Diabetes in care homes: current care standards and residents' experience.

AIMS: The Diabetes UK good clinical practice guidelines for care home residents were revised in 2010. In this study, we examined current care against these standards and sought the views of residents on their diabetes. METHODS: Mixed methods (qualitative and quantitative), including interviews with residents, carers and staff, participant record reviews and focus group discussions were used to gather data in care homes in Newcastle upon Tyne. RESULTS: Thirty-one residents from seven care homes participated. Eighty-seven per cent of residents had probable dementia (based on abbreviated mental test score or clock-drawing test). Weight, body mass index and blood pressure were satisfactorily monitored. Glucose monitoring took place in all residents who received insulin, but was monitored unnecessarily in those with diet-controlled diabetes (63%). The majority of residents (90%) had seen a chiropodist and had received eye screening (> 80%) recently. Only one of the care homes had staff that had diabetes training. Residents reported little knowledge of diabetes management. However, when asked what they knew about diabetes, comments included 'It's a common thing... like cancer'; '[I would have liked a] plain language explanation of diabetes' and 'They told me they could control it by diet, and then it was tablets, then insulin. They didn't explain why.' CONCLUSIONS: In Newcastle upon Tyne care homes there is good care provided but also evidence of inadequacies. Despite high levels of dementia, many patients have strong and valid opinions about their disease and the care they receive. Despite the challenges, we believe that residents must be included in discussions about service development.

The effect of laparoscopic cholecystectomy on insulin sensitivity.

It is well known that there is impaired glucose tolerance after open abdominal surgery. We have investigated the effect on insulin sensitivity of laparoscopic cholecystectomy. Eight non-diabetic patients aged 51 +/- 3.5 years were studied pre and postoperatively. Insulin sensitivity measured by the short insulin tolerance test (ITT) was expressed as % disappearance of glucose per minute (KITT). Preoperative fasting blood glucose was 4.7 +/- 0.15 mmol/l compared with postoperative fasting blood glucose of 5.7 +/- 0.31 mmol/l (p = 0.02). Fasting insulin levels were 8.4 +/- 1.6 mU/l preoperatively compared to 30.0 +/- 9.3 mU/l postoperatively (p = 0.1 NS). KITT was 2.29 +/- 0.2% min-1 (range 1.0-3.03) preoperatively with 1.11 +/- 0.25% min-1 (range 0.13-1.97) postoperatively (p = 0.02). Hence marked insulin resistance is a consequence of major abdominal surgery irrespective of surgical technique.

The effect of high glucose on polyol pathway activity and myoinositol metabolism in cultured human endothelial cells.

Cultured human endothelial cells were incubated with high glucose (27.5 mmol/l) supplemented medium for 0, 2, 6, 12, 24 and 48 h. Lactate dehydrogenase was assayed as a measure of cell number. Sorbitol and myoinositol were determined as trimethyl silyl derivatives using gas chromatography mass spectrometry. Sorbitol, after an initial lag phase of 2 h, accumulated rapidly to plateau at 2 to 3 fold control value by 24 h, no further increase being seen over a further 24 h (Baseline, 1.31 +/- 0.36, 24 h 3.50 +/- 0.74 pmol sorbitol/unit lactate dehydrogenase; p less than 0.001). There was no change in myoinositol levels over the 24 h period. Sorbitol accumulation occurred at glucose concentration greater than 18.1 mmol/l and only returned to baseline levels after 24 h of incubation in normal medium (glucose levels 5.9 mmol/l). Sorbitol levels are increased by incubation of endothelial cells at high glucose levels but myoinositol levels remain unchanged.

The effect of high glucose and high insulin concentrations on pentose phosphate shunt enzymes and malic enzyme in cultured human endothelial cells.

The influence of glucose and insulin on pentose phosphate shunt enzymes and malic enzyme activity in cultured human endothelial cells has been investigated. Glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and malic enzyme were present in endothelial cells. Enzyme activities were not altered either by 20 mM glucose or 10(-8) M insulin after 3, 6 and 12 hour incubations respectively. Neither increased glucose nor increased insulin alter the activity of the pentose phosphate shunt. As a consequence fatty acid and cholesterol synthesis in the endothelial cell is unlikely to be altered in the presence of increased glucose or increased insulin.

Studies on glomerular basement membrane in experimental diabetes using lectin histochemistry in Wistar rats.

This study was designed to establish whether specific early changes in carbohydrate content of proteins in the glomerulus of the diabetic rat could be detected. Lectin staining of kidney sections from streptozotocin-induced diabetic rats were compared with similar sections from healthy and diabetic rats that were treated with insulin. Animal groups were killed 1 month, 3 months and 6 months after induction of diabetes. There were no differences in the staining of the glomerular basement membrane between control, insulin-treated and diabetic rats for the lectins concanavalin A, lotus tetragonolobus, soybean and kidney bean, with and without trypsinisation. Staining of the glomerular basement membrane with wheat germ agglutinin after trypsinisation was significantly increased in the diabetic group when compared to both healthy and insulin-treated groups (p less than 0.01). It was concluded that, in experimental diabetes mellitus in the rat, there is an accumulation of substances in the glomerular basement membrane and mesangium with an affinity for wheat germ agglutinin, most probably N-acetyl glucosamine, and this is partially prevented by insulin treatment.

Amiodarone-induced hypothyroidism. A common complication of prolonged therapy: a report of eight cases.

Amiodarone is a widely used antiarrhythmic drug, which contains 75 mg of iodide per 200 mg of active substance. Eight of our patients receiving long-term amiodarone therapy became hypothyroid. Seven of these patients had no previous history of thyroid dysfunction or goiter. Antithyroid antibodies were absent, and standard perchlorate discharge tests were positive in seven patients when hypothyroidism was diagnosed. In one patient, amiodarone therapy was withdrawn; over the next nine months, the hypothyroidism resolved, and results of the perchlorate discharge test reverted to normal. We conclude that amiodarone-induced hypothyroidism is similar to previously described iodide-induced hypothyroidism. It may develop in the absence of a previous history of thyroid disease, and all patients receiving long-term amiodarone therapy should therefore be regularly monitored for hypothyroidism.

Increase in fast hemoglobin concentration after incubation with acetaldehyde detected by an electrophoretic method.

Incubation of acetaldehyde with hemoglobin has been shown by chromatographic methods to result in an increase in fast hemoglobin. We have studied this increase in fast hemoglobin concentration by a gel electrophoretic method. Increases in fast hemoglobin concentration are detected following incubation with concentrations of 100 microM acetaldehyde and no further increase in yield occurs with concentrations greater than 7 mM acetaldehyde. The reaction is complete within 5 hr and the product is stable with a half-life of greater than 12 days.