Subject(s)
Diuretics/therapeutic use , Heart Failure/drug therapy , Heart Failure/physiopathology , Aortic Valve Stenosis/complications , Diabetes Mellitus, Type 2/complications , Echocardiography , Heart Failure/complications , Humans , Hypertension/complications , Natriuretic Peptides/blood , Stroke Volume/physiologyABSTRACT
This review explores the history, methods and evidence surrounding the various surgical therapeutic options which are available for patients with end-stage heart failure.
Subject(s)
Cardiomyoplasty/methods , Heart Failure , Heart Transplantation/methods , Heart-Assist Devices , Mitral Valve Insufficiency/surgery , Myocardial Revascularization/methods , Disease Management , Disease Progression , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Heart Failure/surgery , Humans , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/physiopathology , Myocardial Ischemia/complications , Myocardial Ischemia/physiopathology , Myocardial Ischemia/surgery , Outcome and Process Assessment, Health Care , Patient Selection , Severity of Illness Index , Ventricular RemodelingABSTRACT
BACKGROUND: A 26-year-old man with Type 1 diabetes presented with an overdose of 4800 units of the long-acting insulin analogue, glargine (Lantus). Glucose supplementation of approximately 800 g/day was associated with acute hepatic injury. METHODS: On day 4, a depot of insulin was excised from the patient's abdominal wall; this was followed by a reduction in his glucose requirements and improvement in liver function. CONCLUSIONS: This report highlights the risk of acute hepatic injury during the treatment of insulin overdose and the importance of careful glucose supplementation. It also demonstrates how earlier excision of an insulin depot could potentially prevent this problem and hasten recovery.
Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Glucose/adverse effects , Hypoglycemia/chemically induced , Hypoglycemia/drug therapy , Hypoglycemic Agents/adverse effects , Insulin, Long-Acting/adverse effects , Insulin/analogs & derivatives , Liver/drug effects , Abdomen/surgery , Adult , Device Removal , Drug Overdose , Glucose/administration & dosage , Humans , Hypoglycemic Agents/administration & dosage , Injections, Subcutaneous , Insulin/administration & dosage , Insulin/adverse effects , Insulin Glargine , Insulin, Long-Acting/administration & dosage , Liver/surgery , Male , Treatment OutcomeABSTRACT
BACKGROUND: There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care. AIM: To determine levels of confidence of doctors in training in the management of diabetes and establish their training needs in this area of clinical practice. DESIGN: A national online survey of trainee doctors in the UK using a pre-validated questionnaire. METHODS: A four-point confidence rating scale was used to rate confidence in the management of diabetes and comparators. A six-point scale was used to quantify how often trainees would contribute to the management of patients with diabetes and trainees were asked about their training in managing diabetes. RESULTS: A total of 2149 doctors completed the survey. The percentage 'fully confident' in diagnosing diabetes was 27%, diagnosing and managing hypoglycaemia 55%, diagnosing and managing diabetic ketoacidosis 43%, managing intravenous (IV) insulin 27%, prescribing IV fluids for patients with diabetes 39% and altering diabetes therapy prior to surgery/other procedure 18%. In comparison, 66% and 65% were 'fully confident' in the management of angina and asthma, respectively (P < 0.05). Forty-one percent would take the initiative to optimize glycaemic control for patients under their care >80% of the time. Respectively, 19% and 35% of respondents reported that their undergraduate and postgraduate training had prepared them adequately to optimize treatment of diabetes. The majority (>70%) wanted further training in managing all aspects of diabetes care. CONCLUSIONS: Trainee doctors in the UK lack confidence in the management of diabetes, are unlikely to take the initiative to optimize glycaemic control and report a need for further training.
