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1.
Rev. Assoc. Med. Bras. (1992) ; 67(6): 822-827, June 2021. tab, graf
Article in English | LILACS | ID: biblio-1346907

ABSTRACT

SUMMARY OBJECTIVE: The aims of this study were to observe the regularity of blood glucose changes in hemodialysis patients with diabetes, time of onset of hypoglycemia and blood glucose level during dialysis, and to explore the sensitive early warning indicators of hypoglycemia in dialysis patients. BACKGROUND: Diabetes patients have a high incidence of hypoglycemia during hemodialysis. METHODS: A total of 124 maintenance hemodialysis patients with diabetes were selected for this study. Before dialysis, one, two, and three h after dialysis, and when hypoglycemia symptoms occurred, the blood glucose changes were monitored, the blood glucose drop range was observed when hypoglycemia symptoms occurred, and the correlation between the two was analyzed. RESULTS: After the start of the dialysis, the patient's blood glucose showed a downward trend. The symptoms of hypoglycemia were most obvious within one-two hours, with an incidence rate of 57.9%. When the blood glucose drop percentage reached 37.7%, the specificity and sensitivity of early warning hypoglycemia symptoms were 84.6 and 73%, respectively. CONCLUSIONS: For hemodialysis patients with diabetes, attention should be paid to the symptoms of hypoglycemia during dialysis, and blood glucose should be monitored before dialysis and after 1-2 h of dialysis. If the blood glucose drop percentage is greater than 37.7%, the timely measures should be taken.


Subject(s)
Humans , Diabetes Mellitus , Hypoglycemia/diagnosis , Hypoglycemia/etiology , Blood Glucose , Incidence , Renal Dialysis/adverse effects
2.
Rev. cuba. endocrinol ; 32(1): e154, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289389

ABSTRACT

La evidencia clínica que ha permitido relacionar la diabetes mellitus con la infertilidad se basa en la importancia del metabolismo de la glucosa durante el proceso de espermatogénesis, debido a que en los episodios tanto de hipoglucemia como de hiperglucemia pueden ocurrir cambios epigenéticos en algunas proteínas involucradas en la espermatogénesis. En la presente comunicación se describen los aspectos teóricos de los efectos de la diabetes sobre el líquido seminal con énfasis en la espermatogénesis(AU)


The clinical evidence that has made it possible to link diabetes mellitus with infertility is based on the importance of glucose metabolism during the spermatogenesis process, because in episodes of both hypoglycemia and hyperglycemia, epigenetic changes can occur in some proteins involved in spermatogenesis. This communication describes the theoretical aspects of the effects of diabetes on seminal fluid with emphasis on spermatogenesis(AU)


Subject(s)
Humans , Spermatogenesis , Diabetes Mellitus/epidemiology , Hyperglycemia/etiology , Hypoglycemia/etiology , Infertility/therapy
3.
Repert. med. cir ; 30(1): 59-63, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1292229

ABSTRACT

La hipoglucemia es una urgencia médica frecuente que en la mayoría de los casos es secundaria al uso de fármacos hipoglucemiantes, orales o inyectados, indicados en pacientes con diabetes mellitus. No obstante, puede presentarse en forma espontánea y severa relacionándose con múltiples condiciones clínicas, incluyendo las neoplasias. Ante una hipoglucemia de origen paraneoplásico se deben reconocer los mecanismos fisiopatológicos que la generan y establecer el diagnóstico oportuno y preciso para disminuir las complicaciones propias de este síndrome clínico. Presentamos dos pacientes con cuadro de hipoglucemia refractaria al manejo médico inicial, de aparición similar con patologías diferentes. El primer caso corresponde a un paciente con insulinoma y el segundo con un hemangiopericitoma.


Hypoglycemia is a common medical emergency which is mostly secondary to the use of oral or injected hypoglycemic drugs indicated in patients with diabetes mellitus. However, it can present spontaneously and severely in relation to multiple clinical conditions, including neoplasms. When faced with hypoglycemia associated with paraneoplastic disorders, the pathophysiological mechanisms of hypoglycemia must be recognized and a timely and accurate diagnosis must be established in order to diminish complications inherent to this clinical syndrome. We herein present two patients with hypoglycemia refractory to initial medical management, sharing similar appearance with other pathologies. The first case corresponds to a patient with an insulinoma and the second to a patient with a hemangiopericytoma.


Subject(s)
Humans , Male , Adult , Middle Aged , Pancreatic Neoplasms/complications , Hemangiopericytoma/complications , Hypoglycemia/etiology , Insulinoma/complications , Pancreatic Neoplasms/diagnostic imaging , Hemangiopericytoma/diagnostic imaging , Insulinoma/diagnostic imaging
4.
Rev. chil. endocrinol. diabetes ; 14(1): 17-20, 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1146467

ABSTRACT

Insulinoma es un tumor neuroendocrino que surge de las células ß del páncreas y produce hiperinsulinemia endógena. Son neoplasias raras con una incidencia reportada de 4 casos por millón de habitantes por año. La presentación clínica típicamente cursa con síntomas adrenérgicos y neuroglucopénicos secundarios a hipoglicemia. Requiere estudios de niveles séricos de insulina, pro-insulina y péptido C, además de imágenes diagnosticas que confirmen los hallazgos. La mayoría de los insulinomas son benignos, su sitio primario más común es el páncreas y pueden extirparse quirúrgicamente. Se presenta el caso de un hombre de 36 años con déficit cognitivo leve y episodios de diaforesis con deterioro neurológico hasta convulsiones tónico clónicas generalizadas que curiosamente resolvían con uso doméstico de "panela molida". Se ingresó a urgencias por ataques recurrentes de hipoglicemia severa con requerimiento de altas dosis de dextrosa al 50% por acceso central, hasta confirmación diagnóstica, intervención y resección de tumor neuroendocrino pancreático bien diferenciado (G1 según clasificación OMS) tipo insulinoma en la cola del páncreas.


Insulinoma is a neuroendocrine tumor that arises from the ß cells of the pancreas and produces endogenous hyperinsulinemia. They are rare neoplasms with a reported incidence to 4 cases per million inhabitants per year. The clinical presentation typically presents with adrenergic and neuroglycopenic symptoms secondary to hypoglycemia. It requires studies of serum levels of insulin, pro-insulin and C-peptide, in addition to diagnostic images that confirm the findings. Most insulinomas are benign, their most common primary site is the pancreas, and they can be removed surgically. We present the case of a 36-year-old man with mild cognitive deficits and episodes of diaphoresis with neurological deterioration to generalized clonic tonic seizures that curiously resolved with domestic use of "ground brown sugar". He was admitted to the emergency department due to recurrent attacks of severe hypoglycemia with a high-dose requirement for 50% dextrose through central access, until diagnostic confirmation, intervention, and resection of a welldifferentiated pancreatic neuroendocrine tumor (G1 according to WHO classification) insulinoma in the tail of pancreas.


Subject(s)
Humans , Male , Adult , Pancreatic Neoplasms/diagnosis , Insulinoma/diagnosis , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/complications , Magnetic Resonance Imaging , Neuroendocrine Tumors , Diagnosis, Differential , Epilepsy/diagnosis , Glucose/therapeutic use , Hyperinsulinism/etiology , Hypoglycemia/etiology , Hypoglycemia/drug therapy , Insulinoma/surgery , Insulinoma/complications
5.
Article in Chinese | WPRIM | ID: wpr-879768

ABSTRACT

OBJECTIVE@#To investigate the risk factors for hypoglycemia after birth in preterm infants with a gestational age of ≤32 weeks.@*METHODS@#A retrospective analysis was performed for 86 neonates with hypoglycemia and a gestational age of ≤32 weeks who were admitted to the neonatal intensive care unit from January 2017 to June 2020 (hypoglycemia group). A total of 172 preterm infants with normal blood glucose who were hospitalized during the same period were randomly enrolled as the control group. Univariate analysis and multivariate logistic regression analysis were used to screen out the risk factors for hypoglycemia in preterm infants.@*RESULTS@#There were 515 preterm infants during the study, among whom 86 (16.7%) had hypoglycemia. Compared with the control group, the hypoglycemia group had significantly higher percentages of small for gestational age (SGA), cesarean section, maternal hypertension, and antenatal steroid administration (P<0.05), but significantly lower birth weight and rate of intravenous glucose use before blood glucose test (P<0.05). SGA (OR=4.311, 95%CI: 1.285-14.462, P<0.05), maternal hypertension (OR=2.469, 95%CI: 1.310-4.652, P<0.05), and antenatal steroid administration (OR=6.337, 95%CI: 1.430-28.095, P<0.05) were risk factors for hypoglycemia in preterm infants, while intravenous glucose use (OR=0.318, 95%CI: 0.171-0.591, P<0.05) was a protective factor against hypoglycemia in preterm infants.@*CONCLUSIONS@#SGA, maternal hypertension, and antenatal steroid administration may increase the risk of early hypoglycemia in preterm infants with a gestational age of ≤32 weeks, and intravenous glucose use is recommended as soon as possible after birth for preterm infants with a gestational age of ≤32 weeks to reduce the incidence rate of hypoglycemia.


Subject(s)
Cesarean Section , Female , Gestational Age , Humans , Hypoglycemia/etiology , Infant , Infant, Newborn , Infant, Premature , Infant, Small for Gestational Age , Pregnancy , Retrospective Studies , Risk Factors
6.
Revista Digital de Postgrado ; 9(1): e202, 2020.
Article in Spanish | LILACS, LIVECS | ID: biblio-1095048

ABSTRACT

La diabetes mellitus (DM) se considera como un conjunto de trastornos metabólicos relacionados con la hiperglucemia, que requiere cambios en estilos de vida, en virtud de que no solo se afecta el estado físico, sino que requiere cambios que pueden influir en el estado emocional y psicosocial. Las personas con diabetes requieren de cuidados continuos orientados al control metabólico centrados en el empoderamiento, autocuidado y en la educación terapéutica para alcanzar metas y resultados orientados a minimizar la aparición de las complicaciones crónicas. Objetivo: analizar la importancia de la educación terapéutica en los pacientes con trastornos afectivos como depresión y ansiedad, asociados a la diabetes. Conclusión: la educación terapéutica como parte integral del tratamiento de la DM ha demostrado mejorar los síntomas asociados a depresión y ansiedad, lo cual podría adquirir un valor importante en el manejo de este grupo de pacientes(AU)


Diabetes mellitus (DM) is considered as a set of metabolic disorders related to hyperglycemia, which requires changes in lifestyle, because not only physical condition is affected, but it also requires changes that can influence emotional state and psychosocial. People with diabetes require continuous care oriented to metabolic control focused on empowerment, self-care and therapeutic education to achieve goals and results aimed at minimizing the occurrence of chronic complications. Objective: to analyze the importance of therapeutic education in patients with affective disorders such as depression and anxiety, associated with diabetes. Conclusion: therapeutic education as an integral part of the treatment of DM has been shown to improve symptoms associated with depression and anxiety, which could acquire an important value in the management of this group of patients(AU)


Subject(s)
Humans , Diabetes Mellitus/pathology , Diabetes Mellitus/prevention & control , Diabetes Mellitus/drug therapy , Diabulimia/pathology , Hypoglycemia/etiology , Anxiety , Therapeutics , Affective Symptoms , Depression
7.
Rev. bras. ginecol. obstet ; 41(11): 647-653, Nov. 2019. tab
Article in English | LILACS | ID: biblio-1057882

ABSTRACT

Abstract Objective The present study aims to compare the maternal and fetal outcomes of parturients with and without a gestational diabetes diagnosis. Methods A case-control study including parturients with (cases) and without (control) a gestational diabetes diagnosis, who delivered at a teaching hospital in Southern Brazil, between May and August 2018. Primary and secondary data were used. Bivariate analysis and a backward conditionalmultivariate logistic regression were used to make comparisons between cases and controls, which were expressed by odds ratio (OR), with a 95% confidence interval (95%CI) and a statistical significance level of 5%. Results The cases (n=47) weremore likely to be 35 years old or older compared with the controls (n=93) (p<0.001). The cases had 2.56 times greater chance of being overweight (p=0.014), and a 2.57 times greater chance of having a positive family history of diabetes mellitus (p=0.01). There was no significant difference regarding weight gain, presence of a previous history of gestational diabetes, height, or delivery route. The mean weight at birth was significantly higher in the infants of mothers diagnosed with diabetes (p=0.01). There was a 4.7 times greater chance of macrosomia (p<0.001) and a 5.4 times greater chance of neonatal hypoglycemia (p=0.01) in the infants of mothers with gestational diabetes. Conclusion Therefore, maternal age, family history of type 2 diabetes, obesity and pregestational overweightness are important associated factors for a higher chance of developing gestational diabetes.


Resumo Objetivo O presente estudo tem como objetivo comparar os desfechos maternos e fetais das parturientes com e sem diagnóstico de diabetes gestacional. Métodos Estudo caso-controle, incluindo parturientes com (casos) e sem (controle) diagnóstico de diabetes gestacional, que tiveram parto em um hospital de ensino no Sul do Brasil, entre maio e agosto de 2018. Foram utilizados dados primários e secundários. Análise bivariada e regressão logística multivariada condicional retrógrada foram utilizadas para fazer comparações entre casos e controles, expressas por razão de probabilidades (RP), com intervalo de confiança de 95% (IC95%) e nível de significância estatística de 5%. Resultados Os casos (n=47) tiveram maior chance de ter idade superior a 35 anos em comparação com os controles (n=93) (p<0,001), chance 2,56 vezes maior de estarem acima do peso (p=0,014), e chance 2,57 vezes maior de terem história familiar positiva de diabetes mellitus (p=0,01). Não houve diferença significativa relacionada ao ganho de peso, história pregressa de diabetes gestacional, estatura ou via de parto. O peso médio ao nascer foi significativamente maior nos lactentes de mães com diabetes gestacional (p=0,01). Houve 4,7 vezes maior chance de macrossomia (p<0,001), e 5,4 vezes maior chance de hipoglicemia neonatal (p=0,01) em lactentes de mães com diabetes gestacional. Conclusão Portanto, idade materna, história familiar de diabetes tipo 2, obesidade e excesso de peso pré-gestacional são importantes fatores associados a uma maior chance de desenvolvimento de diabetes gestacional.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pregnancy Outcome , Diabetes, Gestational/physiopathology , Birth Weight , Fetal Macrosomia/etiology , Brazil , Weight Gain , Case-Control Studies , Maternal Age , Genetic Predisposition to Disease , Obesity, Maternal/complications , Obesity, Maternal/physiopathology , Hospitals, Teaching , Hypoglycemia/etiology
8.
Säo Paulo med. j ; 137(1): 100-103, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004736

ABSTRACT

ABSTRACT CONTEXT: Non-islet-cell-tumor-induced hypoglycemia (NICTH) is caused on rare occasions by secretion of insulin from tumor cells that are reported to have a single tissue origin. CASE REPORT: A 67-year-old male patient had cardia adenocarcinoma and concomitant lung adenocarcinoma with extensive metastases and repeated episodes of intractable hypoglycemia. Immunohistochemical staining for insulin showed that lung adenocarcinoma stained positive and gastric cardia adenocarcinoma stained weakly positive. These results indicate that tumor cells of different tissue origins co-secreted insulin. CONCLUSIONS: This is the first report on intractable hypoglycemia due to co-secretion of insulin from two kinds of primary tumor cells in a single patient.


Subject(s)
Humans , Male , Aged , Stomach Neoplasms/complications , Cardia , Adenocarcinoma/complications , Hypoglycemia/etiology , Lung Neoplasms/complications , Stomach Neoplasms/diagnosis , Immunohistochemistry , Adenocarcinoma/diagnosis , Fatal Outcome , Positron Emission Tomography Computed Tomography , Lung Neoplasms/diagnosis
9.
Ciênc. Saúde Colet ; 24(1): 125-136, ene. 2019. tab
Article in Portuguese | LILACS | ID: biblio-974798

ABSTRACT

Resumo Objetivou-se avaliar o conhecimento sobre o diabetes, a atitude para o autocuidado e os fatores associados, por meio de estudo transversal, na linha de base de um ensaio clínico randomizado, com idosos diabéticos na atenção primária de saúde do Recife, Nordeste do Brasil. Utilizou-se o Diabetes Knowledge Scale (DKN-A) e o Diabetes Attitudes Questionnaire (ATT-19). Dos 202 idosos, 77,7% apresentaram conhecimento insuficiente sobre a doença, com destaque para a cetonúria, substituição de alimentos e desconhecimento das causas e dos cuidados com a hipoglicemia. Quanto à atitude, 85,6% tiveram ajustamento psicológico negativo em relação ao diabetes. O modelo de regressão logística mostrou que morar sozinho foi fator de proteção (OR = 0,24; IC95% 00,9-0,65; OR = 0,22; IC95% 0,07-0,71) e baixa escolaridade fator de risco (OR = 7,78; IC95% 3,36-18,01; OR = 13,05; IC95% 4,63-36,82) para conhecimento insuficiente e atitude negativa para o autocuidado, respectivamente. Os achados reforçam a necessidade de ações educativas interdisciplinares que incluam aspectos socioeconômicos, psicoemocionais e educacionais na gestão do diabetes com vistas à manutenção da autonomia e funcionalidade do idoso.


Abstract This study aimed to assess the knowledge about diabetes, the attitude for self-care and associated factors through a cross-sectional study, the baseline of a randomized clinical trial with elderly diabetic in primary health care in Recife, Northeastern Brazil. We used the Diabetes Knowledge Scale (DKN-A) and Diabetes Attitudes Questionnaire (ATT-19). Of the 202 elderly, 77.7% had insufficient knowledge of the disease, especially for ketonuria, food replacement and were unaware of the causes and care of hypoglycemia. As for attitude, 85.6% had a negative psychological adjustment for diabetes. The logistic regression model showed that living alone was a protective factor (OR = 0.24; 95% CI 0.09-0.65; OR = 0.22; 95% CI 0.07 to 0.71), and low education, a risk factor (OR = 7.78; 95% CI 3.36-18.01; OR = 13.05; 95% CI 4.63-36.82) for the insufficient knowledge and the negative attitude for self-care, respectively. The findings reinforce the need for interdisciplinary educational actions that include socioeconomic, psycho-emotional and educational aspects in diabetes management to maintain elderly autonomy and functionality.


Subject(s)
Humans , Male , Female , Aged , Primary Health Care , Self Care/methods , Health Knowledge, Attitudes, Practice , Diabetes Mellitus/psychology , Socioeconomic Factors , Brazil , Logistic Models , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Diabetes Mellitus/therapy , Educational Status , Protective Factors , Hypoglycemia/etiology , Hypoglycemia/therapy , Middle Aged
10.
Rev. bras. med. esporte ; 24(5): 399-402, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-977832

ABSTRACT

Physical exercise and diet quality are essential for glycemic control of diabetic patients, but consideration must be given to the risk of hypoglycemia in response to exercise. Therefore this study aims at 1) conducting a systematic review of the glycemic index (GI) of the pre-exercise meal and of glycemic behavior during and after aerobic exercise in diabetic subjects, and 2) discussing the safest and most appropriate pre-exercise nutritional guidance for this population. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), two researchers independently undertook a systematic search. A third researcher participated in the selection of articles due to the presence of discrepancies. We selected two studies which both suggest that a low glycemic index (GI) meal is the best pre-exercise option, one of which suggests that the optimal time for food intake is 30 minutes before exercise. However, these results are not sufficient to define a clinical conduct, and other studies are needed to elucidate whether GI is a relevant parameter for pre- and post-exercise clinical monitoring of patients with diabetes mellitus (DM), particularly as regards to the different guidelines for type 1 and type 2 DM. Level of Evidence II; Prognostic Study.


Exercício físico e qualidade da alimentação são fundamentais para o controle glicêmico dos pacientes diabéticos, porém é necessário considerar o risco de hipoglicemia em resposta ao exercício. Dessa forma, os objetivos deste estudo são: 1) conduzir uma revisão sistemática sobre o índice glicêmico (IG) da refeição pré-exercício e do comportamento glicêmico durante e após exercício aeróbico em diabéticos e 2) discutir qual orientação nutricional pré-exercício seria mais adequada e segura nessa população. Em concordância com os Itens de Relatório Preferidos para Revisões Sistemáticas e Metanálises (PRISMA), dois pesquisadores independentes realizaram uma busca sistemática. Um terceiro pesquisador participou da seleção dos artigos por causa da presença de discrepâncias. Foram selecionados dois estudos e ambos sugerem que a refeição de baixo índice glicêmico (IG) é a melhor opção pré-exercício, e um deles sugere que o tempo ideal para ingestão alimentar é 30 minutos antes do exercício. Porém, esses resultados não são suficientes para definir uma conduta clínica, sendo necessários outros estudos para elucidar se o IG é um parâmetro relevante para o monitoramento clínico do paciente com diabetes mellitus (DM) antes e depois do exercício, principalmente com relação às orientações distintas às do DM tipo 1 e tipo 2. Nível de evidência II; Estudo Prognóstico.


Ejercicio físico y la calidad de los alimentos son esenciales para el control glucémico de la diabetes, sin embargo, es necesario prestar atención al riesgo de hipoglucemia en respuesta al ejercicio. Por lo tanto, los objetivos de este estudio son: 1) Realizar una revisión sistemática del índice glucémico (IG) de la comida previa al ejercicio y el comportamiento de la glucemia durante y después del ejercicio aeróbico en los diabéticos y 2) discutir cuál orientación nutricional previa al ejercicio sería más apropiada y segura en esta población. En conformidad con los ítems de Informe Preferido para Revisiones Sistemáticas y Meta-análisis (PRISMA), dos investigadores llevaron a cabo, de forma independiente, una búsqueda sistemática y observaron divergencia; y un tercer investigador participó en la selección de artículos. Se seleccionaron dos estudios, y ambos sugieren que la comida de bajo índice glucémico es la mejor opción antes del ejercicio; uno de ellos sugiere que el tiempo antes de la ingesta de alimentación adecuada es de 30 minutos. Sin embargo, estos resultados no son suficientes para definir una conducta clínica y se necesitan otros estudios para dilucidar si IG es un parámetro relevante para el monitoreo clínico del paciente con diabetes mellitus (DM), durante y después del ejercicio, principalmente en relación con las diferentes orientaciones de DM tipo 1 y tipo 2. Nivel de evidencia II; Estudio Pronóstico.


Subject(s)
Humans , Exercise/physiology , Glycemic Index/physiology , Diabetes Mellitus/prevention & control , Diabetes Mellitus/therapy , Feeding Behavior , Blood Glucose/metabolism , Risk Factors , Hypoglycemia/etiology , Obesity
12.
Arch. endocrinol. metab. (Online) ; 62(3): 337-345, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-950071

ABSTRACT

Abstract Objective: This study aimed to evaluate the effectiveness and safety of carbohydrate counting (CHOC) in the treatment of adult patients with type 1 diabetes mellitus (DM1). Materials and methods: We performed a systematic review of randomized studies that compared CHOC with general dietary advice in adult patients with DM1. The primary outcomes were changes in glycated hemoglobin (HbA1c), quality of life, and episodes of severe hypoglycemia. We searched the following electronic databases: Embase, PubMed, Lilacs, and the Cochrane Central Register of Controlled Trials. The quality of evidence was analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: A total of 3,190 articles were identified, and two reviewers independently screened the titles and abstracts. From the 15 potentially eligible studies, five were included, and 10 were excluded because of the lack of randomization or different control/intervention groups. Meta-analysis showed that the final HbA1c was significantly lower in the CHOC group than in the control group (mean difference, random, 95% CI: −0.49 (-0.85, −0.13), p = 0.006). The meta-analysis of severe hypoglycemia and quality of life did not show any significant differences between the groups. According to the GRADE, the quality of evidence for severe hypoglycemia, quality of life, and change in HbA1c was low, very low, and moderate, respectively. Conclusion: The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.


Subject(s)
Humans , Adult , Diabetes Mellitus, Type 1/diet therapy , Diet, Carbohydrate-Restricted , Quality of Life , Glycated Hemoglobin A/analysis , Randomized Controlled Trials as Topic , Treatment Outcome , Hypoglycemia/etiology
13.
Rev. argent. endocrinol. metab ; 54(4): 151-159, dic. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-957982

ABSTRACT

El síndrome de interrupción del tallo pituitario (PSIS) se caracteriza por la demostración neurorradiológica de un tallo pituitario ausente, interrumpido o hipoplásico, adenohipófisis aplásica/hipoplásica o neurohipófisis ectópica. Este síndrome se ha relacionado con formas severas de hipopituitarismo congénito (HPC), asociado a múltiples deficiencias de hormonas pituitarias (MPHD). Evaluamos a pacientes con HPC y PSIS, analizando los signos y los síntomas neonatales al diagnóstico, relacionándolos con las deficiencias hormonales pituitarias y signos neurorradiológicos presentes. Estudiamos retrospectivamente a 80 pacientes asistidos en el Hospital de Niños de Córdoba, con diagnóstico de HPC, de los cuales 42 (52%) presentaron PSIS; 22 mujeres y 20 varones, EC: 5 días-9,5 años. El 62% presentó MPHD y el 38% insuficiencia somatotrófica aislada (IGHD). El análisis de las variables perinatales demostró antecedentes de parto natural en el 52% (11/21) de las MPHD vs. 13% (2/15) de las IGHD. Cuatro pacientes, 2 con MPHD y 2 con IGHD presentaban antecedentes obstétricos consistentes en presentación podálica y transversa respectivamente, todos ellos resueltos mediante operación cesárea. Los signos y los síntomas perinatales fueron hipo- glucemia: 61% en MPHD vs. 19% en IGHD, p: 0,0105; ictericia: 38% en MPHD vs. 25% en IGHD; micropene: 77% en MPHD y colestasis: 19% en MPHD. Convulsiones neonatales se presentaron en el 75% de los niños con MPHD e hipoglucemia. EC media de consulta: 2,1 años en MPHD (30% en el período neonatal, 70% antes de 2 años) y 3,6 años en IGHD (44% en menores de 2 años). Los pacientes con MPHD presentaban: tallo no visible 81% (n: 21/26) vs. tallo hipoplásico: 19% (n: 5/26), p: 0,0001; en IGHD 56% (n: 9/16) vs. 44% (n: 7/16), p: 0,5067, respectivamente. El 100% de los neonatos con HPC tenían tallo pituitario ausente. Concluimos que la demostración de PSIS en niños con HPC proporciona información valiosa como predictor de la severidad fenotípica, la presencia de MPHD y de la respuesta al tratamiento. La baja frecuencia de antecedentes obstétricos posicionales potencialmente distócicos, como parte de los mecanismos fisiopatogénicos responsables de PSIS, indicaría la necesidad de analizar la importancia de posibles factores genéticos y epigenéticos involucrados. El diagnóstico precoz de HPC debe sospecharse en presencia de signos y síntomas clínicos, tales como hipoglucemia, colestasis, micropene y defectos asociados en la línea media facial. La resonancia magnética cerebral debe formar parte de los estudios complementarios en pacientes con esta presunción diagnóstica, especialmente a edades tempranas. El reconocimiento tardío de esta entidad puede aumentar la morbilidad y la mortalidad con efectos potenciales deletéreos y permanentes.


Pituitary stalk interruption syndrome (PSIS) is characterised by the combination of an interrupted or thin pituitary stalk, absent or ectopic posterior pituitary, and anterior pituitary hypoplasia. It is manifested as isolated (IGHD) or combined pituitary hormone deficiencies (CPHD) of variable degrees and timing of onset, with a wide spectrum of clinical phenotypes. PSIS may be an isolated morphological abnormality or be part of a syndrome. A retrospective evaluation is presented of clinical signs and symptoms present at early life stages, as well as an analysis of their relationship with hormone laboratory tests and diagnostic imaging in children with congenital hypopituitarism (CHP), and PSIS. This study was performed in a single centre on a sample of 42 children out of a total of 80 CHP patients, with a chronological age range between 5 days and 9.5 years from a database analysed over a period of 26 years. The study included 26/42 (62%) with CPHD and 16/42 (38%) with IGHD. The analysis of perinatal variables showed a natural delivery in 52% (11/21) of CPHD vs 13% (2/15) of IGHD. Four patients, two with CPHD and two IGHD had breech and transverse presentation respectively. All of them were resolved by caesarean section. The perinatal histories showed hypoglycaemia (61% CPHD vs 19% IGHD, P=.0105), jaundice (38% CPHDvs25% IGHD), micropenis (75%CPHD), hypoglycaemic seizures (75% CPHD), and cholestasis (19% CPHD). The mean CA of consulting for CPHD patients was 2.1 years, 30% in neonatal period and 70% before 2 years. The mean chronical age (CA) was 3.6 years in IGHD patients, with 44% of them less than 2 years. MRI showed that 81% of CPHD patients had absence of pituitary stalk vs 19% with thin pituitary stalk (P=.0001); Patients with IGHD presented 56% absence of pituitary stalk vs 44% with thin pituitary stalk (P=.5067). All (100%) of the patients diagnosed in the neonatal stage had absent pituitary stalk. The characterisation of GH deficient patients by presence and type of hypothalamic-pituitary imaging abnormality provides valuable information as a predictor of phenotypic severity, treatment response, and the potential to develop additional hormonal deficiencies. We conclude that demonstrating PSIS in children with HPC provides valuable information as a predictor of phenotypic severity, presence of MPHD, and response to treatment. The low frequency of potentially dysfunctional positional obstetric history, as part of the pathophysiological mechanisms responsible for PSIS, would indicate the need to analyse the importance of possible genetic and epigenetic factors involved. Early diagnosis of HPC should be suspected in the presence of clinical signs and symptoms, such as hypoglycaemia, cholestasis, micropenis, and associated facial midline defects. MRI should be part of complementary studies in patients with this diagnostic suspicion, especially at an early age. Late recognition of this entity may increase morbidity and mortality with potential permanent deleterious effects.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Pituitary Gland/abnormalities , Pituitary Gland/physiopathology , Hypopituitarism/congenital , Growth Hormone/deficiency , Cholestasis/etiology , Hypoglycemia/etiology , Hypopituitarism/diagnosis
14.
Rev. méd. Chile ; 145(11): 1387-1393, nov. 2017. tab
Article in Spanish | LILACS | ID: biblio-902458

ABSTRACT

Background Hypoglycemia is the main limitation for the achievement of glycemic goals in the treatment of diabetes. Aim To assess the incidence of hypoglycemia in an emergency department. To characterize and identify which patients are at higher risk of having it. Material and Methods We reviewed the electronic records of patients discharged from an adult emergency room with the diagnosis of hypoglycemia between May 2011 and December 2014. Age, sex, diagnosis of diabetes (DM), antidiabetic therapy, glycosylated hemoglobin, creatinine, destination at time of discharge, blood glucose, impairment of conscience, treatment of the event and predictions were recorded. Results Of 175,244 attentions analyzed, 251 in patients aged 69 ± 17 years (54% women) consulted for hypoglycemia (0.14%). Eighty one percent had a type 2 diabetes, 6% a type 1 diabetes and 12% were non-diabetic. Mean blood glucose was 44.1 mg/dl. In diabetic patients, mean glycosylated hemoglobin was 6.5%. Ninety seven percent had impairment of conscience and 77% were admitted to the hospital. Among patients without diabetes, the main comorbidity was the history of a gastric bypass surgery. In type 2 diabetes, glibenclamide used alone or with other medications was involved in 59% of the events, 87% of patients were older than 65 years with a mean glycosylated hemoglobin of 6.3% and 32% had renal failure. Conclusions The incidence of hypoglycemia was low. There were a significant number of events in older patients with type 2 diabetes mellitus and renal failure, who were treated with glibenclamide. Most of these patients had a glycosylated hemoglobin below accepted recommendations.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Emergency Service, Hospital/statistics & numerical data , Hypoglycemia/epidemiology , Chile/epidemiology , Retrospective Studies , Risk Factors , Age Factors , Diabetes Complications , Hypoglycemia/etiology , Hypoglycemia/therapy
15.
Rev. chil. endocrinol. diabetes ; 10(4): 154-156, oct. 2017. ilus
Article in Spanish | LILACS | ID: biblio-999029

ABSTRACT

A 41-year-old woman, multiparous of 4, with personal or familiar history of diabetes, with a history of Nissen fundoplication due to pathological gastro-oesophageal reflux, is refer to an endocrinologjst during her post-operatiye follow up, 4 months after her surgery for a 14 kg weight loss in 10 months and symtomatic hypoglycemia to repetition. A positive prolonged fasting test for hypoglycemia was performed. In addition, abdominal computed axial tomography was performed, which resulted normal and endosonography, showing a lesion on the head of the pancreas. Octreoscan positive for pancreatic head focal lesion with positive somatostatin receptors compatible with insulinoma. Whipple surgery was performed where surgeon palpated pancreatic tumor, biopsy showed tissue compatible with diffuse nesidioblastosis. In the postoperative period, the patient decreased frequency and intensity of hypoglycemic episodes compared to their previous stage. Control prolonged fasting test and Octreoscan were within normal ranges. However, 4 months after surgery, the patient presented hypoglycemia of lower intensity and frequency than before surgery. Currently he remains in control with nutritionist and endocrinologist, mainly adjusting diet and with good control glycemias.


Subject(s)
Humans , Adult , Pancreas/pathology , Nesidioblastosis/diagnosis , Pancreatic Neoplasms/diagnosis , Nesidioblastosis/surgery , Nesidioblastosis/complications , Diagnosis, Differential , Hyperinsulinism/etiology , Hypoglycemia/etiology , Insulinoma/diagnosis
16.
Medicina (B.Aires) ; 77(5): 410-421, oct. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-894508

ABSTRACT

La hiperglucemia durante la internación es una condición frecuente que se asocia al aumento de complicaciones y resulta en un mal pronóstico para quienes la padecen. La estrategia para su tratamiento es la insulinoterapia. Un adecuado control glucémico se asocia a mejor evolución y pronóstico. Sin embargo, el nivel adecuado de glucemia se encuentra aún en debate, ya que aquellos ensayos en los cuales se fijaron metas estrictas demostraron incrementar las tasas de hipoglucemia y eventos clínicos adversos. La diabetes mellitus es la principal causa de enfermedad renal crónica en nuestro país. El tratamiento en ese contexto merece un análisis especial, ya que la vida media de la insulina puede resultar prolongada. Las opciones de insulinización en pacientes con enfermedad renal crónica e insuficiencia asociada provienen de recomendaciones de expertos en las cuales se jerarquizan esquemas que utilizan insulina de acción intermedia o prolongada asociadas a insulina regular o análogos de acción rápida. Durante el embarazo, las insulinas NPH y regular han demostrado seguridad y eficacia. Sin embargo, el desarrollo de nuevas moléculas de acción lenta y rápida permitió reducir la variabilidad glucémica, mejorar el control de la glucemia postprandial y reducir la tasa de hipoglucemias. El objetivo del presente trabajo es proporcionar una revisión sobre el adecuado uso de insulina en estas tres situaciones especiales.


Hyperglycemia during hospitalization is a common condition associated with poor prognosis. To date, insulin is the best strategy to treat hyperglycemia in these patients. An adequate glycemic control is associated with better clinical results. Nevertheless, glycemic goals are still controversial due to the increase of hypoglycemia and other adverse events. Diabetes mellitus is still the main cause of chronic renal failure in our country and its treatment deserves a special analysis considering that insulin pharmacokinetics is altered. Recommendations in this setting are based in expert panel opinions, focusing mainly in intermediate or long acting insulins combined with regular insulin and/or rapid acting analogues. During pregnancy, NPH and regular insulin are safe and effective. It is worth mentioning that the development of new long and rapid acting molecules yielded lower glycemic variability, better post-prandial control and less hypoglycemia. The aim of this study is to provide a review of the proper use of insulin in these special conditions.


Subject(s)
Humans , Female , Pregnancy , Diabetes, Gestational/drug therapy , Diabetes Mellitus/drug therapy , Diabetic Nephropathies/drug therapy , Hyperglycemia/drug therapy , Hypoglycemia/drug therapy , Hypoglycemic Agents/administration & dosage , Algorithms , Critical Illness , Renal Insufficiency, Chronic/etiology , Hypoglycemia/etiology , Insulin/administration & dosage
17.
Arch. endocrinol. metab. (Online) ; 61(1): 98-102, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-838416

ABSTRACT

SUMMARY Paraneoplastic syndromes are a heterogeneous group of malignant diseases caused by events which involve endocrine, immune and metabolic aspects and whose symptoms vary according to the substance produced and the primary tumor. Hypercalcemia is a frequent complication in cancer patients. Prognosis of cancer patients with hypercalcemia is usually poor. A factor called parathyroid hormone related peptide, whose actions are similar to those of the parathyroid hormone, is thought to be the most common cause of malignancy associated hypercalcemia. Non-islet hypoglycemic cell tumor consists of a rare syndrome characterized by the presence of a solid tumor and severe fasting hypoglycemia determined by an insulin-independent pathway. We report a case of a 59-year-old-man with a renal tumor and a T-cell rich large B cell lymphoma who was hospitalized due to severe hypercalcemia and hypoglycemia. The laboratory examination reported hypercalcemia with inhibited PTH and hypoglycemia with inhibited insulin secretion, arriving to the conclusion of tumoral peptide production. He received denosumab and corticoid therapy. The patient died one month later despite initial improvement after medical treatment. While a single paraneoplastic manifestation may be expected in most tumors, the coexistence of two or more of them is rare, except in hepatocellular carcinomas, and it has not yet been described in renal tumors.


Subject(s)
Humans , Male , Middle Aged , Paraneoplastic Syndromes/etiology , Lymphoma, B-Cell/complications , Hypercalcemia/etiology , Hypoglycemia/etiology , Kidney Neoplasms/complications , Paraneoplastic Syndromes/diagnosis , Fatal Outcome , Hypercalcemia/diagnosis , Hypoglycemia/diagnosis
18.
Rev. latinoam. enferm. (Online) ; 25: e2893, 2017. graf
Article in English | LILACS, BDENF | ID: biblio-845319

ABSTRACT

ABSTRACT Objective: to identify evidence in the literature on the possible risk factors for the risk of unstable blood glucose diagnosis in individuals with type 2 diabetes mellitus, and to compare them with the risk factors described by NANDA International. Method: an integrative literature review guided by the question: what are the risk factors for unstable blood glucose level in people with type 2 diabetes mellitus? Primary studies were included whose outcomes were variations in glycemic levels, published in English, Portuguese or Spanish, in PubMed or CINAHL between 2010 and 2015. Results: altered levels of glycated hemoglobin, body mass index>31 kg/m2, previous history of hypoglycemia, cognitive deficit/dementia, autonomic cardiovascular neuropathy, comorbidities and weight loss corresponded to risk factors described in NANDA International. Other risk factors identified were: advanced age, black skin color, longer length of diabetes diagnosis, daytime sleepiness, macroalbuminuria, genetic polymorphisms, insulin therapy, use of oral antidiabetics, and use of metoclopramide, inadequate physical activity and low fasting glycemia. Conclusions: risk factors for the diagnosis, risk for unstable blood glucose level, for persons with type 2 diabetes mellitus were identified, and 42% of them corresponded to those of NANDA International. These findings may contribute to the practice of clinical nurses in preventing the deleterious effects of glycemic variation.


RESUMO Objetivo: identificar evidências na literatura acerca de possíveis fatores de risco do diagnóstico risco de glicemia instável para pessoas com diabetes mellitus tipo 2 e compará-los com os fatores de risco descritos pela NANDA International . Método: revisão integrativa norteada pela pergunta: quais são os fatores de risco de glicemia instável em pessoas com diabetes mellitus tipo 2? Incluíram-se estudos primários cujos desfechos eram variações nos níveis glicêmicos, publicados em inglês, português ou espanhol no PubMed ou CINAHL entre 2010 e 2015. Resultados: observou-se que alteração nos níveis de hemoglobina glicada, índice de massa corpórea>31 Kg/m2, história prévia de hipoglicemia, déficit cognitivo/demência, neuropatia autonômica cardiovascular, comorbidades e perda de peso correspondiam a fatores de risco descritos pela NANDA International . Outros fatores de risco identificados foram: idade avançada, raça negra, maior tempo de diagnóstico de diabetes, sonolência diurna, macroalbuminúria, polimorfismos genéticos, insulinoterapia, uso de antidiabéticos orais, uso de metoclopramida, atividade física inadequada e glicemia de jejum baixa. Conclusões: identificaram-se fatores de risco do diagnóstico risco de glicemia instável para pessoas com diabetes mellitus tipo 2, dos quais 42% correspondiam àqueles da NANDA International . Esses achados podem contribuir para a prática de enfermeiros clínicos na prevenção dos efeitos deletérios da variação glicêmica.


RESUMEN Objetivo: identificar evidencias en la literatura acerca de posibles factores de riesgo del diagnóstico "riesgo de nivel de glucemia inestable" para personas con diabetes mellitus tipo 2 y compararlos con los factores de riesgo descritos por la NANDA International . Método: revisión integradora orientada por la pregunta: ¿Cuáles son los factores de riesgo de nivel de glucemia inestable en personas con diabetes mellitus tipo 2? Se incluyeron estudios primarios cuyos resultados eran variaciones en los niveles glucémicos, publicados en inglés, portugués o español en el PubMed o CINAHL entre 2010 y 2015. Resultados: se observó que una alteración en los niveles de: hemoglobina glucosilada, índice de masa corporal >31 Kg/m2, historia previa de hipoglucemia, déficit cognitivo/demencia, neuropatía autonómica cardiovascular, comorbilidades y pérdida de peso, correspondían a factores de riesgo descritos por la NANDA International . Otros factores de riesgo identificados fueron: edad avanzada, raza negra, mayor tiempo de diagnóstico de diabetes, somnolencia diurna, macroalbuminuria, polimorfismos genéticos, insulinoterapia, uso de antidiabéticos orales, uso de metoclopramida, actividad física inadecuada y glucemia de ayuno baja. Conclusiones: se identificaron factores de riesgo del diagnóstico riesgo de nivel de glucemia inestable para personas con diabetes mellitus tipo 2, de los cuales 42% correspondían a los de la NANDA International . Esos hallazgos pueden contribuir para la práctica de enfermeros clínicos en la prevención de los efectos deletéreos de la variación glucémica.


Subject(s)
Humans , Blood Glucose/analysis , Nursing Diagnosis , Diabetes Mellitus, Type 2/blood , Hyperglycemia/diagnosis , Hypoglycemia/diagnosis , Risk Factors , Diabetes Mellitus, Type 2/complications , Hyperglycemia/etiology , Hyperglycemia/blood , Hypoglycemia/etiology , Hypoglycemia/blood
19.
Arch. endocrinol. metab. (Online) ; 60(4): 307-313, Aug. 2016. tab
Article in English | LILACS | ID: lil-792943

ABSTRACT

ABSTRACT Objective The oral glucose tolerance test (OGTT) is used in the screening of gestational diabetes, in diagnosis of type 2 diabetes in conjunction with fasting blood glucose and glycated hemoglobin. The aim of this study was to examine the incidence and risk factors of adverse effects of OGTT in patients who underwent bariatric surgery, in addition to proposing standardization for ordering the OGTT in these patients. Subjects and methods This study assessed the incidence of adverse effects in 128 post-bariatric surgery patients who underwent the OGTT. Descriptive and logistic regression analysis were performed, the dependent variables were defined as the presence of signs (tremor, profuse sweating, tachycardia), symptoms (nausea, diarrhea, dizziness, weakness), and hypoglycemia (blood glucose ≤ 50 mg/dL). Results One hundred and seventeen participants (91.4%) were female; 38 (29.7%) participants were pregnant. High incidence (64.8%) of adverse effects was observed: nausea (38.4%), dizziness (30.5%), weakness (25.8%), diarrhea (23.4%), hypoglycemia (14.8%), tachycardia (14.1%), tremor (13.3%), profuse sweating (12.5%) and one case of severe hypoglycemia (24 mg/dL). The presence of signs was associated with hypoglycemia (OR = 8.1, CI 95% 2.6-25.1). The arterial hypertension persisted as a risk factor for the incidence of signs (OR = 3.6, CI 95% 1.2-11.3). Fasting glucose below 75 mg/dL increased the risk of hypoglycemia during the test (OR = 9.5, CI 95% 2.6-35.1). Conclusion In this study, high incidence of adverse effects during the OGTT was observed in post-bariatric surgery patients. If these results are confirmed by further studies, the indication and regulation of the OGTT procedure must be reviewed for these patients.


Subject(s)
Humans , Male , Female , Pregnancy , Adult , Middle Aged , Bariatric Surgery/adverse effects , Glucose Tolerance Test/adverse effects , Hypoglycemia/etiology , Hypoglycemia/epidemiology , Time Factors , Blood Glucose/analysis , Brazil/epidemiology , Logistic Models , Multivariate Analysis , Risk Factors , Fasting/blood , Diabetes, Gestational/diagnosis , Depression/etiology , Depression/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Dyslipidemias/etiology , Dyslipidemias/epidemiology , Hypertension/etiology , Hypertension/epidemiology
20.
Rev. méd. Chile ; 144(1): 129-133, ene. 2016. ilus
Article in Spanish | LILACS | ID: lil-776983

ABSTRACT

We report the case of a 75-year-old man who was admitted to the hospital with symptoms of severe hypoglycemia. He had a history of solitary fibrous tumor diagnosed by Pathology after its complete surgical resection eight years before. The laboratory examination reported hypoglycemia with inhibited Insulin secretion. A computed tomography of the thorax revealed a large solid heterogeneous mass in the left hemithorax. Solitary fibrous tumor is a rare neoplasm. The association of solitary fibrous tumor and paraneoplastic hypoglycemia is known as Doege-Potter syndrome and occurs in less than 5% of all solitary fibrous tumors.


Subject(s)
Humans , Male , Female , Aged , Paraneoplastic Syndromes/etiology , Solitary Fibrous Tumor, Pleural/complications , Hypoglycemia/etiology , Paraneoplastic Syndromes/diagnostic imaging , Tomography, X-Ray Computed , Solitary Fibrous Tumor, Pleural/diagnostic imaging , Hypoglycemia/diagnostic imaging
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