treatment changes were to insulin dose and only one-third had adopted more "physiologic" regimens incorporating rapid-acting insulin. Blood glucose control was not significantly changed from that found in a group of diabetic subjects during the first weeks of monitoring. These results suggest that (1) many patients do not use home glucose monitoring devices in a manner likely to allow rational modification to therapy, (2) neither patients nor family physicians have reacted appropriately to high recorded values, and (3) chronic use of home monitoring has not resulted in good glycemic control for many patients.

Adolescent↗
PubMedDate not supplied

Use of health services by diabetic persons. II. Hospital admissions.

Over a 10-mo period, a computerized admission discharge system was scrutinized to identify all persons with diabetes mellitus admitted to a general hospital in Christchurch, North Canterbury (population 342,000), New Zealand. The 274 admissions by 197 diabetic persons (42% were insulin treated, 14% were newly diagnosed, 44% were non-insulin-dependent) contributed to 3.6% of the total hospital admissions, with duration of stay being longer than for nondiabetic persons (13.6 versus 11.3 days, P = 0.05). Patients admitted were aged 11-91 yr (mean 59 yr); those over 50 yr of age were numerically the largest admission group. Although cardiovascular illnesses were the most frequent events precipitating admission (34%), potentially preventable admissions for reasons of infection, poor glycemic control, or hypoglycemia were found in all age groups. Just under half of the 902 registered insulin-treated diabetic patients living in this health region had at some stage participated in diabetes education programs at the time this admission survey was undertaken. Of these, only nine were admitted. The other 70 insulin-treated patients admitted who lived in this region had never had diabetes education. Overall, only 11.7% of patients admitted had received diabetes education. These data show that, for insulin-treated diabetic individuals at least, admission rates were substantially lower among those who were sufficiently motivated to attend diabetes education programs.

Adolescent↗