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PubMedDate not supplied

Systemic conditions in the Emergency Eye Clinic.

PURPOSE: A systemic disease may be diagnosed for the first time in patients who present to the eye department with ophthalmological manifestations. This study documents the pattern of systemic disorders which were encountered in an emergency eye clinic for the first time. SUBJECTS AND METHOD: Over a period of six months details of all patients who had a previously unknown systemic condition diagnosed in the Emergency Eye Clinic were recorded. Patients were seen in this clinic upon referral from other practitioners. All patients, with the exception of those with minor ophthalmic problems, were screened for hypertension and glycosuria. The patients were subsequently referred to their general practitioner or the appropriate hospital specialist for further management. RESULTS: During this period 1025 new patients visited the emergency eye clinic. Previously undiagnosed systemic disease was present in 86 patients (8.4%). The commonest disorders were neurological 35 (41%), cardiovascular 17 (20%), glycosuria 13 (15%) and respiratory 5 (6%). Visual disturbance and pain were the most frequent ocular presentation. In 54 patients (62.8%) the ocular condition was a direct manifestation of the systemic condition and in 32 patients (37.2%) the systemic disease was a coincidental finding. CONCLUSIONS: Awareness of ophthalmological manifestations of systemic disorders helps in the early diagnosis of these conditions and reduces the resulting morbidity and possibly mortality. This study illustrates the hidden role of the emergency eye clinic in identifying patients with an underlying systemic condition.

Brain Diseases↗
PubMed1980

Beta-cell function and metabolic control in insulin treated diabetics.

In a random one day study beta-cell function was evaluated in 210 insulin treated diabetics by the serum C-peptide concentration 6 min after iv injection of 1 mg of glucagon. Sixty-five patients (31%) had residual beta-cell function. As a group these patients were characterized by having a higher age at onset of diabetes (P less than 0.01), a shorter duration of disease (P less than 0.01) and by receiving a smaller dose of insulin (P less than 0.01). However, their quality of metabolic control did not differ from the patients without beta-cell function. Although the concentrations of post-stimulatory C-peptide correlated inversely with both the 24-hour glycosuria (P less than 0.01) and the fasting blood glucose concentrations (P less than 0.02), only a subgroup with C-peptide concentrations exceeding 0.30 pmol/ml showed a definitely better degree of metabolic control than those without beta-cell function. As this subgroup also received the smallest dose of insulin these observations suggest that maintenance of beta-cell function above this level facilitates good metabolic control. Evidence is presented suggesting that measurements of the 24-hour glycosuria undertaken in a diabetes clinic create a too optimistic impression of the quality of metabolic control during every day life.

Adolescent↗
PubMed1983

Epidemiological study of diabetes mellitus in the Hiroshima area-prevalence of diabetes mellitus and follow-up studies using the glucose tolerance test 5-19 years after initial testing.

Tests for diabetes mellitus have been performed annually since 1963 on about 100,000 A-bomb survivors living in Hiroshima. We report here on the trends over the 19 years leading up to 1981 for the glycosuria positive rate, the 75 g GTT results of positive cases and the findings of the 5-19 year follow-up. The glycosuria positive rate was 3-4 times higher in males. During the period of 1963-1979, the positive rate increased annually in both sexes, reaching 2.6 and 3.0 times the male-female values for 1963, but subsequently levelling off. When Body Mass Index (BMI) less than 25, 24.9% of the sample was diabetic (including those under treatment), 26.0% had Impaired Glucose Tolerance (IGT) and 49.1% were normal, whereas when BMI greater than or equal to 25, the rates were significantly higher being 45.0%, 27.4% and 27.6% respectively (p less than 0.001). Frequency increased with BMI, reaching 75.0% at BMI 33.3). Results of the 5-19 year follow-up showed the annual diabetes onset rate by the person year method in those with BMI less than 25 at initial GTT to be 1.72% among 848 normals, while it was a significantly higher 4.82% in those suffering from IGT. For those with BMI greater than or equal to 25, the rates were 3.77% among 161 normals and 7.93% among 132 IGT cases.

Diabetes Mellitus↗
PubMed1992

Effects of insulin and glucose on renal phosphate reabsorption: interactions with dietary phosphate.

Both insulin deficiency and glycosuria are known to inhibit the tubular reabsorption of phosphate. This inhibition has previously been evaluated either in the fasted state or on a normal phosphate diet. The goal of this study was to evaluate how dietary phosphate depletion affected the relative effects of insulin deficiency and glycosuria on the tubular reabsorption of phosphate. Rats were maintained on either a low- (0.03%) or normal (0.8%) phosphate diet. After 5 days, one half of the animals in each group received streptozotocin to induce short-term insulin deficiency, whereas the other half received vehicle alone. Two days later, sodium-dependent phosphate uptake by renal brush border membrane vesicles (BBMV) was evaluated in each of the four experimental groups. The effect of glucose on phosphate uptake was determined by the addition of varying concentrations of glucose (between 0 and 32 mmol/L) to the extravesicular transport fluid. BBMV phosphate uptake was about threefold higher in the nondiabetic rats fed a low-phosphate diet as compared with the nondiabetic animals maintained on a normal phosphate diet. In rats maintained on a low-phosphate diet, streptozotocin treatment prevented the increase in BBMV phosphate transport; in contrast, in animals fed a normal phosphate diet, streptozotocin treatment had no effect on BBMV phosphate transport. Extravesicular glucose significantly inhibited phosphate transport in a dose-related manner, regardless of dietary phosphate or insulin status. Because fasting mimics the catabolic state associated with insulin deficiency, BBMV phosphate transport was also measured in rats fasted for 48 h after the administration of streptozotocin or vehicle.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Effects of intracisternal glucose or insulin injections on glucose homeostasis in cat.

The injection of glucose (100 mg) into the cisterna magna of intact anesthetized cats elicited immediate glycosuria and natriuresis without significant changes in blood glucose concentration. Immunoreactive insulin (IRI) increased 140% in plasma, and Na+ concentration decreased in cerebrospinal fluid (CSF). After kidney denervation there was a significant decrease in glucose and Na+ concentrations in urine. Control injections with mannitol did not elicit changes in the studied parameters. Abdominal vagotomy abolished the rise in IRI levels and the decrease in Na+ concentration in CSF. Vagotomy or adrenalectomy also attenuated the glycosuria and the rise in urine Na+ concentration. The intracisternal injection of insulin (0.5 U/kg) caused first, a decrease in glucose concentration in CSF and afterwards a longer latency in plasma. Again, these responses were significantly attenuated when insulin was administered in vagotomized cats. These experiments indicate that the nervous system, through the vagi, adrenal glands, and kidneys, plays an important role in glucose homeostasis after increasing glucose or insulin levels in the CSF above physiologic concentrations. The results obtained with a denervated kidney confirm the participation of nervous system in the effector mechanism that brings the sugar and Na+ into the urine. Evidence is presented for an interrelationship between glucose and Na+ concentrations in blood, urine, and CSF.

Adrenalectomy↗
PubMed1979

Altered immune reactivity in encephalomyocarditis-M variant (EMC-M)-induced diabetes in mice.

Approximately 50% of DBA/2j male mice infected with EMC-M develop glycosuria with suppressed immune responsiveness to the mitogens PHA, Con A and PWM. The greatest degree of suppression was noted with Con A treated cultures. In vivo treatment with Levamisole, a known T cell stimulant, especially increased the response to Con A but exacerbated the diabetogenic state as reflected by increased occurrence of glycosuria. Virus infected mice, given anti-lymphocyte serum (ALS), showed marked amelioration of the diabetic syndrome. Indomethacin, a non-steroidal anti-inflammatory agent as well as a prostaglandin-synthetase inhibitor, partially reversed the in vitro splenic cell suppression of infected animals.

Animals↗
PubMed1987

Acute alcohol intoxication in a two-month-old baby.

A 2-month-old, well developed, healthy boy, weighing 5.55 kg, was fed 200 ml of bottle-milk containing 65 ml of sake. So-called kanzamashi (sake boiled in the evening and remaining in a bottle overnight,) was mistaken for yuzamashi (water boiled and left to cool), and used to prepare a 15% formula milk. About 10 minutes later, the baby became flushed, began to breath hard, and lose consciousness, and an alcoholic odor was noticed. He was brought to our clinic, where gastric lavage and parenteral fluid therapy were started. On admission, his main physical signs were, whole body had become red, unconsciousness, alcoholic odor, tachycardia and tachypnea, without low body temperature, while his remarked laboratory findings were metabolic acidosis, hyperglycemia, and high A/G ratio. Moreover, a transient proteinuria, alternately followed by a transient glycosuria, appeared within the course. About 10 hours later, he showed an obvious improvement in both physical and laboratory findings. As an explanation of these changes in his condition due to alcohol ingestion, we speculated that a metabolic acidosis with hyperglycemia caused the disturbed reabsorption in his renal tubulus, which revealed alternating proteinuria and glycosuria.

Acidosis, Renal Tubular↗
PubMed1975

[Detection of diabetes mellitus in young adults. Survey on 161,500 male subjects].

In the course of previous studies concerned with the detection of diabetes in 143,000 persons aged between 19 and 20 years, on the basis of testing for fasting glycosuria, the occurrence of the disorder had been estimated at 1.2 per thousand. By virtue of modifications in technique--in particular testing for glycosuria using special dipsticks after a standard high carbohydrate breakfast (170 Gm carbohydrate)--it emerged that in 6,000 subjects the frequency of diabetes was 20 per thousand. Thus from the age of 20 years onwards, the prevalence of the disorder is high, in the region of levels observed in middle age and close to the occurrence rates for purine metabolism abnormalities and hyperlipidaemias.

Adult↗
PubMed1975

[Comparison of various semi-quantitative tests for determination of urinary glucose in diabetics (author's transl)].

Estimations of urinary glucose in 178 diabetics using 4 tests, Ketodiastix, Tes-Tape, Clinitest 5/10 and Clinitest 2/10 were compared with polarimetric determinitation. Clinitest is more accurate and specific, and as reliable as enzymatic methods. The widened scale of Clinitest 2/10 permits the detection and satisfactory estimation of glycosuria ranging from 0,25% to 5%; it is specially suitable for monitoring the labile insulin dependent diabetes of children or adolescents. Enzymatic methods are suitable for the qualitative detection of glycosuria, for the control of stable, maturity-onset diabetes or to meet the need for rapidly available diagnostic information.

Diabetes Mellitus↗
PubMed1991

[The effects of bisoprolol and atenolol on glucose metabolism in hypertensive patients with non-insulin-dependent diabetes mellitus].

Effects of bisoprolol and atenolol on glucose metabolism in hypertensive patients NIDDM. The aim of the study was to compare the antihypertensive efficacy and the effects on glucose metabolism of a new beta 1-selective beta-blocker with high beta 1 selectivity, bisoprolol and atenolol in 12 hypertensive patients (WHO classes I e II) suffering from untreated not insulin-dependent diabetes mellitus (NIDDM). According to a cross-over design after a placebo run-in period of 4 weeks, the patients were randomly allocated to receive bisoprolol 10 mg o.d. or atenolol 100 mg o.d. for 4 weeks, with a four-week wash-out period between the two active treatments. In basal condition and after each therapy an intravenous glucose tolerance test (i.v. GTT, 20 g) was performed, with evaluation of serum glucose and insulin at 0, 15, 30, 60, 90, 120 minutes and glycosuria during the test. At the same time blood pressure, heart rate (supine, upright), ECG, laboratory tests were assessed and subjective tolerability was evaluated. The glucose and insulin responses to the i.v. GTT did not significantly change to basal condition. Similarly glycosuria did not show significative increment during the test with both beta-blocking therapies. Blood pressure and heart rate values were significantly reduced (p less than 0.001) after bisoprolol and atenolol treatment. During the study no side effects were reported and laboratory tests and ECG remained substantially unchanged. These data confirm the antihypertensive efficacy of bisoprolol and atenolol and demonstrate the absence of important effects of these drugs on glucose metabolism in hypertensive patients with NIDDM.

Adrenergic beta-Antagonists↗
PubMed1990

[Asymptomatic bacteriuria in patients with diabetes mellitus].

The prevalence of asymptomatic bacteriuria and the relation of bacteriuria to pyuria, glycosuria and HbA1c in patients with diabetes mellitus were investigated. The study population included 110 diabetic patients and 100 healthy persons (control group). The ratio of bacteriuria was found as 25.5% (31.3% in women, 17.4% in men) in the diabetic group and as 9% (16% in women, 0% in men) in the control group. The prevalence of asymptomatic bacteriuria was significantly higher in the diabetic patients than in the control group (p less than 0.05). There was a significant relation between bacteriuria, pyuria and HbA1c levels (p less than 0.05). But, there wasn't any important correlation between bacteriuria and glycosuria.

Bacteriuria↗
PubMed1990

Relationship between insulin antibodies and metabolic control in type I diabetes mellitus.

1. The objective of the present study was to investigate whether a change in insulin therapy from bovine to purified porcine insulin would result in a decreased level of insulin antibodies (IA) in type I diabetic patients and whether there would be better metabolic control. 2. Insulin antibodies were measured by ELISA. Fifteen type I diabetic patients were prospectively followed for 8 months with monthly evaluations after changing insulin therapy from bovine to purified porcine insulin. 3. Group I patients (N = 4) had IA greater than or equal to 1.5 (value obtained by dividing the ELISA absorbance of the tested serum by the absorbance of a standard serum) at the beginning of the study. For group I patients, the modification of insulin therapy caused a 57% reduction in insulin antibody levels, and this reduction was correlated with a decrease in 24-hour glycosuria (rs = 0.66, P less than 0.001) and glycated protein (rs = 0.65, P less than 0.01). Group II patients (N = 8) had IA less than 1.5 and greater than or equal to 0.3 and group III (N = 3) had IA less than 0.3. Insulin antibody levels were unchanged during the follow-up period in both group II and group III. 4. We also studied endogenous insulin secretion, measured as fasting C-peptide, and its relationships with metabolic control and insulin antibody levels. Patients with residual insulin secretion (C-peptide greater than 60 pmol/l) showed lower levels of 24-h glycosuria, glycated protein and glycated hemoglobin. Furthermore, in this group of patients a negative correlation was found between C-peptide and insulin antibody levels (rs = -0.36, P less than 0.01). 5. We conclude that insulin antibodies could be one of the factors having a detrimental effect on metabolic control.

Adolescent↗
PubMed1986

Determinants of microangiopathy in growth-onset diabetes. With special reference to retinopathy and glycaemic control.

In a quasi-experiment all diabetic children in a defined area were exposed either to an intense clinical treatment or served as a constructed control. The cohort of 146 diabetics was observed prospectively for at least 15 years as to diabetic control, mainly glycosuria, and cross-sectionally examined for microangiopathy on four occasions. Data on family background, social situation, smoking, blood pressure, biochemical status, anthropometry, HLA factors and mortality were also gathered. Throughout the analysis duration was considered and treated as a concomitant variable. Two different strategies have been followed in the analysis, one trying to predict microangiopathy at a fixed and predetermined duration, the other to study determinants of the pattern of microangiopathy occurrence over time. Multiple logistic regression and Cox analysis have been used to fit these strategies. The prevalence of microaneurysms or more advanced stages of retinopathy at 10 years duration was 30 per cent and within 20 years 81 per cent. About 52 per cent had haemorrhages after 20 years. Mild and severe nephropathy after 20 years have been contracted by 50 and 15 per cent respectively. No clear sex differences were seen. Variables significantly explaining retinopathy within 10 years were post-pubertal duration, blood pressure, place of medical supervision and the HLA/DR4 marker. The mean glycosuria was high during puberty irrespective of age at onset. The overall pattern of retinopathy occurrence seemed to be influenced by place of medical supervision, age at onset, blood pressure, family history of ischaemic heart disease and glycemic control. For the progression of retinopathy the role of factors reflecting medical supervision and control of diabetes seemed even greater. Even after accounting for degree of diabetic control the experimental group had a more favourable outcome, suggesting additional quality of care components. Mild nephropathy was less predictable from the above risk factors while previous findings of the important role of elevated blood pressure for severe nephropathy was confirmed. We estimate that half of retinopathy cases were preventable by the "experimental" care and conclude the near-normalization of glycaemia under routine conditions favourably influences the development of diabetic retinopathy.

Adolescent↗
PubMed1986

Subclinical diabetes mellitus in the BB rat.

The spontaneously diabetic BB Wistar rat is a well recognized animal model for the study of insulin-dependent diabetes mellitus (IDDM). Previously we have noted hyperglycemia and insulitis in BB rats without clinical diabetes. 121 rats were studied prospectively. 43 (36%) were normal and 64 (52%) developed IDDM suspected by the presence of glycosuria and acute weight loss, and confirmed with pancreatic histology. In the remaining 14 (12%) animals, pancreatic histology was also abnormal, varying from mild insulitis only to moderate insulitis and beta-cell degranulation. Since these rats gained weight normally, had no glycosuria, or hyperglycemia they were designated as having subclinical diabetes. At death, their plasma-insulin concentrations and the amount of extracted pancreatic insulin was intermediate between that of the normal and diabetic group (p less than 0.001). We have identified a group of rats with pancreatic features of diabetes but no clinical expression. Further investigation of this syndrome may reveal clinical, immunological or histological features which protect these animals from the development of overt disease.

Animals↗
PubMed1987

Routine urinalysis (dipstick) findings in mass screening of healthy adults.

We present results of simple urinalysis examinations (dipstick) in a large (approximately 21,000 people) working population. In about 10% of the screened individuals at least one abnormality was found. In men the most common finding was proteinuria (4.9%). Hematuria was found in 2.6% and glycosuria in 0.6%. The most prevalent finding in women was hematuria (8.1%), followed by proteinuria (3.9%) and glycosuria (0.6%). Only about 1% of the examinees had two or more abnormalities in their urine examinations. These findings attest to the utility and practicability of incorporating urine testing into various screening and clinical examinations.

Adult↗
PubMedDate not supplied

[Renal diabetes. Apropos of 103 cases in children].

A longitudinal study of 103 cases of renal glycosuria (94 families) led to the following conclusions. 1. When the condition is genetically determined, it is probably inherited as an autosomal recessive. 2. There is no relationship with diabetes mellitus. 3. The renal glycosuria is persistent but does not get worse.

Adolescent↗
PubMed1985

Urinary magnesium loss in aging diabetic mellitus rats.

Past studies on urinary loss of magnesium (Mg) have focused on young diabetic rats. The aims of the present study were to determine the rapidity at which glycosuria and magnesuria occur after the induction of diabetes mellitus (DM) in old male rats, and the maximal amount of Mg and glucose (Glu) loss in the urine and whether or not the loss is persistent and (3) the most sensitive means of correlating the Mg and Glu loss in the urine. Three methods of expressing urinary Mg and Glu concentrations were selected: Method A: mg/24 h; Method B: mg/24 h/kg body weight (BW), and Method C: ratio of Mg to creatinine (Mg/Crea) or ratio of Glu to Crea (Glu/Crea). Our study indicated a maximal and rapid loss of Mg and Glu occurring within 1 week after induction of DM (by streptozotocin injection) and remained in effect for 6 weeks, the end of the study. The urinary Mg loss due to DM correlated best with urinary Glu when expressed as mg/24 h/kg BW. In addition, the increase in urinary Mg concentration paralleled the degree of glycosuria and reached a maximum of 5-12 times baseline values when expressed by Method B. This was 4-10 times when expressed by Method A, and 2-6 times when expressed by Method C. Since polyuria is a feature of DM, we also correlated the relationship between these two factors, and found a significantly positive correlation (r = 0.735) particularly when Mg was expressed as mg/24 h. In summary, rapid and significant urinary Mg loss is observed in old rats made diabetic with streptozotocin.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1979

Characterization of renal defects in dogs with a syndrome similar to the Fanconi syndrome in man.

Ten adult dogs with multiple spontaneous defects of renal tubular reabsorption were studied. Clinical signs included polydipsia, polyuria, and glycosuria for 2 to 12 months. Eight of the dogs were Basenjis. Urinalyses revealed hyposthenuria, glycosuria, and amino aciduria in most dogs. Renal function was normal in 5 dogs and slightly reduced in the remainder. Moderate metabolic acidosis had developed in 3 dogs. Renal clearance studies revealed reduced tubular reabsorption of glucose, phosphate, sodium, potassium, and uric acid. Abnormal glucose tubular maximal curves were found. Results of oral glucose tolerance tests were normal. Two patterns of abnormal amino aciduria were evident: generalized amino aciduria and a pattern similar to that of cystinuria in dogs. Radiography of long bones and bone densitometry did not reveal any skeletal abnormalities. Five of the dogs died within 90 days of diagnosis; death was due to acute renal failure associated with profound dehydration, acidosis, and papillary necrosis. The other dogs remained stable without treatment after 18 months. Histopathology of kidneys did not reveal uniform abnormalities; some dogs had variable and nonspecific changes and others were normal. Electron microscopy did not reveal ultrastructural abnormalities in renal tubular cells. It was concluded that the syndrome in these dogs represents a new entity of renal disease in dogs, similar to idiopathic Fanconi syndrome in man.

Animals↗