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Biomedical subjects

H Dorchy

Publications and source records attributed to H Dorchy.

At least 73 records · Page 4Linked to original sources
PubMed1989

Sport and the diabetic child.

The triad of insulin, diet and exercise has been the basis for treatment of diabetes for several decades. However, the choice of sporting activities for young diabetics requires an understanding of: (a) the energy metabolism and the adaptation to physical activity in the healthy; (b) the metabolic adaptation during physical activity in the diabetic child; and (c) the practical recommendations concerning diet and insulin that have to be learned by the children themselves. The healthy child utilises immediately available substrates, such as ATP and creatine phosphate in much the same fashion as the adult. However, the capacity for anaerobic degradation of glycogen and glucose seems limited in the muscles of children relative to that of adults. Consequently, the adaptation to resistance exercise should be undertaken with prudence in children and adolescents. In diabetic children, an adequate insulin therapy is required to allow the full benefit of muscular activity on glucose assimilation and to reach the same level of physical performance as the non-diabetic. In the case of insufficient metabolic control, exercise can provoke severe hypoglycaemic episodes, even after muscle activity has ceased, or increase glucose levels and lead to ketoacidosis. Regular physical training induces a reduction in postexercise proteinuria measured in diabetic adolescents but its role in metabolic control remains controversial. If a diabetic child or adolescent follows individual recommendations concerning diet and insulin, he or she can perform physical activity much the same as a young non-diabetic. These recommendations include: (a) self-measurement of blood glucose concentration before and after exercise; (b) ingestion of carbohydrates before, during, and after exercise; (c) reduction of the insulin dose during and immediately after exercise; and (d) not choosing an injection site involved with muscular work. The only prohibited sports are those which constitute a danger to the diabetic child by provoking an eventual hypoglycaemia. The best sports are those that require progressive physical effort and that are spread out over several hours.

Adolescent↗
PubMed1988

[A pen-injector of insulin in young diabetics: freedom and excessive weight gain].

This study was undertaken to evaluate the use of a pen injector (Novopen) in 23 type I diabetic adolescents and young adults between 14 and 28 years of age. All patients were diabetic before age 15 and the duration of diabetes varied from 5 to 23 years. All patients were previously treated with a conventional regimen of Actrapid HM and Monotard HM or Protaphane HM twice daily (0.98 +/- 0.24 U/kg/day). The patients used Novopen to inject Actrapid HM in a bolus regimen with Ultratard HM as basal insulin, administered before bedtime. The mean duration of the Novopen experience was 8.1 months [1-12]. During the first 4 months after transfer to Novopen, the total daily dosage of insulin was higher than 1 U/kg; afterwards the insulin needs decreased to 0.8 U/kg (at 12 months). On the other hand, the weight/height ratio increased significantly from the 4th month. After one year, the mean increase was 14%. The "objective" determination of metabolic control was obtained by measuring total glycosylated haemoglobin, the mean level of which was unchanged after the transfer to Novopen. The patients' self evaluation of the therapy was documented by asking them to fill in a questionnaire. Results were as follows: 91% of the patients considered the use of Novopen more pleasant than the previous injection therapy; 87% reported a greater freedom regarding diet; 83% found Novopen easier to handle than syringes; 74% experienced greater freedom in everyday life; 70% found the injection by Novopen less painful; 61% considered that their metabolic control improved; 39% experienced minor signs of hypoglycaemia more frequently; 100% wanted to continue on Novopen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Femoral versus peroneal neuropathy in diabetic children and adolescents--relationships to clinical status, metabolic control and retinopathy.

In order to estimate the prevalence of diabetic neuropathy in proximal and distal peripheral nerves, femoral and peroneal motor conduction was evaluated in 61 diabetic children, adolescents and young adults whose type 1 diabetes had become clinically apparent before the age of 14 years. Femoral motor nerve conduction velocity (FMNCV) in diabetic patients (63.8 +/- 10.4 m/sec) was not significantly different from FMNCV in control subjects (65.6 +/- 7.1 m/sec). By contrast, peroneal motor nerve conduction velocity (PMNCV) in diabetic patients (50.2 +/- 6.9 m/sec) was significantly lower than in controls (54.1 +/- 3.5 m/sec). Distal motor weakness, sensory deficit and absent Achilles reflexes were strongly correlated to impaired motor conduction in peroneal and also in femoral nerve. Peroneal nerve abnormality was negatively correlated with HbA1 levels, while femoral nerve abnormality was positively correlated with the presence of retinopathy. This discrepancy is not fully understood. Age and duration of diabetes were unrelated to femoral or peroneal motor nerve conduction velocity. Our data emphasize the frequent occurrence of subclinical proximal neuropathy in diabetic children and adolescents.

Adolescent↗
PubMed1986

HLA-DR 3 is associated with a more slowly progressive form of type 1 (insulin-dependent) diabetes.

The presence of HLA-DR 3 was analysed in 745 patients with Type 1 (insulin-dependent) diabetes with age at diagnosis between 1-19 years. HLA-DR 3 and/or 4 was found in 678/745 (91%) of the patients. Presence of DR2 with neither DR 3 nor 4 was demonstrated in 15 patients. Patients with HLA-DR 3 without DR 4 presented with Type 1 diabetes more evenly over the year; they also presented without incidence peaks at 7 years or 10-11 years, as seen especially in DR 3/4 patients. The DR 3 patients more often had mild disease with less ketonuria at diagnosis, less often ketoacidotic symptoms and more often a subsequent partial remission. The apparently more severe disease among diabetic girls may, at least to some extent, be explained by their higher prevalence of HLA-DR 4. The differences found were similar in North America and Europe. The results suggest that Type 1 diabetes is a genetically heterogeneous disease and that HLA-typing may be a useful marker of this heterogeneity.

Adolescent↗
PubMed1986

Influence of the degree of metabolic control on physical fitness in type I diabetic adolescents.

Seventeen type I male diabetic adolescents and 17 control subjects matched for age, height, and weight were submitted to maximal exercise on a bicycle ergometer. The diabetic subjects were divided into two groups according to their degree of metabolic control using total glycosylated hemoglobin (HbA1): group 1, diabetics with HbA1 less than 8.5% (n = 9) and group 2, diabetics with HbA1 greater than 8.5% (n = 8). Oxygen uptake, pulmonary ventilation, and heart rate were recorded at rest and at maximal load. Glucose, lactate, and free fatty acids were determined in blood before and after exercise. Maximal work load and oxygen uptake were significantly lower in the two diabetic groups than in the healthy controls. An inverse relationship was observed between HbA1 concentration and the maximal work load (r = -0.63; P less than 0.01). It can be concluded that diabetic adolescents should obtain the best possible degree of metabolic control to improve their performances.

Adolescent↗
PubMed1985

Peroneal motor nerve conduction velocity in diabetic children and adolescents. Relationships to metabolic control, HLA-DR antigens, retinopathy, and EEG.

To investigate incipient diabetic neuropathy, peroneal motor nerve conduction velocity (PMNCV) was measured in 61 diabetic children and adolescents whose type 1 diabetes became clinically apparent before the age of 14 years. PMNCV in diabetic patients (48.3 +/- 5.6 m/s) was significantly lower than in controls (56.5 +/- 5.5 m/s), 23 diabetics (36%) having a value more than 2 SD below the mean for normals. There was a highly significant negative correlation between PMNCV and HbA1 levels concomitant with PMNCV measurement or mean annual HbA1 concentrations preceding PMNCV. The relationship between PMNCV and the clinical score of diabetic control since the onset of the disease was also significant. Age, duration of diabetes and HLR-DR antigens were unrelated to PMNCV. EEG abnormalities and retinopathy, whose pathogenesis is different, were not necessarily associated with subclinical neuropathy. Being easy and sensitive, PMNCV determination provides the paediatric diabetologist and the patient himself with an important motivation to improve diabetic control.

Adolescent↗
PubMed1985

Transient acute disc swelling associated with improved metabolic control in an adolescent with type-I diabetes: role of dexamethazone therapy.

Acute disc swelling in type-I diabetic patients is a distinct syndrome that may be distinguished clinically, particularly from papilloedema due to increased intracranial pressure. This paper reports the first detailed case of this rare condition in which disc swelling seems to be associated with rapid improvement of metabolic control. We suggest that the pathogenesis of disc swelling is related to a local breakdown of the blood retinal barrier at the level of the optic nerve, resulting in an intense leakage. Compression of the optic nerves secondary to this vasculopathy appeared to be reversed by administration of dexamethazone. It is suggested that in diabetic patients with long-standing poor metabolic control, rapid conversion to good metabolic control could have this result. However further information is necessary to substantiate this relationship.

Adolescent↗
PubMed1985

Subclinical thyroid hormone abnormalities in type I diabetic children and adolescents. Relationship to metabolic control.

The serum levels of thyroid hormones and thyroid stimulating hormone were compared in 64 type I diabetic children and adolescents without ketosis and in 28 age matched normal subjects. Only T3 levels were significantly different in the diabetic patients (2.38 +/- 0.41 nmol/l) than in controls (2.64 +/- 0.52 nmol/l) (p less than 0.01) confirming the existence of the 'low T3 syndrome' in diabetic children. A negative correlation was found between T3 and blood glucose as well as glycosylated haemoglobin suggesting that short-term hyperglycaemia could regulate T3 concentration. Thyroid function was not different in diabetic children with or without thyroid antibodies. We conclude that serum T3 level is influenced by the degree of metabolic control and that thyroid function in diabetic children should be assessed by the measurement of the serum concentration of T4, FT4 and TSH.

Adolescent↗