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K Howorka

Publications and source records attributed to K Howorka.

15 recordsLinked to original sources
PubMed1988

[Conventional or functional insulin therapy?].

The main difference between "conventional" and "functional" insulin replacement is that the former requires meals to be taken at set times throughout the day to avoid hypoglycaemic insulin reactions, while the latter separates insulin replacement in the basal ("fasting") state from that required with food intake. Such strategy reverses conventional insulin treatment (namely balancing the action of administered insulin by a fixed dietary intake), by substitution with a functional control of hyperglycaemia on the basis of tailored insulin doses. To this end blood glucose self control and systemic blood glucose correction are a must during functional insulin substitution, but not necessarily so during conventional insulin therapy. From this it is apparent that "conventional" and "functional" insulin therapy refer to different strategies, both of which may be intensified by more strict rules, although the term "intensified" remains without any conceptional meaning per se. However, whatever the therapeutic recommendation, the attending physician has to be aware that he must appropriately inform and train the insulin-deficient patient (a) on how to deal with a proposed treatment schedule, and (b) to the point that he fully understands the available therapeutic possibilities and the difference in their quality. Experience has shown that a majority of informed patients opt for functional therapy.

Blood Glucose↗
PubMed1987

[Type I diabetes mellitus and pregnancy: an interdisciplinary management program].

The obstetrical management of pregnant women with pregestational diabetes has been significantly improved throughout recent years. In the past, efforts to maintain euglycaemia during pregnancy in the presence of a labile maternal metabolism led to repeated, long-term hospitalization. In an interdisciplinary joint effort a protocol was delineated to obtain euglycemia throughout pregnancy by functional insulin therapy aiming at "near-normoglycemic insulin substitution (NIS)". In order to achieve this goal, home glucose monitoring and, depending on the glucose levels, self-made adjustments to the insulin therapy (according to individual algorithm) are the essential parts of this protocol. Of our study group of 18 pregnant diabetic women, already eight of them (2 class B, 1 class C, 1 class D, 2 class R and 2 class RF) have been delivered. The mean maternal age was 27 years (21-39). All metabolic variables of consequence for a diabetic woman were within the normal limits. The mothers' mean weight gain was 16 kg (12-20), and the mean gestational age at delivery was 37.8 weeks (35-40). The mean birth weight was 3293 grams (2700-3700) and all newborns were within the 50th percentile. Five fetuses were delivered by caesarian section (indications: proliferative retinopathy 3, breech presentation 1, previous caesarian section 1). No congenital malformations were found, nor macrosomia, respiratory distress syndrome or postpartum hyperglycaemia in the newborn. These preliminary results are encouraging. We feel that functional insulin therapy aiming at "near-normoglycaemic insulin substitution" promises to be very effective for women who are able and willing to follow the instructions received in the special education program.

Adult↗
PubMed1971

[A new pipet ball].

Explore the source record for details and available documents.

Chemistry, Pharmaceutical↗
PubMedDate not supplied

Failure and efficacy of insulin therapy in insulin dependent (type I) diabetic patients.

In order to determine the degree of metabolic control (HbA1c [normal less than 5.8%], mean blood glucose [MBG], glucosuria and lipids) and the prevalence of late diabetic complications in insulin-dependent diabetic patients treated by conventional insulin therapy both patients of a diabetes center (DC: n = 130; age 37.1 +/- 1.4 years) and a rural area (RA: n = 73; age 38.4 +/- 2.4 years) were examined within their local setting. Eighty such insulin-dependent diabetic patients were also taught a technique of near normal glycemic insulin substitution (NIS), which separates basal from prandial insulin replacement and instructs the patients to immediately correct self-controlled (3.8 +/- 0.1/day) aberrant blood glucose values. None of the groups on conventional insulin therapy was able to achieve satisfactory metabolic control or to avoid late diabetic complications, but rural patients were even worse off (BG 240 +/- 10 mg/dl; HbA1c 8.7 +/- 0.2% [normal: 3/73 = 4%]) than those of the DC (MBG 191 +/- 5 mg/dl; HbA1c 7.1 +/- 0.2% [normal: 27/130 = 21%]), while the prevalence of late diabetic complications was almost identical (RA/DC: neuropathy 22%/25%; retinopathy 41%/38%; macroangiopathy 15%/13%; but proteinuria 14%/5.4%). Metabolic control was improved by NIS with twice daily injections of basal (long acting) and separately of prandial (regular) insulin (total: 4.8 +/- 0.1 injections/day; MBG 130 +/- 2 mg/dl; HbA1c 5.8 +/- 0.1% [normal: 41/80 = 51%]. We conclude (1) that conventional insulin therapy just prevents metabolic catastrophe but in more than 79% of insulin-dependent diabetic patients lacks the ability to provide good metabolic control, while (2) NIS, a more physiological form of insulin therapy, improves this deplorable situation 5- to 12.4-fold.

Adult↗
PubMedDate not supplied

Phases of functional, near-normoglycaemic insulin substitution: what are computers good for in the rehabilitation process in type I (insulin-dependent) diabetes mellitus?

We have divided the rehabilitation process in patients with insulin-dependent diabetes mellitus into the following four phases. The basic phase, the so-called 'phase 0', provides information about literature, different strategies of treatment and introduces the use of regular insulin as well as blood sugar self-monitoring. During 'phase 1' (i.e. 'diabetes education common sense') all the initial information from 'phase 0' will be used practically and discussed in depth. After the patient's actual insulin need (U/24 h) has been estimated, initial algorithms for functional insulin use can be defined. And this is the turning point to 'phase 2' of the group rehabilitation process, the so-called education in functional insulin use. Initial algorithms should be understood as a preliminary answer to the patient's questions, 'What is my basal insulin need?', 'How much insulin do I need for a particular amount of carbohydrates?', and 'What is the hypothetical response of my blood glucose to a particular amount of insulin?'. These algorithms are going to be used and optimised now by the patient (under the supervision of the physician) during the so-called 'insulin games' (fasting or 24 h, experimental violation of traditional dietary rules, etc.) to demonstrate (1) how to influence actual glycaemia through immediate correction of blood sugar off blood sugar target (primary adjustment of insulin dosing), and (2) how to optimise algorithms for insulin use (secondary insulin adjustment) in future conditions of different insulin sensitivity. The 'phase 3' of individual teaching is an ongoing process of updating the patient's knowledge and practical skills.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMedDate not supplied

Diabetes care in rural area: clinical and metabolic evaluation.

To evaluate the efficacy of conventional diabetes care in a rural area, metabolic control and the presence of late complications were studied in 622 diabetic patients treated by general practitioners beyond the reach of diabetic centers. Seventy-three (12%) of the patients were classified as type I diabetics (age, 38.0 +/- 16.1 yr; duration of diabetes, 12.8 +/- 9.3 yr) and 549 as type II diabetics (age, 67.0 +/- 10.8 yr; duration of diabetes, 7.3 +/- 5.8 yr). Fifty-eight percent of type I diabetic patients administered insulin once daily and 42% twice daily, whereas most (83%) type II diabetics on insulin received only one insulin injection per day. Treatment of type II diabetic patients consisted of sulfonylureas (58%), diet alone (22%), insulin (18%), and biguanides or a combination of sulfonylurea with biguanides (2%). Poor therapeutic efficacy was observed in all patients, and postprandial hyperglycemia (blood glucose greater than 160 mg/dl) was predominant both in type I diabetics (86%) and in type II diabetics on insulin (80%) as well as off insulin (55%). HbA1c above normal (greater than 5.8%) was seen in 96% of type I and in 90 and 73% of type II diabetics with or without insulin therapy, respectively. Accompanying glucosuria was present in type I (73%) and in type II diabetics (on insulin, 71%; off insulin, 33%). Mean prevalence of late diabetic complications was greatest for insulin-treated patients (type I, type II with, and type II without insulin treatment: retinopathy, 41, 56, 22%; proteinuria, 13, 14, 3%; peripheral neuropathy, 21, 51, 12%), whereas macroangiopathy (16, 53, 31%) predominated in type II diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗