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J Páv

Publications and source records attributed to J Páv.

At least 19 recordsLinked to original sources
PubMed1998

[Personal experience with the treatment of organic hyperinsulinism].

In 1981-1997 at the Third Medical Clinic 52 patients with confirmed organic hyperinsulinism were treated. Forty-three were operated and the remaining nine were treated conservatively. An insulinoma was removed surgically in 35 patients, in one female microadenomatosis was detected. The operation was successful in 84%, while topographic preoperative examination aroused suspicion of a focus (i.e. insulinoma) only in 49% of the operated patients. A total of 11 patients (four after surgery and seven not operated) were treated successfully with diazoxide, in nine patients this treatment is still administered. According to the response to diazoxide it is possible to differentiate "responsive" and "non-responsive" insulinomas. Pharmacological treatment is thus justified only in the first group of patients. Surgically and pharmacologically treated patients have no signs of hyperinsulinism. The authors experience suggests that surgical treatment is indicated when the diagnosis is unequivocal even when the topographic finding of imaging methods is negative, as in 35% of operated patients the insulinoma was found only on operation.

Adolescent↗
PubMed1996

[Personal experience with the diagnosis of organic hyperinsulinism].

The diagnosis of organic hyperinsulinism was established in 47 patients based on the typical clinical symptomatology supported by laboratory evidence of hypoglycaemia and raised serum insulin concentrations. For the diagnosis of the disease the test of controlled fasting is suited best. During this test and after its termination the blood sugar level (in mmol/l), serum insulin (in mU/l) and their ratio (insulin/blood sugar) are assessed. In all patients the test had to be discontinued because clinical manifestations of hypoglycaemia developed which are typical for organic hyperinsulinism. Other methods, incl, examination by means of an isoglycemic clamp or insulin receptors are not specific and cannot be used for diagnosis. As to imaging (localisation) methods in the examined group the lowest yield was obtained by computed tomography (positive only in one patient), better results were obtained by sonography (21%) and angiography resp, (45%). When methods were combined an insulinoma was detected in 55% patients while on operation it was found in 82% patients. The authors' experience provides evidence that for the diagnosis of organic hyperinsulinism a decisive role is played by the clinical symptomatology supplemented by laboratory evidence of hypoglycaemia and possibly by a raised serum insulin concentration.

Adolescent↗
PubMed1995

[Factors with insulin-like effects: IGF-I and GLP-1].

In the submitted review the author discusses two substances secreted into the circulation which can similarly as insulin lower the blood sugar level. These substances are IGF-I (insulin-like growth factor I) and GLP (glucagon-like peptide). While in case of the former it is not certain whether it participates in the glucose homeostasis, this is beyond doubt in the latter. IGF-I prepared by the recombinant technique can be used therapeutically in cases of insulin resistance caused by a receptor or postreceptor disorder, because it may act via its own receptor. Side-effects after larger doses are a problem. GLP-1, the use of which would be useful in type 2 diabetics as it stimulates insulin secretion, is not used so far in therapy because hitherto prepared preparations have a very short period of a effectiveness.

Blood Glucose↗
PubMed1995

Clinical research of glucose metabolism.

Glucose metabolism in diabetes and in hypoglycemic states has been studied at IIIrd Medical Department for more than 30 years. The research is now concentrated on the evaluation of insulin action on receptor and postreceptor levels and in biochemical changes accompanying early stages of diabetic microangiopathy. The changes of insulin action has been examined by using the clamp techniques also in patients with organic hyperinsulinism. We study molecular changes of insulin action and pathogenesis of vascular complications.

Diabetes Mellitus↗
PubMed1994

[Thoughts on insulin therapy].

The submitted review concentrates on several important features of contemporary insulin treatment of diabetes (1). Only in the minority of cases, and only in insulin-dependent diabetes typical substitution treatment is involved. Even if it approaches physiological conditions, either by a permanent insulin supply beneath the skin by means of a pump, or using the tactics of several injections per day in the system called "basal bolus", it differs from the latter by the fact that it supplies insulin first into the peripheral circulation and not into the liver and does no imitate the pulsatile character of insulin secretion (2). Contemporary insulin preparations imitate only imperfectly the physiological rapid post-prandial rise of insulinaemia with a subsequent rapid drop. In an attempt to approach this as closely as possible various insulin analogues are used and substitution of amino acids in its molecules by others (3). The antibody formation against insulin was restricted to a great extent by the introduction of mono-component insulin but was not eliminated even when biosynthetic human insulin is used. The importance of these antibodies is, however, in common cases small and is manifested by a prolonged period of action (4). Non-substitutional insulin administration in non-insulin dependent diabetes is indicated where without it satisfactory compensation of diabetes is not achieved. There are favourable reports on combined treatment with insulin and oral antidiabetics in this type. The risk are in particular undesirable body weight increments.

Diabetes Mellitus, Type 1↗
PubMed1994

[Hypoglycemia and modern treatment of diabetes].

During insulin treatment, when the objective is to achieve blood sugar levels as close as possible to normal values by an intensified regime, hypoglycaemia is three times as frequent as compared with the conventional regime. The author discusses in the submitted review the relationship between a reduced blood sugar level and associated symptoms, he describes the counterregulation reparative response and draws attention to its changes in conjunction with prolonged duration of diabetes and mentions short-term as well as long-term consequences of hypoglycaemia. In the conclusion he mentions possible ways how to prevent this complication of insulin treatment.

Diabetes Complications↗
PubMed1991

[Evaluation of the status of diabetes mellitus during a 2-year period using traditional methods and determination of glycosylated hemoglobin A1c and fructosamine in the blood].

In the course of two years the authors checked 23 diabetic patients (13 type 2, 10 type 1), using the traditional approach, by assessment of haemoglobin A1c and serum fructosamine. The patients were classified according to compensation into four and three groups resp. Assessment of haemoglobin A1c evaluated the patients, in the same group as the traditional evaluation in 57.7% into the best compensated group and in 62.5% into the worst compensated group. In fructosamine agreement with traditional evaluation in the best compensated group was in 84.2% and in the worst compensated group in 50.0%. In 40.2% the evaluation was in agreement for all three methods of evaluation, differences between evaluation according to haemoglobin A1c and serum fructosamine were recorded in 51.5%. Assessment of haemoglobin A1c and serum fructosamine improves information on the state of diabetes, concurrent estimation of both is, however, often associated with difficulties as regards interpretation. These problems are discussed in the presented paper.

Diabetes Mellitus↗
PubMed1991

[Variations in the dietary regimen in type I diabetes mellitus. I. Short-term use of a high-carbohydrate diet].

For a period of two days, while maintaining compensation of diabetes mellitus type I (treated by insulin pump), the authors replaced the usual diabetic diet by a bland carbohydrate diet (2.6 +/- 0.6 MJ/24 h, practically without amino nitrogen). This resulted in a negative energy and nitrogen balance with an indicated adaptation reaction on the second day of administration--reduced amount of catabolic urinary nitrogen, concentration of non-esterified serum fatty acids suggested a slightly increased lipolysis. The insulin consumption per 24 h was significantly reduced, as compared with the control day. A low energy carbohydrate diet is, when administered for a short period under careful control of compensation of diabetes type I, relatively safe and can be used e. g. during intercurrent digestive diseases.

Adult↗
PubMed1991

[Changes in the dietary regimen during treatment of type I diabetes mellitus with continuous insulin infusion. II. Omitting food].

UNLABELLED: The authors investigated in 11 type diabetics the effect of omission of a meal on the compensation of diabetes during treatment with an insulin pump IP 1003. After stabilization of treatment by the pump, the patients were left on the 5th day without breakfast, while the basal operation of the pump was maintained and the patient received their insulin bolus in the morning. The test was terminated as planned after 180 mins. in 6 patients, in 5 it was terminated early because of typical signs of clinical hypoglycaemia. The course of the blood sugar curves revealed differences between patients from abrupt drops of hyperglycaemic values to hypoglycaemia to balanced low blood sugar levels. For the rest of the day till the following morning after the test the blood sugar was elevated, as compared with the control level of the 4th day. CONCLUSIONS: the tests revealed the relatively small drop of the blood sugar level after omission of the meal, hypoglycaemia develops in the majority of diabetics only after 120 to 180 mins. The danger of early hypoglycaemia within 60 minutes was recorded only in patients with a known history of severe hypoglycaemic states. Posthypoglycaemic hyperglycaemia influences the compensation of diabetics during the rest of the day.

Adult↗
PubMed1990

[The development of theories on the mechanisms of insulin action].

In 1924 Laufberger formulated his block theory on the action of insulin. Its basic thesis that insulin prevents the new formation of glucose and its supply into the blood stream is still valid, although knowledge on the multiple action of insulin expanded substantially. The theory put forward in 1955 by Levine and Goldstein which ascribed all insulin actions to the influence on the cellular membrane permeability for glucose, could, however, not explain all data associated with insulin, the knowledge of which was expanded steadily. At present the mechanism of insulin action is explained most comprehensively by the concept based on the bond of insulin to its membrane receptor which by activation of tyrosine kinase it contains induces either cascade phosphorylation of intracellular protein kinases or (and) leads to the release of the "second messenger" from the cell membrane, i.e. of glycosyl-phosphatidyl inositol. In both instances activation of the glucose and amino acids transmitter from the medium into the cells results, as well as activation of enzymes catalyzing in the cell various degrees of carbohydrate, fat and protein metabolism.

Czechoslovakia↗
PubMed1990

[Compensation in diabetes and serum insulin levels in type I diabetics during insulin pump therapy and after changing to treatment with a combination of short- and long-acting insulin].

Twenty-one type diabetics previously treated in the conventional way with insulin with unsatisfactory results were admitted to hospital. The blood sugar level, serum insulin and non-esterified fatty acids in serum (NEFA) were assessed from 6 a.m. to 2 a.m. during treatment with an insulin pump and after changing the patients to insulins with varying length of action. Patients in the following groups were followed up separately: a) patients with antibodies against insulin treated either by two (n = 4) or three (n = 12) injections; b) patients with antibodies (n = 16) and without antibodies (n = 5), regardless of the number of insulin injections. Changes from the insulin pump regime implied an increased insulin requirement, (significant only in group b) and deteriorated compensation of diabetes which was more markedly manifested when evaluated by index M according to Schlichkrull with the exception of the group without antibodies, where M remained despite the increase in the range of satisfactory compensation. The NEFA profile behaved in a reversed manner, as compared with the serum insulin level. The results confirm the greater success of insulin pump treatment when attempting to maintain the blood sugar level as close as possible to normal values. From the analysis of the blood sugar and serum insulin profile recommendations for the tactics of treatment are derived, when the use of an insulin pump is not possible.

Adult↗
PubMed1990

[A consulting system for insulin therapy in diabetes].

The authors describe a computer system which provides consultations on insulin treatment of diabetes. The intentions and aims of computer consultation and means for their implementation are described. The basic element of the system is the model of insulin pharmacodynamics. Two concepts are used to differentiate individual characteristics of the patient: the basal need and insulin sensitivity. The basal need is the amount of insulin which maintains the blood sugar level at the desired level in the course of the day, provided the subject adheres to a standard regime. The insulin sensitivity represents the sensitivity of the glucose metabolism to deviations from the basal requirement. These purely individual parameters are currently adapted by the "learning" module. The module compares the assessed and predicted blood sugar levels and corrects the parameters to achieve a minimum difference. The accuracy of approximation depends on the number of assessed blood sugar levels. The system foresees a minimum of two assessments per day. Individualized parameters are used for the prediction of the blood sugar level. The system visualizes predicted blood sugar levels for manually administered alternative insulin doses. The module of the automatic therapeutic plan is part of the module. The system recommends treatment with an "optimal" development of the predicted blood sugar level. As a criterium of the optimal profile of the blood sugar level the M-value was selected which is used for the evaluation of the daily blood sugar profile. The predictive capacity of the system was evaluated on the basis of retrospective data.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus↗
PubMed1989

[Hyperlipoproteinemia and the genetic epidemiology of diabetes mellitus].

Cardiovascular diseases are the most frequent cause of mortality in the sub-population of type II diabetics (cca 600,000 in the CSSR). Type II diabetics very frequently cumulate several very serious risk factors (hyperlipoproteinaemia, arterial hypertension, obesity, hyperuricaemia, smoking) for the manifestation of cardiovascular disease. Concurrent comprehensive treatment of all revealed risk factors is essential for primary prevention. Systematic application of methods of genetic epidemiology in families of affected diabetics helps to detect in time and to treat other affected members of the family. It is at the same time a rational way of primary prevention of cardiovascular disease in the highest risk sub-populations. The authors submit an algorithm of treatment of hyperlipoproteinaemic type II diabetics.

Aged↗
PubMed1989

Use of euglycaemic clamping in evaluation of diazoxide treatment of insulinoma.

The use of diazoxide in patients with insulinoma has been evaluated using the euglycaemic clamp technique. There was significantly reduced mean tissue sensitivity to insulin, expressed as the ratio of glucose disposal rate to serum insulin concentration (M/I), in untreated patients compared to the control group. The metabolic clearance rate of insulin (MCRI) was reduced in the patients before treatment in comparison with the controls. The administration of diazoxide (Proglicem1) for three days (3 mg.kg-1 per day) caused a fall in serum insulin concentrations, together with an increase in the metabolic clearance rate of insulin and increased tissue sensitivity to insulin.

Adenoma, Islet Cell↗