[Long-term study of glucose tolerance in individuals with a suspected diagnosis of diabetes]. / Dlouhodobé sledování glukózové tolerance u osob podezrelých z cukrovky.

The authors evaluated the results of the long-term monitoring of the glucose tolerance in 90 subjects, 40 men and 50 women, who were referred to a diabetological clinic as suspect diabetics. The mean age during the initial examination was 55.7 years (mean 55.7 +/- 12.5), a diabetic family--history was recorded in 60% of the patients, obesity in 61%. The monitoring proceeded on average for 8.5 years (mean 8.5 +/- 6.8). During the baseline examination diabetes was detected only in three subjects (3.3%), in 41 (45.6%) impaired glucose tolerance was revealed which in the course of 18 years developed in 28 into diabetes. In 32 examined subjects (35.6%) the oral glucose tolerance test (oGTT) was repeatedly normal, however, 9 subjects developed in the course of 23 years diabetes, although the stage of impaired glucose tolerance was not recorded. oGGT in 11 patients (12.2%) was variable in the course of the follow-up, normal glucose tolerance alternated with impaired glucose tolerance. In three subjects (3.3%) repeated examinations are consistent with renal glycosuria. From the results ensues that subjects suspect of diabetes with a marked family-history of diabetes and who are moreover obese it is important to ensure monitoring on a long-term basis as positivity during the initial examination is low (3.3%), while during long-term follow up the prevalence of diabetes is 54%. In patients with an impaired glucose tolerance there is a high risk of the development of diabetes, although the stage of impaired glucose tolerance is not always detected.

[Treatment of hyperglycemic coma states in diabetics]. / Lécba hyperglykemických komatózních stavu u diabetiku.

In the treatment of acute decompensation of diabetes, diabetic ketoacidosis and hyperosmolar non-acidotic syndrome the basic demand is insulin administration--in small doses by the i.v. route, preferably by means of an injectomat in a permanent infusion. An alternative method for departments which do not possess a suitable infusion pump, is fractionated administration of small insulin amounts into the vein after 30 minute intervals. Equally important is rehydration treatment with saline; only in case of hypernatriaemia above 150 mmol/l the author recommends 0.45% NaCl. Acidosis in DKA is corrected by sodium bicarbonate only at pH 7.1 or less. As to K cations, the replacement of potassium ions is most important; the value of substitution of other cations (Ca, Mg) is doubtful and is not currently done, the same applies to phosphate anion replacement. It has not been proved that prevention of thromboembolic complications by heparin is expedient in these conditions.

[Diabetic ketoacidosis and hyperglycemic hyperosmolar nonacidotic syndrome in type I and II diabetics]. / Diabetická ketoacidóza a hyperglykemický hyperosmolární neacidotický syndrom u diabetiku I. a II. typu.

The author analyzes 46 hyperglycaemic comatose conditions in diabetics treated at the medical clinic of the Paediatric Faculty, Charles University Prague in 1978-1985. In the group older patients with type II diabetes predominated, where acute decompensation was frequently of the hyperosmolar type without acidosis and it was usually associated with a higher mortality. The cause of the metabolic breakdown was most frequently infection, in type II diabetes, however, an equally important part was played by acute cardiovascular disease. Insulin was administered in small doses by the i.v. route either as a continuous infusion or in fractionated doses. The results of both procedures were comparable only the insulin requirement in the fractionated doses was higher.