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  1. Article ; Online: Acute consequences of hypoglycaemia in diabetic patients.

    Halimi, S

    Diabetes & metabolism

    2010  Volume 36 Suppl 3, Page(s) S75–83

    Abstract: ... the most limiting factor in the daily management of patients with diabetes. Acute consequences ... trials in type 2 diabetic patients have not shown the anticipated mortality benefits of strict glycaemic ... as myocardial ischaemia or stroke seem to be rare, but possibly ignored mainly in older frail patients. Recent large ...

    Abstract Strict glycaemic control is a major concern in many people with diabetes, hypoglycaemia being the most limiting factor in the daily management of patients with diabetes. Acute consequences of hypoglycaemic attacks are not precisely evaluated. Acute cardiovascular (CV) complications as myocardial ischaemia or stroke seem to be rare, but possibly ignored mainly in older frail patients. Recent large trials in type 2 diabetic patients have not shown the anticipated mortality benefits of strict glycaemic control, and reported a higher frequency of severe hypoglycaemia in the intensive treatment arms with an excess of CV deaths. The authors of these trials persist to deny a direct link between CV deaths and hypoglycaemia. In young type 1 diabetics "dead in bed" syndrome represents a rare but devastating consequence probably due to arrhythmia and prolonged QTc interval. Driving mishaps represent another complication but with a controversial frequency. Neurologic syndromes are frequent during severe hypoglycaemia but usually reversible. Major brain damages are scarce, but cognitive defects or dementia should be underestimated in older and frail type 2 diabetics. Thus, iatrogenic hypoglycaemia due to insulin or sulphonylureas may cause recurrent morbidity in type 1 and type 2 diabetic subjects, and should be prevented by a reevaluation of glycaemic targets in some patients, patient education and the use of new antidiabetic drugs without hypoglycaemic risk.
    MeSH term(s) Cardiovascular Diseases/blood ; Diabetes Complications/blood ; Humans ; Hypoglycemia/complications ; Hypoglycemia/physiopathology ; Risk Factors
    Language English
    Publishing date 2010-10
    Publishing country France
    Document type Journal Article ; Review
    ZDB-ID 1315751-6
    ISSN 1878-1780 ; 1262-3636 ; 0338-1684
    ISSN (online) 1878-1780
    ISSN 1262-3636 ; 0338-1684
    DOI 10.1016/S1262-3636(10)70471-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1267: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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  2. Article ; Online: Hyperglycaemia in acute stroke--to treat or not to treat.

    Quinn, T J / Lees, K R

    Cerebrovascular diseases (Basel, Switzerland)

    2009  Volume 27 Suppl 1, Page(s) 148–155

    Abstract: Diabetes is common amongst patients with stroke and is associated with poorer outcome. Post-stroke ... hyperglycaemia is also recognised in up to half of the patients, and is independently associated with adverse ... consequences are postulated to occur. A distinction between occult diabetes and non-diabetic hyperglycaemia ...

    Abstract Diabetes is common amongst patients with stroke and is associated with poorer outcome. Post-stroke hyperglycaemia is also recognised in up to half of the patients, and is independently associated with adverse sequelae: both increased mortality and poorer functional outcomes. Neither the aetiology nor the pathophysiology of such hyperglycaemia is fully understood. Both direct neurological toxicity and systemic consequences are postulated to occur. A distinction between occult diabetes and non-diabetic hyperglycaemia seems important as prognosis and effect of intervention differ in these two groups. The optimal management of the milder forms of hyperglycaemia associated with acute stroke is unknown. Randomised trial data remain limited but presently offer no strong support for aggressive intervention in stroke, though in other critical illness settings tight control of blood sugar appears beneficial. Studies based in coronary care and high dependency units have shown a possible beneficial effect of insulin, but evidence for intervention in acute stroke is at best limited. However, if glucose management is to be undertaken, this should be instituted while there is still salvageable tissue and the glucose reduction must be substantial. Intravenous insulin may be more effective than glucose-potassium-insulin infusion. Both interventions carry a risk of hypoglycaemia and any proposed intervention must balance safety, convenience and glycaemic control. Until further trial data are available, consensus guidelines may be followed, which are generally conservative for blood glucose levels below 10 mM (180 mg/dl).
    MeSH term(s) Blood Glucose/drug effects ; Critical Illness ; Diabetes Mellitus/blood ; Diabetes Mellitus/drug therapy ; Diabetes Mellitus/epidemiology ; Glucose/administration & dosage ; Glucose/adverse effects ; Humans ; Hyperglycemia/blood ; Hyperglycemia/drug therapy ; Hyperglycemia/epidemiology ; Hyperglycemia/etiology ; Hypoglycemia/chemically induced ; Hypoglycemic Agents/administration & dosage ; Hypoglycemic Agents/adverse effects ; Insulin/administration & dosage ; Insulin/adverse effects ; Patient Selection ; Potassium/administration & dosage ; Potassium/adverse effects ; Risk Factors ; Stroke/blood ; Stroke/complications ; Stroke/drug therapy ; Stroke/epidemiology ; Time Factors ; Treatment Outcome
    Chemical Substances Blood Glucose ; Hypoglycemic Agents ; Insulin ; glucose-insulin-potassium cardioplegic solution ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2009
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 1069462-6
    ISSN 1421-9786 ; 1015-9770
    ISSN (online) 1421-9786
    ISSN 1015-9770
    DOI 10.1159/000200453
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3181: Show issues Location:
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    Zs.MO 226: Show issues

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  3. Article: Hyperglycaemia in Acute Stroke – To Treat or Not to Treat

    Quinn, T.J. / Lees, K.R.

    Cerebrovascular Diseases

    2009  Volume 27, Issue 1, Page(s) 148–155

    Abstract: Diabetes is common amongst patients with stroke and is associated with poorer outcome. Post-stroke ... hyperglycaemia is also recognised in up to half of the patients, and is independently associated with adverse ... consequences are postulated to occur. A distinction between occult diabetes and non-diabetic hyperglycaemia ...

    Institution Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
    Abstract Diabetes is common amongst patients with stroke and is associated with poorer outcome. Post-stroke hyperglycaemia is also recognised in up to half of the patients, and is independently associated with adverse sequelae: both increased mortality and poorer functional outcomes. Neither the aetiology nor the pathophysiology of such hyperglycaemia is fully understood. Both direct neurological toxicity and systemic consequences are postulated to occur. A distinction between occult diabetes and non-diabetic hyperglycaemia seems important as prognosis and effect of intervention differ in these two groups. The optimal management of the milder forms of hyperglycaemia associated with acute stroke is unknown. Randomised trial data remain limited but presently offer no strong support for aggressive intervention in stroke, though in other critical illness settings tight control of blood sugar appears beneficial. Studies based in coronary care and high dependency units have shown a possible beneficial effect of insulin, but evidence for intervention in acute stroke is at best limited. However, if glucose management is to be undertaken, this should be instituted while there is still salvageable tissue and the glucose reduction must be substantial. Intravenous insulin may be more effective than glucose-potassium-insulin infusion. Both interventions carry a risk of hypoglycaemia and any proposed intervention must balance safety, convenience and glycaemic control. Until further trial data are available, consensus guidelines may be followed, which are generally conservative for blood glucose levels below 10 mM (180 mg/dl).
    Keywords Acute stroke ; Diabetes mellitus ; Glucose ; Hyperglycaemia ; Stroke outcome ; Thrombolysis
    Language English
    Publishing date 2009-04-03
    Publisher S. Karger AG
    Publishing place Basel, Switzerland
    Document type Article
    Note Acute Stroke Management: Brain Protection and Reperfusion
    ZDB-ID 1069462-6
    ISBN 978-3-8055-9051-8 ; 978-3-8055-9052-5 ; 3-8055-9051-2 ; 3-8055-9052-0
    ISSN 1421-9786 ; 1015-9770
    ISSN (online) 1421-9786
    ISSN 1015-9770
    DOI 10.1159/000200453
    Database Karger publisher's database

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 3181: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 226: Show issues

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

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