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Biomedical subjects

R B Tattersall

Publications and source records attributed to R B Tattersall.

At least 91 records · Page 5Linked to original sources
PubMed1982

Insulin-induced hypoglycaemia in an accident and emergency department: the tip of an iceberg?

In one year a prospective survey in a large accident and emergency department identified 204 admissions of adults with severe hypoglycaemia, 200 in insulin-treated patients. Ninety-six had one admission while 34 others were admitted on 104 occasions. Of the 130 patients, 111 attended diabetic clinics in Nottingham, forming 9% of a known clinic population of 1229 on insulin treatment. Since many other episodes of hypoglycaemia were presumably treated outside hospital, 9% a year is a minimum estimate of the incidence of severe hypoglycaemia in our area. The mean insulin dose was 1.2 units/kilogram/day for those admitted twice or more and 0.9 U/kg/day for those admitted once; these doses were significantly higher than those of an age-matched clinic population. A year after the latest admission with hypoglycaemia, the mean insulin dose in the group with two or more admissions had fallen to 0.8 U/kg/day, suggesting that over-treatment had been an important causal factor. A similarly high incidence has been reported in other studies, and we believe that it is due mainly to the inadequacy of conventional subcutaneous insulin treatment.

Adolescent↗
PubMed1981

Severely uncontrolled diabetes in the over-fifties.

Between 1969 and 1976, 317 adults were admitted to hospital in Nottingham with severely uncontrolled diabetes (plasma glucose over 33 mmol/l and/or venous bicarbonate less than 14 mmol/l). A third of episodes were in patients over the age of 50 years, of which 43% were fatal. In contrast, only 3.4% of episodes in patients under 50 years were fatal. In the older group, 65% of deaths occurred within 48 h of admission and in 44% no cause was found other than uncontrolled diabetes. Later deaths were due to underlying disease, infection or thromboembolism. Amongst older patients 38% were not previously known to have diabetes. Presentation to hospital was late and we conclude that many deaths were potentially avoidable by earlier detection in the community.

Age Factors↗
PubMed1980

In search of the Somogyi effect.

Insulin-treated diabetic patients may show a rapid swing to hyperglycaemia after episodes of hypoglycaemia. This rebound hyperglycaemia, or Somogyi effect, is thought to be caused by the unopposed actions of hormonal antagonists to insulin secreted in response to hypoglycaemia. To test this theory a study was made of 15 patients who had 17 episodes of asymptomatic untreated hypoglycaemia (blood-glucose less than 2 mmol/l) between 11 P.M. and 3 A.M. After nocturnal hypoglycaemia, mean fasting blood-glucose concentrations at 7 A.M. ranged from 0.7-17 mmol/l and were over 7 mmol/l in 6 patients. These 6 patients with apparent rebound hyperglycaemia did not have higher levels of growth hormone, cortisol, or glucagon than those who had little or no recovery of blood-glucose. There was a close inverse correlation (r = -0.996, p < 0.001) between blood-glucose and free insulin, suggesting that hyperglycaemia, when present, was due to relative insulin deficiency in the latter part of the night. Early changes in blood-glucose after untreated hypoglycaemia seem to be primarily due to changes in free insulin rather than a response to antagonist hormones.

Activity Cycles↗
PubMed1980

Insulin-induced lipoatrophy: evidence for an immune pathogenesis.

Skin biopsy samples from 14 diabetic patients with lipoatrophy at injection sites and from five insulin-treated diabetic patients without such lipoatrophy (controls) were examined by immunofluorescence for the deposition of immunological components. Also sera from 13 of the patients with lipoatrophy and from all of the controls were assayed for insulin-binding capacity. Biopsy samples from the edge of lipoatrophic areas (eight cases) invariably showed abnormal deposition of immunological components in dermal vessel walls, whereas no such deposition was seen in the control samples. Mean serum insulin-binding capacity was 33.1 microgram/l in the patients with lipoatrophy compared with only 4.6 microgram/l in the controls. These findings suggest that insulin-induced lipoatrophy results from the local formation of immune complexes, complement fixation, and release of inflammatory mediators from the cellular infiltrate.

Adolescent↗
PubMed1979

Self-monitoring of blood glucose in diabetic pregnancy.

Admission to hospital is usually recommended to achieve the best possible diabetic control during pregnancy. We have used blood glucose monitoring at home to find out if patients can achieve equally good control outside hospital. Twenty-five consecutive diabetic patients were studied, of whom 20 had taken insulin before pregnancy. Six of their 14 previous pregnancies had ended in perinatal death. The 25 women performed 4247 blood glucose measurements during their pregnancies. Overall the mean blood glucose concentration was 7.1 mmol/l (128 mg/100 ml); before meals the mean was 6.5 mmol/l (117 mg/100 ml). Mean concentrations were lower in the third trimester, but at no stage was control in hospital significantly better than at home. The mean hospital stay before delivery was 22 days, and all patients had live babies. Monitoring blood glucose concentrations at home produces greater understanding and motivation among patients, improves control early in pregnancy, and shortens time spent in hospital.

Adolescent↗
PubMed1979

Unrecognised nocturnal hypoglycaemia in insulin-treated diabetics.

Overnight metabolic studies in 39 poorly controlled insulin-treated diabetic patients aged 9 to 66 years showed hypoglycaemia (blood-glucose less than 2 mmol/1) in 22 patients; it lasted 3 h or more in 17. Hypoglycaemic symptoms were very mild or absent, but 19 patients had other features of overtreatment with insulin. These included lethargy, depression, night sweats, morning headaches, fits (3 patients), glycogen-laden hepatomegaly (3), and acquired tolerance to high doses of insulin (mean 1 u/kg/24 h). The best clinical clue to recurrent nocturnal hypoglycaemia was the intermittent occurrence of symptoms, however "mild" and infrequent these appeared to be. Reduction of insulin by a mean of 25% in these patients (without change of species) did not result in loss of overall control; 1 patient with recurrent ketoacidosis was stablished on 40% of his initial dose. It is difficult, sometimes impossible, to achieve good overnight control with conventional once or twice daily insulin therapy. Since patients readily become tolerant of low blood-glucose levels, reliance on urine tests and symptoms of hypoglycaemia as a guide to dosage easily produces a spiral of overtreatment.

Adolescent↗
PubMed1979

Remittent painful ophthalmoplegia: the Tolosa-Hunt syndrome? A report of seven cases and review of the literature.

Seven patients with remittent painful ophthalmoplegia for which no specific local cause was found were seen during a period of five years. One had coincidental rheumatoid arthritis, and another had actinomycosis of the ipsilateral middle ear and contralateral parotid gland. The other five had no evidence of generalised autoimmune disease nor any other systemic disorder, two having separate episodes affecting each side. A history of relapsing and remitting painful ophthalmoplegia is suggestive of the Tolosa-Hunt syndrome, but it is rarely possible to confirm that the lesion in the cavernous sinus is the result of non-specific granulomatous infiltration so that the diagnosis remains one of exclusion. Carotid arteriography may show narrowing of the intracavernous part of the internal carotid artery. Orbital venography may also be helpful, particularly when the carotid arteriogram is normal. We believe that the Tolosa-Hunt syndrome is more common in England than is generally realised, but that its clinical features do not necessarily indicate a single pathological entity. Its recognition is important since the response to steroids, although not specific, is rapid in most patients, and the prognosis for complete recovery is relatively good.

Actinomycosis↗
PubMed1978

Hypothermia: a complication of diabetic ketoacidosis.

During 1969-77, 20 episodes of severe hypothermia occurred in 19 diabetic patients in Nottingham. Thirteen were associated with ketotic hyperosmolar coma, two with lactic acidosis, and one with hypoglycaemia, while in four there was no loss of diabetic control. Ketoacidosis accounted for 11.8% of all admissions for severe accidental hypothermia and was a commoner cause than hypothyroidism (8%). Patients with ketoacidosis were younger and developed hypothermia as often during the summer as during the winter. The metabolic disturbance was characteristic, with severe acidosis (mean pH 7.04), a high blood glucose concentration (mean 56.6 mmol/l; 1020 mg/100 ml), and high plasma osmolality (mean 379.7 mmol (mosmol)/kg). Eight of the 13 episodes proved fatal. Hypothermia may aggravate ketoacidosis and complicate treatment and should be sought in all patients with severe diabetic coma.

Adult↗
PubMed1978

Self-monitoring of blood-glucose. Improvement of diabetic control.

An accurate pattern of blood-glucose changes in everyday life is the basis for treatment in insulin-dependent diabetes. 69 patients were taught to obtain their own blood-glucose profiles with a 'Reflomat' Boehringer Mannheim) reflectance meter on one working and one rest day, and to repeat these where necessary after adjustment of treatment. 2 did not complete the study satisfactorily. The other 67 produced profiles on 241 dyas. Even patients with a limited education could use the technique accurately and their readings correlated closely with simultaneous laboratory values (r = 0.96). Self-monitoring was especially useful in elucidating problems in diabetic control, preventing hypoglycaemia, and managing diabetic pregnancy. Unlike the measurement of HbA1c which only detects poor diabetic control, self-monitoring also shows how to improve it. Patients found self-monitoring more informative than urine tests; their active involvement in management of their disease resulted in better motivation, greater understanding of diabetes, and a sustained improvement in control. By the end of the study 32 of the 67 patients ahd profiles in which no more than one blood-glucose value exceeded 10 mmol/l. Smaller and more portable machines will make the technique more widely applicable.

Adolescent↗