[The cardiac complications of meningococcal infections].
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Biomedical subjects
Publications and source records attributed to J Mockel.
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The present study was designed to evaluate the long-term effects of a short course of insulin therapy on glycaemic control in type 2 diabetic patients after failure with oral therapy. Twenty type 2 diabetic patients poorly controlled with maximal doses of sulfonylurea were given intensified insulin treatment for 12-14 days adjusted so as to achieve near normoglycaemia. They were then restarted on their previous oral medication to which one bedtime injection of NPH insulin was added if the mean diurnal glucose profile exceeded 10 mM (n = 8). At the follow up evaluation (n = 18), 6 +/- 1 months later, fasting glucose (12.3 +/- 1.1 to 8.3 +/- 0.6 mM) and HbA1c (10.2 +/- 0.5 to 8.5 +/- 0.5%) levels were significantly improved in the patients receiving a combined therapy. In the group maintained on sulfonylurea alone, fasting glucose (13.2 +/- 0.7 to 6.9 +/- 0.7 mM) and HbA1c (9.6 +/- 0.6 to 6.9 +/- 0.6%) were also significantly improved in 5 patients who had lost weight (-6 +/- 1 kg) whereas none of these parameters were significantly different from the preinsulin value in the 6 patients whose weight remained unchanged. In conclusion, the current results do not provide any evidence that short-term insulin therapy is able to reinduce the efficacy of a previously ineffective sulfonylurea treatment, on a long term basis.
In the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), rapid elevation of serum sodium concentration may be imperative to correct neurological symptoms. Seven patients with hyponatremia secondary to SIADH were treated by oral intake of two to three doses of 30 g of urea over 24 hours or infusion of 80 g of urea as a 30% solution of over six hours, water restriction (500 mL/24 hr), and sodium supplements (120 to 360 mmole/24 hr). Serum sodium concentration increased from 117 +/- 2 to 126 +/- 1.4 mmole/L (mean +/- SEM) after eight hours, to 130 +/- 1.3 mmole/L after 12 hours, and to 134.5 +/- 1.2 mmole/L after 24 hours. The normalization of serum sodium was secondary to osmotic diuresis and to sodium retention induced by urea. Use of urea should be considered when symptomatic hyponatremia in SIADH must be quickly corrected.