Diabetic medicine : a journal of the British Diabetic Association
-
A study was carried out to determine the incidence of maternal ketoacidosis in 635 insulin-treated diabetic pregnancies managed in a combined antenatal/diabetic clinic between 1971 and 1990. A total of 11 episodes occurred, representing 1.73% of diabetic pregnancies of which 9 were in the antenatal period. Overall fetal loss including spontaneous abortion was 22%, but there was only one fetal death in the seven episodes of ketoacidosis in the second and third trimesters. Ketoacidosis is an infrequent occurrence in diabetic pregnancy managed in a combined clinic and is not associated with a high fetal loss after the first trimester.
-
Comparative Study
Frequency and symptoms of hypoglycaemia experienced by patients with type 2 diabetes treated with insulin.
This study ascertained the prevalence of severe hypoglycaemia and loss of awareness of hypoglycaemia in patients with Type 2 diabetes treated with insulin. One hundred and four sequentially selected Type 2 diabetic patients were compared with 104 patients with Type 1 diabetes who were matched for duration of insulin therapy. The patients were interviewed using a standardized questionnaire. ⋯ All 86 Type 1 diabetic patients matched to the 86 Type 2 patients had experienced multiple episodes of hypoglycaemia; 71 (83%) had normal awareness, 14 (16%) had partial awareness and one patient (1%) reported absent awareness of hypoglycaemia. The Type 1 patients who had altered awareness of hypoglycaemia had longer duration of diabetes and insulin therapy (normal awareness: 5 (1-17) years (median (range)) vs partial awareness: 9 (3-18) years, p < 0.01). Similarly, Type 2 patients with altered awareness had longer duration of diabetes (normal awareness: 11 (2-25) years vs partial awareness: 19 (8-24) years, p < 0.02) and had received insulin for longer (normal awareness: 3 (1-18) years vs partial awareness: 12 (6-17) years, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Type 2 diabetes is four times more common in people originating from the Indian subcontinent (Asians) than in white English Caucasians. British Asians with diabetes have been shown to have poorer blood glucose control, awareness of diabetes management, and knowledge of complications. This review examines some of the dietary customs that can affect glucose control, problems with communication and diabetic education, and a brief description of health beliefs commonly held by Asian patients that may help the physician understand why some patients appear to show poor compliance with accepted Western medicine. Patients must always be approached as individuals with their own unique needs within the context of their cultural backgrounds.
-
A questionnaire survey of anaesthetists, based at the three main hospitals in Bristol, was undertaken to determine what methods are currently being used by anaesthetists to manage diabetes in patients for surgery. Replies were received from 56 of the 90 anaesthetists (62%). Surgical procedures were defined as minor, moderate, and major. ⋯ In addition, no consensus view was apparent for the preferred intra-operative blood glucose range or for the threshold blood glucose level at which to postpone an operation. It was apparent that anaesthetists preferred to administer intravenous insulin by a syringe pump rather than by a drip bag containing insulin, potassium, and glucose, particularly if more severe metabolic upset was anticipated. No difference in management was apparent between different hospital grades or between the three hospitals.