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Biomedical subjects

S M MacRury

Publications and source records attributed to S M MacRury.

14 recordsLinked to original sources
PubMed1995

Blood rheology and albumin excretion in diabetic pregnancy.

Blood rheology is altered in diabetes and also in non-diabetic pregnant women. The cumulative effect of hyperfiltration, abnormal rheology of pregnancy, and diabetes could be one mechanism contributing to increased intraglomerular pressure and albuminuria in diabetic pregnancy. We conducted a prospective study of 22 Type 1 (insulin-dependent) diabetic patients and 22 non-diabetic women to determine if there was an association of altered blood rheology on glomerular function in diabetic pregnancy. Albumin excretion showed no increment with increasing gestation and was similar in diabetic and non-diabetic women throughout pregnancy (first trimester: 5.0 (3.0-14.0) vs 5.8 (3.7-10.7) mg l-1, p = 0.89; second trimester: 6.0 (5.0-12.0) vs 5.1 (3.6-10.4) mg l-1, p = 0.25; third trimester: 7.5 (3.5-16.0) vs 4.9 (2.9-7.3) mg l-1, p = 0.18). Red cell aggregation index increased in both groups between the first and third trimesters (diabetic patients: mean difference 2.0; Cl: 1.0-2.9, p = 0.003, and control patients: mean difference 2.3, Cl: 1.0-3.5, p = 0.002). Fibrinogen levels were significantly higher between the third and first trimesters in diabetic patients (mean difference 0.7, Cl: 0.2-1.3 g l-1, p = 0.006). Pregnancy, therefore, was associated with increased red cell aggregation, related in part to increased fibrinogen levels but the extent of change was similar in diabetic and nondiabetic women and appeared to have no adverse effect on glomerular function in pregnant insulin-dependent diabetic women.

Adult↗
PubMed1993

A comparison of different methods of assessing free radical activity in type 2 diabetes and peripheral vascular disease.

Increased free radical activity in diabetes mellitus may contribute to the higher prevalence and mortality from macrovascular disease in diabetic patients. To investigate this, levels of plasma antioxidants (superoxide dismutase, caeruloplasmin, plasma, and lysate thiol), diene conjugates, lipid peroxides, and chemiluminescence were measured in diabetic and non-diabetic patients with peripheral vascular disease compared with healthy control subjects. Caeruloplasmin, diene conjugate ratio, and lipid peroxides were significantly increased in patients with vascular disease but there was no difference between diabetic and non-diabetic patients. Conjugated diene ratio correlated with caeruloplasmin (r = 0.40, p < 0.02) and inversely with superoxide dismutase level (r = 0.36, p < 0.05) but there was no significant correlation between other antioxidants and diene conjugates, lipid peroxides or chemiluminescence. The relationship between different indirect measurements of free radical activity is variable but there appears to be no additive effect of diabetes on the increased free radical activity associated with vascular disease.

Aged↗
PubMed1992

Sarcoidosis: association with small bowel disease and folate deficiency.

A 30 year old woman with recurrent anaemia due to folate deficiency had evidence of sarcoid granuloma on small bowel biopsy but was presumed to have Crohn's disease. The diagnosis of small bowel sarcoidosis was not seriously considered until she developed systemic manifestations of sarcoidosis (cutaneous and pulmonary lesions) over the following 20 years. Sarcoidosis of the gastrointestinal tract, particularly the small bowel, is rare and this case is unusual because bowel pathology preceded more generalised lesions. As far as is known it is also the first case to be described presenting with malabsorption of folic acid.

Adult↗
PubMed1992

Seasonal and climatic variation in cholesterol and vitamin C: effect of vitamin C supplementation.

Vitamin C (ascorbic acid) is an important anti-oxidant which may help to reduce free radical damage and atheroma formation in blood vessels. In a study in which a group of healthy volunteer subjects were followed up for 12 months and a group of patients with vascular disease taking Vitamin C supplements were followed for 23 months, we confirmed previous findings of seasonal variations in ascorbic acid and cholesterol and have shown an inverse relationship between leucocyte ascorbic acid and serum cholesterol levels. In healthy control subjects the increase in ascorbate and fall in cholesterol during the summer months was reversed when the weather changed to a more winter pattern, presumably due to dietary alterations. We found that ascorbic acid levels were lower in patients with peripheral vascular disease and that although normal ascorbic acid levels were achieved with Vitamin C supplementation, when supplements were stopped at the height of a normal summer, there was a fall in ascorbic acid and a rise in serum cholesterol to winter levels. Given these findings we suggest that patients with vascular disease should have Vitamin C supplements throughout the year.

Adult↗
PubMed1991

Serum fructosamine/haemoglobin A1 ratio predicts the future changes in haemoglobin A1 in type 2 (non-insulin dependent) diabetic patients.

The aim of the study was to define clinical interpretation of the parallel measurements of serum fructosamine and HbA1 in diabetic patients. We studied 14 type 2 diabetic patients over a 16-wk period. The cross-sectional analysis showed no correlation between serum fructosamine and HbA1 concentrations during the period of changing glycaemic control. The correlations, however, became significant (P less than 0.05) at 12 (r = 0.60) and 16 (r = 0.87) weeks, i.e. after glycaemia had stabilised. Longitudinal analysis of individual patients' data over the 16-wk period showed a significant correlation between serum fructosamine and HbA1 (r = 0.55 to r = 0.94) which was present in 8 out of 14 patients. The changes in fructosamine concentration preceded those observed in HbA1. The ratio of fructosamine/HbA1 predicted the changes in HbA1 over the following month (r = 0.54, P less than 0.001). Thus, we demonstrated that the parallel measurement of fructosamine and HbA1 provides information on future trends in HbA1 concentration in diabetic patients.

Adult↗
PubMed1991

Do rheological variables play a role in diabetic peripheral neuropathy?

Whole blood viscosity and its determinants were measured in diabetic patients with and without peripheral neuropathy to assess whether these variables could have a role in the microvascular aetiology of diabetic peripheral neuropathy. Although corrected whole blood viscosity at high and low shear rates (5.29 +/- 0.51 and 21.10 +/- 3.03 mPa s), plasma viscosity (1.41 +/- 0.13 mPa s), and red cell filtration ratio (0.49 +/- 0.04) in diabetic patients were significantly different from non-diabetic control subjects (high shear rate 4.83 +/- 0.54, low shear rate 17.36 +/- 2.78, plasma 1.29 +/- 0.09 mPa s, all p less than 0.001, and red cell filtration ratio 0.55 +/- 0.03, p less than 0.001) there were no significant differences between diabetic patients with neuropathy and those without. Blood rheology is altered to a similar extent in diabetic patients with and without neuropathy.

Blood Viscosity↗
PubMed1990

Evaluation of red cell deformability by a filtration method in type 1 and type 2 diabetes mellitus with and without vascular complications.

Previous studies of red cell deformability (RCD) in diabetic patients have produced conflicting results. We have therefore reassessed this problem with the Carri-Med Filtrometer, which measures RCD independently of the rate of clogging of the filter. The initial red cell filtration ratio relative to buffer (mean +/- SD) of 69 diabetic patients (28 type 1 and 41 type 2) was significantly impaired in both type 1 (0.470 +/- 0.047) and type 2 diabetic patients (0.488 +/- 0.065), when compared to 66 non diabetic control subjects (0.540 +/- 0.032; both p less than 0.001). A significant difference in RCD was noted between type 1 and type 2 diabetics (p less than 0.03), but no association with vascular complications was found. No significant correlations were noted between RCD and the duration of diabetes, age, HbA1, leucocyte count, or mean red cell volume. However RCD was inversely related to mean red cell haemoglobin concentration (r = -0.43, p less than 0.01). Diabetics had significantly lower mean red cell volume and significantly higher mean cell haemoglobin concentration than non-diabetics, but these changes could not explain the difference in RCD, which may be related to alterations in the red cell membrane.

Adult↗
PubMed1989

Changes in phagocytic function with glycaemic control in diabetic patients.

Phagocytic function was assessed by serial whole blood chemiluminescence in poorly controlled type 2 (non-insulin dependent) diabetic patients during efforts to improve glycaemic control and compared with a group of well controlled type 1 (insulin dependent) diabetic patients. Chemiluminescence (corrected to a standard polymorphonuclear count) remained below normal (0.15-0.30 photons/second/cell) for most of the type 2 patients until 12 weeks when the value was significantly increased in patients showing improved glycaemic control (mean (range) 0.25 (0.01-0.43) photons/second/cell) compared with those showing no improvement (0.12(0.01-0.31) photons/second/cell). There was a significant inverse correlation of delta HbA1 with delta chemiluminescence. Although mean chemiluminescence for the type 1 diabetic patients was within the normal range, there was a wide scatter of values (0.19 (0.04-0.43) photons/second/cell) and there was no significant difference compared with the final value of type 2 patients with improved control. Glycaemic control is therefore a major determinant of phagocytic function in diabetic patients, but other factors must contribute, particularly in type 1 (insulin dependent) patients.

Adult↗
PubMed1988

Diabetic ketoacidosis during NovoPen therapy.

To improve flexibility and acceptability of diabetic management five patients (age 15-26 years) were changed to NovoPen therapy (Human Actrapid Insulin 3 x daily + Human Ultratard Insulin at night). Diabetic ketoacidosis developed within 2-4 months of commencing this regimen and in one patient twice in only 4 weeks. All failed to increase their insulin dose in response to hyperglycaemia and two patients omitted insulin when they did not take meals believing this to be appropriate irrespective of the prevailing blood glucose. The NovoPen regimen may increase the risk of diabetic ketoacidosis in patients who do not monitor and control their diabetes assiduously and should not be seen as a solution for poorly motivated or ill-educated patients.

Adolescent↗
PubMed1988

Association of hypertension with blood viscosity in diabetes.

Plasma and whole blood viscosity and its determinants were measured in 86 diabetic patients (29 hypertensive and 57 normotensive) and compared with 52 non-diabetic control subjects to assess whether hypertension has an additive and adverse effect on blood viscosity. Whole blood viscosity (corrected for haematocrit), at high and low shear rates (95 and 0.95 s-1), was significantly higher in both Type 1 (5.1 +/- 0.5 (+/- SD), 19.8 +/- 2.9) and Type 2 (5.2 +/- 0.3, 21.1 +/- 2.0) diabetic patients compared with control subjects (4.9 +/- 0.6, 17.4 +/- 2.6 mPa s, p less than 0.01). Corrected whole blood viscosity at high shear rate was significantly higher in hypertensive than in normotensive Type 2 diabetic patients (5.5 +/- 0.4 vs 5.2 +/- 0.3 mPa s, p less than 0.01). Plasma viscosity was significantly higher in diabetic patients compared with control subjects (1.4 +/- 0.1 vs 1.3 +/- 0.1 mPa s, p less than 0.01), but there was no difference between hypertensive and normotensive diabetic patients (1.4 +/- 0.1 vs 1.4 +/- 0.2 mPa s). Fibrinogen levels were similar in all the groups.

Adult↗
PubMed1988

Management of diabetes resistant to subcutaneous insulin with intravenous insulin via an implanted infusion pump.

Diabetes resistant to conventional subcutaneous insulin injection is a rare complication of insulin-dependent diabetes which poses a major management problem. We report three cases treated for a total of over seven patient years with fully implanted insulin infusion devices. Technical difficulties with the devices and their operation have been substantial but the patients are much improved and hospitalisation has been dramatically reduced. We suggest that implanted insulin pumps are a real treatment option for patients with this unusual syndrome.

Adolescent↗
PubMed1987

Hyperkalaemia, ketoacidosis and subcutaneous or intravenous insulin infusions.

We report a case of a previously stable Type 1 insulin-dependent diabetic who developed diabetic ketoacidosis with marked hyperkalaemia after starting continuous subcutaneous insulin infusion for neuropathy. On two occasions during his hospital admissions he had a rapid onset of hyperkalaemia after short interruptions to this intravenous insulin infusion. Hyperkalaemia can occur rapidly in patients who are treated with short acting insulin only.

Adult↗
PubMedDate not supplied

Increased red cell aggregation in diabetes mellitus: association with cardiovascular risk factors.

Red cell aggregation may be higher in diabetic patients and may predispose to cardiovascular disease. Red cell aggregation was measured by a simple photometric method in 122 diabetic patients and 100 matched control subjects, to determine its relationship to cardiovascular risk factors. Red cell aggregation was significantly increased in both Type 1 (4.3 +/- 1.3 vs 3.4 +/- 1.2, p < 0.002) and Type 2 diabetic patients (5.5 +/- 1.5 vs 3.2 +/- 1.3, p < 0.0001). In all diabetic patients aggregation correlated with triglycerides, VLDL, and inversely with HDL and in Type 2 diabetic patients also with body mass index, hypertension, and inversely with duration of diabetes. On multiple regression analysis, triglycerides and body mass index showed an independent association with red cell aggregation and in Type 2 diabetic patients smoking was also associated with increased red cell aggregation. It is concluded that increased red cell aggregation may be one mechanism by which some cardiovascular risk factors could promote cardiovascular disease in diabetes.

Adult↗