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R Tattersall

Publications and source records attributed to R Tattersall.

At least 37 records · Page 2Linked to original sources
PubMed1991

Course of brittle diabetes: 12 year follow up.

OBJECTIVE: To determine the course of brittle diabetes. DESIGN: 12 year follow up of patients identified in 1977-9 as having brittle diabetes; retrospective review of the case notes. SETTING: Nottingham health district. SUBJECTS: 25 brittle diabetic patients were identified in 1979-9; 11 (five men) had three or more admissions with ketoacidosis between June 1977 and 1979 and 14 (eight men) had three or more attendances at the accident and emergency department with hypoglycaemia in 1978. Two controls from our diabetic register were matched to each patient for age, sex, and duration of diabetes. MAIN OUTCOME MEASURES: Frequency of ketoacidosis and severe hypoglycaemia in the 12 years after ascertainment; diabetic control and complications in 1988-90; retrospective attribution of the cause of brittleness. RESULTS: Patients with recurrent ketoacidosis had had a median (range) of 28 (8-67) episodes. One man died of a cerebral tumour but five of the surviving nine patients had not been admitted in the past two years, although diabetic control remained poor (median haemoglobin A1 concentration 14%). Seven patients had pure hypoglycaemic brittleness, and five had also had eight or more admissions with ketoacidosis (mixed brittleness). Two died of uraemia within a year after ascertainment and two others in hypoglycaemic coma seven and 12 years later. Brittle diabetes was in most cases related to a specific situation, usually unhappiness at home or school. CONCLUSIONS: Brittle diabetes is often episodic and almost always related to stressful life circumstances. Once the underlying cause is removed it tends to improve. Recurrent hypoglycaemic brittleness of psychological origin has a poor prognosis.

Adolescent↗
PubMed1985

Brittle diabetes.

Explore the source record for details and available documents.

Adolescent↗
PubMed1981

Patient self-monitoring of blood glucose and refinements of conventional insulin treatment.

The compelling evidence that blood glucose control will slow or prevent microvascular complications has stimulated research to find better ways of managing insulin-dependent diabetes. The excellent results obtained with "open loop" insulin infusion systems suggest that the relative failure of conventional treatment is the result of (1) a lack of appropriate feedback to the patient and (2) the use of insulin regimens which do not mimic physiologic insulinemia, particularly in the basal state. Doctors regard blood glucose measurements as an essential part of diabetic management and extension of this technology to patients has added a new dimension, particularly in the assessment of control. Nevertheless, home blood-glucose monitoring will not necessarily improve diabetic control; the best results have been obtained when it has been offered as part of a package deal which includes more investment of time and interest by patients and doctor together with joint discussions of problems and changes in treatment. The biggest problem with conventional twice daily insulin regimens is to sustain constant basal insulin levels during the night. Attempts to obtain fasting normoglycemia with an injection before supper often result in nocturnal hyperinsulinemia and hypoglycemia. This can usually be resolved by changing to a three times daily regimen with an extra injection of NPH insulin at bedtime. Three times daily insulin injections with feedback from home blood-glucose monitoring give as good blood glucose control as infusion systems and are cheaper and more acceptable to patients.

Blood Glucose↗
PubMed1980

Genetic patterns in diabetes mellitus.

Diabetes comprises many syndromes whose only common feature is a high blood glucose level. Some are entirely genetic, some partially so, and others not at all. Perhaps the most important advance in the past 10 years is proof that insulin dependent diabetes is genetically different from the insulin independent form. Most progress has been made in unraveling the etiology of insulin dependent diabetes, although more information is needed before the mode of inheritance is finally settled. The last few years have produced a plethora of new facts about insulin dependent diabetes mellitus, providing geneticists, clinicians, and epidemiologists with the fascinating challenge of a disease with an apparently genetic susceptibility to external (environmental) triggers. Little progress has been made in the field of insulin independent diabetes, and one might safely predict that the diabetic syndrome will still produce some nightmares for researchers who take up the challenge of trying to unravel its various etiologies and methods of inheritance.

Adolescent↗
PubMed1979

Energetics of peptide bond formation at elevated temperatures.

The free energies of formation of the peptide bond between carbobenzoxy-glycine and L-phenylalanine amide in aqueous solution at temperatures up to 60 degree C were calculated from experimentally determined equilibrium constants. The reaction was catalyzed by a thermophylic enzyme. The thermodynamic energy barrier to peptide bond formation was found to decrease with increasing temperature: the standard free energy of peptide bond formation did appear to become negative in the region of 60 degrees C. The possible significance of these results for peptide bond formation under prebiotic conditions is discussed.

Biological Evolution↗