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Biomedical subjects

A C MacCuish

Publications and source records attributed to A C MacCuish.

At least 55 records · Page 3Linked to original sources
PubMed1988

Diabetic hyperosmolar non-ketotic decompensation.

To assess whether the outcome of hyperosmolar non-ketotic decompensation has changed in the past 20 years with modern medical management, a retrospective study analysis was performed of all patients presenting with the syndrome to a large teaching hospital during the period 1982 to 1986. Twenty-two patients were identified of whom 68 per cent had no previous history of diabetes mellitus. The immediate mortality rate (within 72 h of presentation) was 36 per cent (eight of 22), the overall mortality rate was 41 per cent (nine of 22) and vascular thromboembolism was common. A comparison was made of the early deaths (n = 8) and survivors (n = 14) in an attempt to identify favourable prognostic factors. The two groups could not be distinguished either by clinical or laboratory variables at presentation nor by treatment regimen; however there was a significant delay in establishing the diagnosis in some of the patients who died. Our results indicate there has been no improvement in the outcome of the hyperosmolar non-ketotic decompensation syndrome in the last two decades and that a high index of suspicion is required to identify patients presenting with this condition.

Aged↗
PubMed1988

Comparison of conventional twice daily subcutaneous insulin administration and a multiple injection regimen (using the NovoPen) in insulin-dependent diabetes mellitus.

Thirty-seven stable insulin-dependent diabetic patients receiving twice daily premixed porcine soluble and isophane insulins (Mixtard or Initard, Nordisk Laboratories) were enrolled in a trial to compare the effects of this regimen and an intensified regimen on glycaemic control and flexibility of lifestyle. After a two month run-in period patients were randomized to continue taking premixed insulin (n = 18) or to change to Human Actrapid (three times daily pre-prandial doses using a NovoPen) plus Human Ultratard (n = 19: "pen" group, Novo Laboratories). Diabetic control was assessed at monthly intervals for six months by glycosylated haemoglobin assay (HbA1), 7-point blood glucose profiles and frequency of hypoglycaemic episodes. At randomization, glycaemic control had significantly improved in the group as a whole and patients were well matched with respect to body mass index (BMI) and glycaemic control. No significant changes in BMI, HbA1, mean 7-point glucose profiles or hypoglycaemic episodes were found after six months either within or between groups. Hypoglycaemic episodes were common during the study. There were no technical problems with the NovoPen. Patients using the NovoPen felt it added greater flexibility to their lifestyle. From our study results the main indication to start a multiple injection regimen is to improve the flexibility of the patient's lifestyle and not to improve glycaemic control.

Adult↗
PubMed1988

Albumin excretion rate, albumin concentration, and albumin/creatinine ratio compared for screening diabetics for slight albuminuria.

Slight albuminuria, an overnight albumin excretion rate (AER) greater than 30 micrograms/min in an "Albustix"-negative sample, predicts development of diabetic nephropathy. This study compares the AERs for 261 timed overnight urine collections with the albumin concentrations and albumin/creatinine ratios for the same specimens (equivalent to first morning specimens). Thirty-one specimens (11.9%) had AERs greater than 30 micrograms/min. Use of an albumin/creatinine ratio greater than 3.0 mg/mmol to predict an AER greater than 30 micrograms/min gave a sensitivity of 96.8%, a specificity of 93.9%, and a predictive value of 68.2%, with a correlation coefficient of 0.921. Use of an albumin concentration greater than 17 mg/L gave a sensitivity of 96.8%, a specificity of 90.9%, a predictive value of 58.8%, and a slightly poorer correlation (r = 0.904). Evidently either method is acceptable as an initial screening procedure, but determination of albumin concentration alone would be preferable because of lesser cost.

Albuminuria↗
PubMed1988

Fetal glycaemic control and neonatal complications in diabetic pregnancy.

To examine the relationship between fetal glycaemic control and macrosomia or neonatal hypoglycaemia, we measured umbilical cord glycosylated haemoglobin (GHb) by affinity chromatography in 44 diabetic and 40 normal pregnancies. Levels of GHb in cord blood were not significantly different between these two groups, suggesting good maternal glycaemic control was achieved in the diabetic patients. Moreover in the diabetic pregnancies, cord GHb levels did not differ in infants who were macrosomic or developed hypoglycaemia by comparison with those infants who showed neither phenomenon. We conclude that overall fetal glycaemic control in the 4-6 week period prior to delivery does not appear to influence these common neonatal complications of diabetic pregnancy.

Adult↗
PubMed1988

Thyrotrophin receptor antibodies in type 1 (insulin-dependent) diabetes mellitus.

Graves' disease and type 1 (insulin-dependent) diabetes are common autoimmune endocrine disorders which may co-exist. Since the class II HLA-DR3 antigen is associated with both these diseases, and since an association between DR3 and the thyrotrophin receptor antibody (TRAb) has been suggested, we wished to determine whether TRAb levels were increased and were HLA-D related in diabetes mellitus. In 115 clinically euthyroid subjects (33 type 1 diabetics, 82 healthy controls) there was a correlation between age and TRAb levels (r = -0.39, p less than 0.001). TRAb levels were elevated in DR3 subjects (n = 32) compared to an age matched group of non-DR3 (n = 61) subjects [median (range): 18.1 (-1.7 to 47.4) versus 6.7 (-9.8 to 19.1), p less than 0.001]. Diabetic DR3 and control DR3 subjects had similar TRAb levels which were elevated when compared to their respective non-DR3 control group (both p less than 0.001). All but two subjects (both diabetic) had TRAb levels in our normal range. Thus TRAb levels are elevated in the subjects who possess the HLA-DR3 antigen. Since DR3 is found so commonly in type 1 diabetes this phenomenon may partly explain the association with Graves' disease in this patient population.

Adult↗
PubMed1987

Missed Addisonian crisis in surgical wards.

Three women were admitted to the surgical wards with acute gastro-intestinal symptoms and despite good clinical (pigmentation, hypotension) and biochemical (hyponatraemia, acidosis) evidence of Addisonian crisis had unnecessary investigations with delay in the diagnosis and appropriate management of this medical emergency. Clinicians should take careful note of the typical electrolyte upset seen in Addisonian crisis.

Addison Disease↗
PubMed1987

The hyperglycaemic, hyperosmolar non-ketotic syndrome: some aspects of management.

Hyperosmolar non-ketotic coma is a relatively uncommon but important medical emergency. It is associated with a high mortality, which has changed little over the past twenty years. Approximately half of all patients give no prior history of diabetes and since patients often present with neurological abnormalities, resembling a cerebrovascular accident, the diagnosis can sometimes be delayed or missed. Therefore every patient presenting to hospital with a state of clouded consciousness or objective signs of neurological abnormality, should have a blood glucose estimation performed at an early stage. It has been suggested that a regimen of less aggressive early fluid replacement, with more attention being directed to the associated or underlying problems, may be beneficial to the patient. Claims that the continuing high mortality in non-ketotic coma can be improved by such measures await confirmation.

Anti-Bacterial Agents↗
PubMed1987

Thrombin and plasmin activity in diabetes mellitus and their association with glycaemic control.

Abnormalities of haemostasis are common in diabetes mellitus. As indicators of fibrinolysis and coagulation, plasmin and thrombin activity were assessed by assay of the fibrinogen peptide derivatives B beta 15-42 and fibrinopeptide A respectively in 60 diabetic patients and 50 control subjects in a cross-sectional study. Glycosylated haemoglobin (HbA1) correlated with B beta 15-42 (r = -0.26, p less than 0.05) and fibrinopeptide A (r = 0.30, p less than 0.05) in the diabetic patients suggesting that poor glycaemic control (i.e. high HbA1 levels) was associated with depressed plasmin and enhanced thrombin activity. Compared to controls, fibrinopeptide A levels were increased in diabetics (p less than 0.001) irrespective of sex or type of diabetes. B beta 15-42 levels were normal in diabetic females but increased in diabetic men (p less than 0.001) possibly secondary to the activation of coagulation. These results suggest that in diabetes mellitus activation of coagulation is the dominant haemostatic abnormality and that better glycaemic control could influence in-vivo plasmin and thrombin activity favourably.

Adult↗
PubMed1987

Hyperkalaemia, ketoacidosis and subcutaneous or intravenous insulin infusions.

We report a case of a previously stable Type 1 insulin-dependent diabetic who developed diabetic ketoacidosis with marked hyperkalaemia after starting continuous subcutaneous insulin infusion for neuropathy. On two occasions during his hospital admissions he had a rapid onset of hyperkalaemia after short interruptions to this intravenous insulin infusion. Hyperkalaemia can occur rapidly in patients who are treated with short acting insulin only.

Adult↗
PubMed1987

Oestradiol levels in diabetic men with and without a previous myocardial infarction.

Elevated oestradiol levels have been found in men with a previous myocardial infarction and it has been suggested that hyperoestrogenaemia may explain partly the increased risk of coronary heart disease in diabetes mellitus. Therefore we have measured concentrations of oestradiol and testosterone (the main substrate for oestradiol) in a group of diabetic men with a previous myocardial infarction (n = 15), a matched group of diabetic men without overt cardiovascular disease (n = 13) and a group of healthy, non-diabetic men (n = 15). The diabetics had elevated oestradiol levels (p less than 0.03) despite lower testosterone levels (p less than 0.02) compared with control subjects. In the diabetic patients, a correlation between oestradiol and testosterone was found (r = 0.55, p less than 0.02) which suggested that the elevated oestradiol levels were only partly derived from the aromatization of testosterone. There were no differences in oestradiol or testosterone levels between the two diabetic groups. This study has shown that endogenous hyperoestrogenaemia is a consistent finding in diabetic men, irrespective of whether they have or have not sustained a previous myocardial infarction. The source of the raised oestradiol levels is uncertain. It is unclear whether hyperoestrogenaemia can be regarded as a risk for myocardial infarction in diabetic men.

Diabetes Complications↗
PubMed1986

A comparison of biosynthetic human insulin with porcine insulin in the blood glucose control of diabetic pregnancy.

Fifty insulin-dependent pregnant diabetic women were treated from presentation at the antenatal clinic with a regimen of either porcine or biosynthetic human soluble and isophane insulins. Blood glucose values, glycosylated haemoglobin, insulin requirements and outcome of pregnancy were compared in the two groups of patients. No difference was noted in blood glucose control, birth weight or neonatal complications. In the group treated with human insulin, fasting blood glucose could only be controlled by significantly greater doses of human isophane insulin injected before the evening meal. Furthermore, in two cases adequate glycaemic control required the injection of the evening human isophane insulin to be delayed until bedtime.

Adult↗
PubMed1986

Impaired thyrotrophin secretion following the administration of thyrotrophin-releasing hormone in type II diabetes mellitus.

Serum thyrotrophin has been measured before and after the intravenous administration of 200 micrograms of thyrotrophin-releasing hormone in 91 white subjects (33 stable diabetic patients and 58 healthy controls), none of whom had any clinical evidence of thyroid or pituitary dysfunction. Seven of the diabetic subjects failed to achieve a rise of serum thyrotrophin of greater than 2 mU/l above basal concentrations, as compared with only one of the control subjects (P = 0.006). The difference in response between diabetics and controls was confined to patients with Type II (non-insulin-dependent) diabetes: thus 5 of 13 Type II patients and 2 of 20 Type I (insulin-dependent) patients failed to show a normal response to thyrotrophin releasing hormone injection. No significant effect of glycaemic control on thyrotrophin responses was noted. These results suggest that Type II diabetes mellitus may be a cause of impaired thyrotrophin secretion in patients with no clinical evidence of pituitary disease. The mechanism for this impaired pituitary hormone release remains to be clarified.

Adolescent↗
PubMed1986

Effect of insulin therapy on coagulation and platelet function in type II (non-insulin-dependent) diabetes mellitus.

Twenty type II (non-insulin-dependent) poorly controlled diabetics had tests of coagulation and platelet function performed while receiving high-dose sulphonylurea therapy and at 1 and 3 months following their conversion to insulin. Although no overall change in glycaemic control (assessed by glycosylated haemoglobin) was noted, a reduction in thrombin generation was observed, as judged by a significant fall in fibrinopeptide A concentrations. No changes in factor VIII coagulant activity (VIII:C), factor VIII-related antigen or antithrombin III were found. Glycosylated haemoglobin concentrations showed significant correlations with antithrombin III and factor VIII:C, suggesting that improved glycaemic control might lead to an improvement of antithrombin III function and lower factor VIII:C concentrations. No changes in platelet function were detected. The introduction of an insulin regimen that improves glycaemic control might lead to a reversal of the 'hypercoagulable state' found in type II diabetes.

Aged↗
PubMed1986

Outcome of pregnancy in insulin-dependent (type 1) diabetic women between 1971 and 1984.

We have looked at the outcome of pregnancy in women with type 1 (insulin-dependent) diabetes mellitus who were confined at Glasgow Royal Maternity Hospital between 1971 and 1984. Of 134 pregnancies, 123 proceeded beyond 28 weeks' gestation and yielded 125 live infants. The perinatal mortality rate was 16/1000, due solely to congenital foetal malformation. Malformations were not related either to the severity of maternal diabetes (as graded by the White classification) or the glycaemic control in the first trimester (as judged by maternal glycosylated haemoglobin concentration). Over the period of study, there has been a marked reduction in the frequency of ketoacidosis during pregnancy and in the delivery of small-for-dates babies; more mature lecithin:sphingomyelin ratios have been obtained by amniocentesis; and better Apgar scores have been demonstrated in the infants at delivery. The Caesarean section rate has fallen from 83 to 30 per cent, and babies now spend less time separated from their mothers in paediatric units. These improvements largely reflect better diabetic treatment (improved insulin regimens and glycaemic control) and closer obstetric assessment. Foetal malformation occurred overall in 11.4 per cent of pregnancies and did not become less frequent over the period of study. Further major improvement in the outcome of diabetic pregnancy will only come from a reduction in the congenital malformation rate, which implies better diabetic control at and around the time of conception.

Adult↗