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Biomedical subjects

S Walford

Publications and source records attributed to S Walford.

32 records · Page 2Linked to original sources
PubMed1984

Continuous intraperitoneal insulin infusion in the management of severely brittle diabetes--a metabolic and clinical comparison with intravenous infusion.

We report a comparison of continuous intraperitoneal insulin infusion (CIPII) and continuous intravenous insulin infusion (CIVII) in 6 diabetic patients in whom severe hyperglycaemia and ketoacidosis could not be prevented with subcutaneous or intramuscular insulin. In the short term both methods were equally effective in maintaining glycaemic control. Blood glucose, glycerol, and 3-hydroxybutyrate levels were normal but lactate and pyruvate levels remained elevated with both treatments. Insulin requirements were significantly lower on CIPII than CIVII (70 vs 113 U/day, p less than 0.01). Intraperitoneal insulin delivery was associated with near physiological peripheral plasma insulin profiles in 3 patients. In the longer term CIVII was associated with frequent septicaemia and thrombosis, and was successful in preventing hospitalization for 6 months or more in only one patient. Despite technical problems with CIPII complications were less serious and hospital admission due to metabolic decompensation was prevented for 6 months or more in 3 patients. When subcutaneous insulin delivery is unsuccessful in the management of brittle diabetes, CIPII should be considered rather than CIVII because it is more likely to be successful and less likely to cause serious complications.

Adolescent↗
PubMed1984

A laboratory trial of two new blood-glucose reflectance meters featuring automatic external calibration.

Two new battery-operated digital reflectance meters for blood glucose measurement have been tested for precision and accuracy in a laboratory trial. Reflocheck (Boehringer Company Ltd) is calibrated from a bar code printed on each test strip, Reflolux (Boehringer Company Ltd) from a bar code on acetate film provided with each bottle of BM-Test-Glycemie 20-800R strips, which can also be read visually. Three aqueous standards (3.3, 8.3 and 11.7 mmol/l) were assayed 10 times on each of 10 days. Overall coefficients of variation for Reflocheck were 2.8, 1.7 and 2.0% and for Reflolux 3.1, 1.5 and 2.8% respectively. One hundred and four blood samples measured on the machines gave very high correlations with a manual hexokinase assay: for Reflocheck, y = 1.1x - 0.7, r = 0.99 and for Reflolux, y = 1.07x + 0.1, r = 0.99. In the range 2.2-10 mmol, errors of 1 mmol or more occurred on seven occasions with Reflocheck and eight with Reflolux (n = 80) but none of these errors was of therapeutic significance. The performance of both machines was as good or better than previously published data for similar instruments. The ease of calibration and accuracy of both machines are advantageous as is the use of BM-Test-Glycemie 20-800R by Reflolux which enables a check to be made on visual readings.

Blood Glucose↗
PubMed1982

The effect of insulin antibodies on insulin dose and diabetic control.

In a single blind randomised cross-over study, 40 patients were changed from ordinary bovine to highly purified porcine insulins for a period of 6 months. Half were later rechallenged with bovine insulin. Sequential determinations of IgG insulin binding capacity for bovine insulin were correlated with insulin dose and diabetic control. After changing to highly purified insulins the following correlations were observed between percentage change in insulin dose and change in insulin binding capacity: at 2 months r = 0.35 (p less than 0.05), at 4 months r = 0.38 (p less than 0.02) and at 6 months r = 0.37 (p less than 0.02). When the patients who showed substantial changes in HbA1 were removed from the analysis, the remaining 29 demonstrated a clearer relationship between these two variables (r = 0.56, p less than 0.01). Removal of patients with a low initial insulin binding capacity left 18 patients with stable diabetes, and changes in insulin binding capacity and insulin dose showed an even closer correlation for this group (r = 0.77, p less than 0.001). A similar degree of positive correlation was observed after rechallenge with bovine insulin. We conclude that the level of circulating insulin antibody affects the dose of insulin required to maintain stable diabetic control.

Adolescent↗
PubMed1979

Self-monitoring of blood glucose in diabetic pregnancy.

Admission to hospital is usually recommended to achieve the best possible diabetic control during pregnancy. We have used blood glucose monitoring at home to find out if patients can achieve equally good control outside hospital. Twenty-five consecutive diabetic patients were studied, of whom 20 had taken insulin before pregnancy. Six of their 14 previous pregnancies had ended in perinatal death. The 25 women performed 4247 blood glucose measurements during their pregnancies. Overall the mean blood glucose concentration was 7.1 mmol/l (128 mg/100 ml); before meals the mean was 6.5 mmol/l (117 mg/100 ml). Mean concentrations were lower in the third trimester, but at no stage was control in hospital significantly better than at home. The mean hospital stay before delivery was 22 days, and all patients had live babies. Monitoring blood glucose concentrations at home produces greater understanding and motivation among patients, improves control early in pregnancy, and shortens time spent in hospital.

Adolescent↗
PubMed1978

Self-monitoring of blood-glucose. Improvement of diabetic control.

An accurate pattern of blood-glucose changes in everyday life is the basis for treatment in insulin-dependent diabetes. 69 patients were taught to obtain their own blood-glucose profiles with a 'Reflomat' Boehringer Mannheim) reflectance meter on one working and one rest day, and to repeat these where necessary after adjustment of treatment. 2 did not complete the study satisfactorily. The other 67 produced profiles on 241 dyas. Even patients with a limited education could use the technique accurately and their readings correlated closely with simultaneous laboratory values (r = 0.96). Self-monitoring was especially useful in elucidating problems in diabetic control, preventing hypoglycaemia, and managing diabetic pregnancy. Unlike the measurement of HbA1c which only detects poor diabetic control, self-monitoring also shows how to improve it. Patients found self-monitoring more informative than urine tests; their active involvement in management of their disease resulted in better motivation, greater understanding of diabetes, and a sustained improvement in control. By the end of the study 32 of the 67 patients ahd profiles in which no more than one blood-glucose value exceeded 10 mmol/l. Smaller and more portable machines will make the technique more widely applicable.

Adolescent↗
PubMedDate not supplied

Diabetes in the UK West indian community: the Wolverhampton survey.

A survey was carried out to determine the prevalence of known diabetes amongst West Indians living in Wolverhampton. Two hundred and fifty-one West Indians with diabetes were identified from a computerized register, which records all diabetic patients in the Wolverhampton area attending either the hospital diabetic clinic or general practitioner mini-clinics, and from questionnaire data obtained through local general practitioners. An estimated 4.4% of the Wolverhampton population are of West Indian origin determined by the 1981 census, giving a prevalence of known diabetes of 2.2% compared with 1.2% in the indigenous UK white Caucasian population. Only 4% of these patients were truly insulin-dependent but 38% were insulin-treated, 43% were on oral hypoglycaemic agents and 19% on diet alone. Only 1.6% were diagnosed below the age of 20 years, with peak frequency of diabetes occurring in the age group 45-64 years. Thirty-eight percent of all patients were obese, 40% were hypertensive, but only 4% had a history of angina or myocardial infarction. In UK West Indians non-insulin-dependent diabetes is common and is predominantly a disease of middle age, whereas insulin-dependent diabetes is relatively uncommon.

Age Factors↗
PubMedDate not supplied

A critical evaluation of methods of monitoring diabetic control.

Patients with insulin-treated diabetes need to be actively involved in their own treatment. We have found that measurement of blood rather than urinary glucose by our diabetic patients leads to greater understanding and enthusiasm as well as to better control of blood glucose. Home blood glucose monitoring is complementary to rather than a substitute for measurement of hemoglobin A1. The latter provides an objective index of long-term control that is of more use to the doctor than to the patient. The former gives the patient information that enables him to master his own disease from day to day.

Blood Glucose↗
PubMedDate not supplied

The influence of renal threshold on the interpretation of urine tests for glucose in diabetic patients.

A knowledge of the renal threshold for glucose is important in the interpretation of urine tests in diabetes. We describe a simple method for determining renal threshold from blood and urine tests performed by the patients themselves. In a group of 65 insulin-dependent diabetic patients there was a wide variation in renal threshold, with a mean of 130 mg/dl (range 54-180 mg/dl). Threshold tended to rise with age, and it is suggested that the higher the renal threshold, the higher is the mean blood glucose achieved by the patient (r = 0.50, P = < 0.001). The change in blood glucose required to convert urine tests from 0% to 2% is very variable and ranged from 36 to 288 mg/dl (mean 110 mg/dl). The simple method that we describe may improve understanding of the significance of urine test results without the necessity for hospital admission.

Blood Glucose↗