Diabetic medicine : a journal of the British Diabetic Association
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Randomized Controlled Trial Clinical Trial
The effect of glucose and insulin infusion on the fall of ketone bodies during treatment of diabetic ketoacidosis.
During the treatment of diabetic ketoacidosis intravenous glucose is infused when blood glucose has fallen to around 14 mmol l-1. The use of hypertonic (10%) glucose has been recommended in order to hasten the clearance of blood ketone bodies. In a randomized controlled study 17 patients presenting with severe diabetic ketoacidosis were allocated to one of two regimens of intravenous glucose and insulin when blood glucose had fallen to less than 14 mmol l-1. ⋯ This difference between groups at 6 h was significant (p less than 0.05). Over the 6 h of infusion the fall in blood total ketone bodies was significantly greater in the group receiving the higher rate of glucose/insulin infusion (7.34 +/- 0.57 vs 5.18 +/- 0.57 mmol l-1; p less than 0.05). Despite the greater fall in total ketone bodies in this group there was no difference in the improvement in capillary blood pH or bicarbonate.(ABSTRACT TRUNCATED AT 250 WORDS)
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In 148 patients admitted to hospital with acute cerebrovascular accidents (CVA), the levels of glycosylated haemoglobin (HbA1c) and blood glucose were measured to evaluate the effect of the duration and severity of hyperglycaemia on stroke outcome. Eighty-eight (59%) patients had clearly normal blood glucose and HbA1c concentrations (blood glucose less than 5.5 mmol l-1, HbA1c less than 8.6%). The remaining 60 patients were defined as hyperglycaemic. ⋯ Recovery after CVA was best among normoglycaemic patients (good 45%, moderate 29%, poor 14%, fatal 12%) and poorest among diabetic patients (moderate 21%, poor 37%, fatal 42%). Fatal outcome in patients from the normoglycaemic group differed significantly from patients belonging to known diabetic and unrecognized diabetic groups (p less than 0.05), but was not different from that in patients with transient hyperglycaemia, who did however differ from both diagnosed and unrecognized diabetic patients (p less than 0.05). No significant differences were found between CVA outcome in the known diabetic and unrecognized diabetic groups.