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Biomedical subjects

J M Steel

Publications and source records attributed to J M Steel.

At least 73 records · Page 4Linked to original sources

An assessment of a reflectance meter system for measurement of plasma or blood glucose in the clinic or side ward.

The Reflomat System for rapid estimation of plasma or blood glucose concentration has been evaluated. The System gave a linear response throughout its analytical range and the recovery of glucose added to glucose-free plasma was 97-105%. Addition of sodium fluoride to plasma produced a 7-15% reduction in the estimated glucose concentration. Plasma glucose concentration estimated with the Reflomat agreed closely with results of a glucose oxidase and a hexokinase based method, and blood glucose concentration measured with the Reflomat agreed well with results of a glucose oxidase method.

Blood Glucose↗

Urinary glucose testing by diabetic patients.

One hundred diabetic patients were watched while testing urine with "Clinitest" tablets. Only 20 made no mistakes. The main errors were in the use of the dropper and timing. We consider that more time should be spent on the initial instruction of patients.

Adult↗

Withdrawal depression in obese patients after fenfluramine treatment.

Measurements of subjective feeling in 20 patients receiving fenfluramine alternating with placebo and in 19 patients receiving phentermine alternating with placebo indicated that depression of mood occurred four days after fenfluramine withdrawal but no such depression was seen with phentermine.

Adult↗

Observations on the metabolic basis for altered insulin dose distribution in diabetic pregnancy.

Insulin requirements are known to increase during pregnancy, but it has not been reported whether this relates to prandial or basal requirements, or to a change in insulin pharmacokinetics. In nine unselected pregnant patients the pattern of this increase was that of a large increase in the total morning dose and a reduction in the evening dose of intermediate acting insulin, in order to maintain good control while avoiding nocturnal hypoglycaemia. 24 h metabolic profiles were carried out in these patients in the third trimester of pregnancy. Plasma free insulin profiles reflected the dosage patterns and there was no change in insulin metabolic clearance rate in pregnancy. Pregnant diabetic patients had a broad peak of free insulin concentration around lunchtime followed by a steady fall until next morning. Blood lactate and alanine were higher than normal and 3-hydroxybutyrate lower than is usually seen in non-pregnant diabetic patients. The observations suggest that there may be differential changes in insulin sensitivity in diabetic pregnancy between the fed and fasting states, and that the therapeutic response to this causes a measurable metabolic change.

3-Hydroxybutyric Acid↗

Pregnancy after vitrectomy for proliferative diabetic retinopathy.

A 26-year-old female with insulin-dependent diabetes of 16 years duration had a vitrectomy for a dense non-resolving vitreous haemorrhage. Two months later she became pregnant. She delivered a healthy baby and despite the known adverse effects of pregnancy on retinopathy no deterioration occurred in visual acuity or in retinal appearance.

Child↗

Haemoglobin A1 and congenital malformation.

Two hundred and thirty pregnancies were studied in 196 diabetic women. Seven women with babies found to have major malformations had a higher median first trimester haemoglobin A1 (12.9%) than the median HbA1 (10.8%) in those with normal babies (p = 0.06). No relationship was found between the occurrence of minor malformations and first trimester maternal haemoglobin A1. Two of the seven congenital malformations were diagnosed antenatally at a time when therapeutic abortion could be offered. Expert antenatal ultrasound scanning should be offered to all pregnant diabetic women as poor glycaemic control at the time of conception and organogenesis, as evidenced by raised first trimester HbA1, predisposes to congenital malformation.

Adult↗

Contraception for the insulin-dependent diabetic woman: the view from one clinic.

Experience in a large diabetic clinic has confirmed the suspicion that insulin-dependent diabetic women are at considerably increased risk of thromboembolic disease if they take combined estrogen/progestogen oral contraceptive preparations. The most obvious alternative, an intrauterine device, is associated with an unexpectedly high failure rate, probably because of an unusual metabolic interaction with the diabetic endometrium. In a small group of diabetic women the progestogen-only pill was found to be a successful form of contraception not associated with any side effects except for menstrual irregularities. For most diabetic women the choice of contraceptive should therefore be between a progestogen-only pill and a mechanical method. Female sterilization and injectable progesterone each have their place in particular circumstances. Careful counseling of each patient is essential to ensure the best choice of contraceptive and correct application of the chosen method.

Adult↗