Diabetes mellitus

The effective management of diabetes in children and teens requires a daily balancing of insulin administration, food intake, and exercise. To optimize outcome and avoid the neuropathic and microcirculatory effects of hyperglycemia, blood glucose levels should be maintained within a targeted range, which can be accomplished with frequent evaluation and adjustment of the overall treatment regimen. This requires meticulous attention to the disease not only by the patient and family, but by school personnel, baby sisters, coaches, and other individuals responsible for the child's welfare. Diabetes must be diagnosed as early as possible once the signs and symptoms of insulin deficiency have developed to avoid DKA and the associated risks of this acute metabolic disturbance. In addition, careful monitoring of patient progress and assurance that osmolality is reduced gradually without a rapid decrease in the serum sodium level may be required to help prevent cerebral edema associated with DKA. Individuals at risk for autoimmune diabetes should be offered the option of diabetes screening, and if appropriate, entered into diabetes prevention trials. With these aggressive measures, it is possible to decrease the acute complications and the long-term morbidity of this chronic disease and the tremendous negative impact that it has on the health-care system.     

Diabetes mellitus in pregnancy

Physiologic changes that occur during pregnancy are diabetogenic. If diabetes does not exist before pregnancy, it may become evident, and if diabetes pre-exists, it becomes aggravated. The changing insulin requirements and propensity for ketoacidosis require weekly visits and careful urine testing on a daily basis by the mother. In addition, microvascular complications of diabetes must be carefully monitored. Delivery is planned progressively early in the pregnancy according to diabetic class. Hospitalization is necessary one week before anticipated delivery. Urinary estriol tests, OCT, amniocentesis, and ultrasound are all helpful in managing the pregnancy. Delivery of the fetus and placenta results in a profound fall in the insulin requirement. The neonate should be carefully observed during the first few days of life because of the increased frequency of complications.     

Diabetes mellitus in sub-saharan Africa

The value of total coliforms, faecal coliforms and faecal streptococci in predicting the presence of Salmonella spp. and the numbers of Staphylococcus aureus and Candida albicans in sewage polluted coastal water were assessed. All indicators had strong positive association with Salmonella and moderate positive correlations with Staph. aureus and C. albicans. Total coliforms correlated better with salmonellas and Staph. aureus than did the two faecal groups. Regression analysis revealed that total coliforms have a better value as predictors of the presence of Salmonella and Staph. aureus, while faecal coliforms are better predictors of C. albicans, in moderately polluted areas. The conclusion reached is that enumeration of total coliforms is sufficient to predict the presence of Salmonella spp. or Staph. aureus in sea water moderately affected by sewage pollution, without the additional measurement of faecal coliforms and faecal streptococci.     

Diabetes mellitus in older persons

The relative importance and mechanisms of deficient insulin secretion versus deficient action during aging are still debated. Whatever mechanisms eventually explain the emergence of impaired glucose tolerance during aging, the clinically important extrinsic modifiers of glycemic levels include diet, medications, activity, and chronic illness and stress. Although prospective studies are not available in the elderly, retrospective studies suggest that good blood glucose control reduces the likelihood and severity of stroke, cardiovascular disease, visual impairment, nephropathy, infections, and even cognitive dysfunction. Good control also seems to reduce nocturia, polyuria, and hypovolemia. Therapy of older persons begins with diet, exercise, and oral agents, failing which, insulin is employed. Since many of the newer oral agents carry less risk of hypoglycemia, achieving tighter control in the elderly has become more feasible.     

Diabetes mellitus and sports

The adolescent with insulin-dependent diabetes mellitus (IDDM) can safely participate in sports activities without interference from the disease. To ensure safe and successful participation, clinicians must appreciate how diabetes may alter the physiologic adaptation to strenuous exercise and how an individualized self-care plan can empower the adolescent with IDDM to effectively manage meal planning, blood glucose testing, and insulin injections. Various types of insulin, insulin schedules, and insulin delivery devices that may suit a wide variety of training and activity regimens are described.     

Genetic dissection of "OLETF", a rat model for non-insulin-dependent diabetes mellitus

Granulation tissue formation was studied in viscose cellulose sponges with different cellulose contents and sizes after subcutaneous implantation in rats. Samples were removed and studied histologically and histomorphometrically 1-16 weeks after implantation. The implants with lower cellulose content and smaller size were invaded by more cells and filled with connective tissue more rapidly than those with the higher content and larger size. In larger sponge implants the beneficial effect of the lower cellulose content was more conspicuous.     

Diabetes mellitus and acute myocardial infarction

A series of 597 consecutive patients with acute myocardial infarction (AMI) have been screened for diabetes mellitus (DM). Six per cent of the series had DM, which is exactly the frequency of DM in an age-matched population. This finding corresponds with results of other investigators, indicating that treated diabetics do not have an increased risk of AMI. Diabetics suffering from AMI do not have an increased mortality, nor do patients treated with oral antidiabetics have a higher mortality than those treated with insulin.     

Diabetes mellitus. A significant risk

Crohn's recurrence is the appearance of objective signs--defined radiologically, endoscopically or pathologically--of Crohn's disease in the bowel of a patient who has previously had a resection of all macroscopically diseased tissue. New lesions can be visualized endoscopically within weeks to months after ileal resection and ileocolonic anastomosis in the neoterminal ileum. The evolution of these lesions mimics the natural history of ileal Crohn's disease at the onset. If we are able to prevent recurrence of early lesions, we could probably interrupt the natural course of the disease. Metronidazole decreases the severity of early recurrence without totally preventing it. The data on 5-ASA are conflicting. Claversal seems to have little effect whereas Asacol was found to prevent not only endoscopic but also clinical recurrence. Pentasa prevented the development of severe recurrence. New therapies including topically acting glucocorticosteroids and immune suppression should be studied.     

Diabetes mellitus accompanied by nonocclusive colonic ischemia

A 70-year-old man with diabetic triopathy was hospitalized with left lower quadrant abdominal pain and tenderness, muscle guarding and absent bowel sounds. Three hours after admission, creatine phosphokinase (CPK) was elevated and an abdominal plain film X-ray showed intestinal gas retention, indicating paralytic ileus due to inferior mesenteric artery occlusion. Urokinase (60,000 units/day) and heparin (10,000 units/day) were administered. Angiography showed no occlusion in the mesenteric artery. On the 16th day, the abdominal signs had disappeared and CPK was normalized. We diagnosed this case as nonocclusive colonic ischemia because of the hemorheological abnormalities due to diabetic triopathy and the hypercoagulable state.     

Aromatic hydroxylation in animal models of diabetes mellitus

Although the involvement of oxidative stress is well documented in the diabetic state, the individual active oxygen species generated have not been demonstrated in animal models of diabetes currently used. Since streptozotocin-induced diabetes mellitus in animals still serves as an animal model of diabetes mellitus, but streptozotocin induces diabetes and generates oxidative stress per se, we decided to study whether aromatic hydroxylation reflecting hydroxyl radical attack was found in three animal models of diabetes mellitus without streptozotocin induction or in streptozotocin-induced diabetes only. For this purpose, we compared lipid peroxidation, aromatic hydroxylation of phenylalanine, glycoxidation in genetically determined diabetic mouse strains db/db and kk, and the diabetic BB rat to these parameters in the streptozotocin-treated rat. Kidney malondialdehyde concentrations, reflecting lipid peroxidation, pentosidine, and Nepsilon-caboxymethyllysine concentrations, reflecting glycoxidation, were significantly elevated in all diabetic groups as compared to their nondiabetic mates. Aromatic hydroxylation was significantly elevated in the streptozotocin-induced diabetic state exclusively. We conclude that biochemical, pathophysiological, and treatment studies in the streptozotocin model of diabetes mellitus may be confounded by the presence of products, reactions, and tissue damage generated by aromatic hydroxylation reflecting hydroxyl radical attack. We suggest it is not the diabetic state but streptozotocin that generates the hydroxyl radical, as reflected by aromatic hydroxylation in this model.