British medical journal (Clinical research ed.)
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Br Med J (Clin Res Ed) · Jan 1981
Comparative StudyManagement of severely brittle diabetes by continuous subcutaneous and intramuscular insulin infusions: evidence for a defect in subcutaneous insulin absorption.
Severely brittle diabetes is defined as a rare subtype of insulin-dependent diabetes with wide, fast, unpredictable, and inexplicable swings in blood glucose concentration, often culminating in ketoacidosis or hypoglycaemic coma. To assess the role of inappropriate type, amount, or timing of insulin treatment and the route of administration as a cause of severe brittleness six patients with continuous subcutaneous insulin infusion, which provides a high degree of optimisation of dosage with exogenous insulin in stable diabetics. The glycaemic control achieved during continuous subcutaneous insulin infusion was compared with that during continuous intramuscular insulin infusion. ⋯ The remaining patient with brittle diabetes, previously safely controlled only with continuous intravenous insulin, did not respond to continuous intramuscular infusion. It is concluded that in five of the six patients with brittle diabetes studied here impaired or irregular absorption of insulin from the subcutaneous site played a more important part in their hyperlability than inappropriate injection strategies. This absorption defect was presumably bypassed by the intramuscular route.
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To find the incidence of the various types of head injury that occur in the community separate yearly rates (per 10(5) population in Scotland) for deaths, admissions to hospital, and attendance at accident and emergency departments were estimated and compared (when possible) with rates in England and Wales and the United States. Hospital admissions provide the best data for comparing incidences in different geographical areas and rates of attendance at accident and emergency departments the most reliable guide to incidences in the community. Admission rates, however, vary with local facilities and policies, and these also determine the proportion of patients referred to regional neurosurgical units. Such epidemiological data must be sought both for planning health care for head injury and for monitoring the effectiveness of services.