Further Reading

BMJ2004 328 1105. 2 The Diabetes Control and Complications Trial Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000 342 381-9. 3 Perkins BA, Ficociello LH, Silva KH, Finkelstein DM,Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med 2003 348 2285-93. 4 Levey AS, Bosch JP, Lewis JB, Greene...

Recent Developments

1 Insulin resistance in muscle and liver may be increased by accumulation of lipid in these tissues. This accumulation may involve a transcription factor called the liver X receptor, activation of which increases enzymes of the lipogenic pathway including fatty acid synthase.3 The liver X receptor is also involved in the increased expression of the glucose transporter GLUT4 in response to insulin. Variations in certain key genes that regulate lipid storage in tissues may control susceptibility...

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Macroalbuminuria 130,163-6 macrosomia in gestational diabetes 103, 105, 106 in type 1 diabetes 107 macrovascular complications angina in type 2 diabetes 187-90 foot ulceration 199-202 peripheral arterial disease 191-4 prevention in elderly people 94 renal artery stenosis 195-8 transient ischaemic attack 203-6 macrovascular complications risk, relationship to plasma glucose 18 macular disease 175-7 macular oedema MO 167,173 vitreal triamcinolone acetonide 174 magnesium use in eclampsia 117-18...

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St Vincent declaration 107 sarcopoenic obesity 93 Scandinavian Simvastatin Survival for coeliac disease 221,222,223 for diabetes 18-19,20 cystic fibrosis patients 213 for gestational diabetes 103-4, 106 neuropathy 150 for retinopathy 169 for secondary hypertension 147 secondary hypertension 144-6,147 secondary prevention, value of aspirin 137, 138 self-management of diabetes adolescents 69-71 perioperative 52 self-monitoring of blood glucose, during pregnancy 104-5,108 sensory loss 150 in...

1

Your 54-year-old patient with diabetes is keen to stop smoking. He has tried to give up smoking four years previously but was successful for only two months. His general practitioner recently prescribed him a nicotine gum but he did not find it effective. Discuss briefly the pathogenesis of smoking-induced atherogenesis. Consider the current evidence relating to the pharmacological treatment of smoking cessation within the broader context of a smoking-cessation strategy.

T

Angioplasty Open surgical reconstructions Fig. 12.1 Management of critical limb ischaemia. plete, an embolectomy with a Fogarty catheter is the treatment of choice and can be done either with a local anaesthetic or with general anaesthesia. This is followed by anticoagulation. If the ischaemia is not severe and if the clot is more likely to be a thrombus, intraarterial thrombolysis with recombinant tissue plasminogen activator rTPA may be the best method of treatment.4 Sympathectomy is no...

How To Treat Insulin Resistance Naturally

Imaging 180 icodextrin, in dialysis fluid 217,218 iliac artery stenting 50 imaging techniques Charcot foot 183 renal artery stenosis 196 immobilization, in treatment of neuroarthropathy 183,185 immunisation, effect on risk of type 1 diabetes 3, 4 immunosuppression, preventive value 2 immunosuppressive treatment in insulin resistance 22, 23, 24 impaired fasting glucose IFG 19 diagnostic criteria 18 impaired glucose tolerance IGT 19-20 diagnostic criteria 18 prevention of type 2 diabetes 5-8...

Q

The risk of stroke in patients with diabetes mellitus is two- to three-fold higher than in people without diabetes. Diabetes doubles the risk of stroke recurrence, while stroke outcomes are often worse among patients with diabetes, e.g. a higher hospital and long-term stroke mortality, more residual functional disability, higher risk of stroke-related dementia as well as longer hospital stay. At one year, mortality rate was two-fold higher in diabetes and after five years, only a fifth of...

PROBLEM

Ir n A 67-year-old woman with no previous history of diabetes mellitus was admitted to the Acute Medical Admission Unit with a four-day history of progressive drowsiness and dehydration. An urgent blood test showed pre-renal uraemia Na 174 mmol l K 4.0 mmol l urea 26.2 mmol l creatinine 168 mol l , severe hyperglycaemia 34.2 mmol l and arterial blood gas parameters of pO212.1 kPa, pCO2 5.2 kPa, HCO3-18.9 mmol l and pH 7.32. Urinalysis showed 2 protein, trace blood and nil else. How would you...

Case History

A 32-year-old solicitor with type 1 diabetes and glycosylated haemoglobin HbA1c of 8.2 states that she is trying for a baby. She has had type 1 diabetes for 16 years and has mild background retinopathy. She takes lisinopril 10 mg per day as she has previously been noted to have microalbuminuria. She has never been pregnant before. She takes Mixtard insulin 32 units in the morning and 28 units in the evening. Would you advise a change of insulin

Explain Gmr In The Treatment And Testing Of Diabetes

ECG, indications for coronary angiography 188 use of magnesium 117-18 economic analysis, CSII 62 ECST European Carotid Surgery Trial 205 educational input, insulin pump therapy 63-4 educational interventions, adolescent diabetes 70-1 elderly people 93-6 embolectomy, limbs 48-9 ENDIT European Nicotinamide Diabetes Intervention Trial 3 endomysium antibodies, coeliac disease 221 endothelial function, effect of statins 194 endurance running 65-8 enteral feeding 85-8 enteroviruses, as risk factor...

Abbreviations

4S Scandinavian Simvastatin Survival Study ABCD trial Appropriate Blood Pressure Control in Diabetes Trial ABPI Ankle-brachial pressure index ABPM Ambulatory blood pressure monitoring ACAS Asymptomatic Carotid Atherosclerosis Study ACHOIS trial Australian Carbohydrate Intolerance Study in Pregnant Women AER Albumin excretion rate AHI Apnoea-Hypopnea Index ALLHAT Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial AMD Age-related macular degeneration ANG-1 and ANG-2...

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1 Gale EAM.The rise of childhood type 1 diabetes in the 20th century. Diabetes 2002 51 3353-61. 2 Kukko M, Virtanen SM, Toivonen A, Simmell S, Korhonen S, Ilonen J, Simel O, Knip M. 8 Gale EA, Bingley PJ, Emmett CL, Collier T. European Nicotinamide Diabetes Intervention Trial ENDIT a randomised controlled trial of intervention before the onset of type 1 diabetes. Lancet2004 363 925-31. 9 Skyler JS, Krischer JP, Wolfsdorf J, Cowie C, Palmer JP, Greenbaum C, Cuthbertson D, Rafkin-Mervis LE, Chase...