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  • 1990-1994  (2)
  • 1985-1989  (4)
  • Engineering General  (3)
  • hypoglycaemia  (3)
  • 1
    Electronic Resource
    Electronic Resource
    Effective and safe translation of intensified insulin therapy to general internal medicine departments (1993)
    Springer
    Diabetologia 36 (1993), S. 99-105 
    Details
    ISSN: 1432-0428
    Keywords: Insulin therapy ; education ; hypoglycaemia ; ketoacidosis ; hospitalisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Up to now all published experience with intensified insulin therapy has originated from specialized diabetes centres. However, even in diabetes centres and under research conditions intensification of insulin therapy may substantially increase the risk of severe hypoglycaemia. The aim of the present study was to demonstrate the feasibility of effectively and safely transfering intensified insulin therapy based upon a 5-day in-patient treatment and teaching programme from a University diabetes centre to non-specialized general hospitals. A total of nine general hospitals were recruited; the University diabetes centre served as a reference centre. From each general hospital a nurse and a dietitian were trained as diabetes educators, and a diabetes unit with about 10 beds was organized within each department of internal medicine. A total of 697 consecutively admitted Type 1 (insulin-dependent) diabetic patients (age 26±7 years, duration of diabetes 8±7 years) who participated in the programme either in one of the general hospitals (n=579) or in the reference centre (n=118) were re-examined after 1, 2 and 3 years. Insulin therapy was intensified to a similar extent in the reference centre and the general hospitals: at the 3-year follow-up about 80% of the patients injected insulin at least three times daily or used continuous subcutaneous insulin infusion (10%), and about 70% reported measuring blood glucose levels more than twice per day. HbA1 levels were lowered (p〈0.0001) to comparable levels, i. e. from 10.6 % (reference centre) and 9.9 % (general hospital), respectively, at baseline to 9.4 % and 9.3 %, respectively, at the 3-year follow-up. The yearly incidence rates of severe hypoglycaemia decreased from 0.23 (reference centre) and 0.29 (general hospitals), respectively, during the year before intensification of insulin therapy, to 0.19 (NS) and 0.12 (p〈0.005), respectively, during the third year of follow-up. Days spent in hospital were reduced in both groups (from 11 and 7 days per patient per year, respectively, to 5 and 4 days, respectively, p〈0.0001). In conclusion, this study shows that intensified insulin therapy based upon a structured and comprehensive training of the patients by diabetes educators can be effectively and safely translated from a specialized University diabetes centre to general medicine departments.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400688
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Human insulin: much ado about hypoglycaemia (un)awareness (1987)
    Springer
    Diabetologia 30 (1987), S. 829-833 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; human insulin ; hypoglycaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The biological effects, hypoglycaemic symptoms, endocrine counterregulatory responses and glucose recovery following the injection of purified porcine and human insulin preparations were compared in a number of controlled clinical investigations and prospective clinical trials. In these studies involving healthy volunteers, Type 1 (insulin-dependent) diabetic patients on continuous subcutaneous insulin infusion or intensified conventional insulin therapy and insulin treated Type 2 (non-insulin-dependent) diabetic patients, no differences with regard to biological effects, counterregulatory responses, hypoglycaemic awareness or the long-term incidence of severe hypoglycaemia between porcine and human insulin preparations were identified. These data fail to confirm any specific risk of severe hypoglycaemia attributable to the use of human insulin preparations in the treatment of patients with diabetes mellitus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00274789
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Exercise in Type 1 (insulin-dependent) diabetic patients treated with continuous subcutaneous insulin infusion (1990)
    Springer
    Diabetologia 33 (1990), S. 696-703 
    Details
    ISSN: 1432-0428
    Keywords: Exercise ; Type 1 (insulin-dependent) diabetes ; CSII ; hypoglycaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The study was performed to investigate the effects of mild to moderate exercise on blood glucose levels, metabolite concentrations and responses of counterregulatory hormones in tightly controlled Type 1 (insulin-dependent) diabetic patients treated by continuous subcutaneous insulin infusion, and to quantify the measures necessary to prevent acute and late exercise-induced hypoglycaemia. Seven male patients started a 60 min exercise period 90 min after an insulin bolus and a standard breakfast; they were monitored during a post-exercise resting period of 5 h 30 min. Different basal and premeal insulin infusion rates were applied. (Near)normoglycaemia prevailed throughout the study during the control protocol when the subjects did not exercise and received their usual insulin dose. When they exercised without changing the insulin dose, four patients were forced to stop due to hypoglycaemia. This effect of exercise could be attenuated but not completely avoided if the basal infusion rate of insulin was discontinued during the exercise period. The pronounced increase in catecholamine and growth hormone concentrations during exercise were not sufficient to prevent hypoglycaemic reactions. Hypoglycaemia during exercise could only be prevented when the premeal insulin bolus was reduced by 50% in addition to the discontinuation of the basal insulin infusion during exercise. In order to reduce late hypoglycaemic reactions after exercise the best measure proved to be a reduction of the basal insulin infusion rate by 25% during post-exercise hours. Administration of only 50% of the basal insulin infusion rate during this time was associated with blood glucose levels being raised up to 8 mmol/l. In conclusion, Type 1 diabetic patients treated with continuous subcutaneous insulin infusion at (near)normoglycaemia need to reduce their insulin dosage before, during, and after mild to moderate endurance exercise in order to minimize the risk of acute and late hypoglycaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400572
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  • 4
    Electronic Resource
    Electronic Resource
    Computer-extended series for a source/sink driven gas centrifugeBased on work performed at Oak Ridge Gaseous Diffusion Plant, operated by Martin Marietta Energy Systems, Inc, for the U.S. Department of Energy under U.S. Government contract DE-AC05-840R21400. (1987)
    Chichester : Wiley-Blackwell
    International Journal for Numerical Methods in Fluids 7 (1987), S. 233-246 
    Details
    ISSN: 0271-2091
    Keywords: Computer Extended Series ; Rotating Fluid Mechanics ; MACSYMA ; Engineering ; Engineering General
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Mechanical Engineering, Materials Science, Production Engineering, Mining and Metallurgy, Traffic Engineering, Precision Mechanics
    Notes: We have reformulated the general problem of internal flow in a modern, high speed gas centrifuge with sources and sinks in such a way as to obtain new, simple, rigorous closed form analytical solutions. Both symmetric and antisymmetric drives lead us to an ordinary differential equation in place of the usual inhomogeneous Onsager partial differential equation. Owing to the difficulties of exactly solving this sixth order, inhomogeneous, variable coefficient ordinary differential equation we appeal to the power of perturbation theory and techniques. Two extreme parameter regimes are identified, the so-called semi-long bowl approximation and a new short bowl approximation. Only the former class of problems is treated here. The long bowl solution for axial drive is the correct leading order term, just as for pure thermal drive. New O(1) results are derived for radial, drag and heat drives in two dimensions. Then regular asymptotic, even ordered power series expansions for the flow field are carried out on the computer to O(ε4) using MACSYMA. These approximations are valid for values of ε near unity. In the spirit of Van Dyke, one can carry out this expansion process, in theory, to apparently arbitrary order for arbitrary but finite decay length ratio. Curiously, the flows induced by axial and radial forces are proportional for asymptotically large source scale heights, x*. Corresponding isotope separation integral parameters will be given in a companion paper.
    Additional Material: 2 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/fld.1650070304
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Computer extended series for a thermally driven gas centrifuge (1986)
    Chichester : Wiley-Blackwell
    International Journal for Numerical Methods in Fluids 6 (1986), S. 395-401 
    Details
    ISSN: 0271-2091
    Keywords: Computer Extended Series ; Gas Centrifuge Theory ; MACSYMA ; Engineering ; Engineering General
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Mechanical Engineering, Materials Science, Production Engineering, Mining and Metallurgy, Traffic Engineering, Precision Mechanics
    Notes: Linearized, multidimensional, thermally driven flow in a gas centrifuge can be approximately described in regions away from the ends by Onsager's homogeneous pancake equation.1 Upon reformulation of the general problem, we find a new, simple and rigorous closed form, analytical solution by assuming a special separable solution and replacing the usual Ekman end cap boundary conditions with idealized impermeable, free slip boundary conditions. Then the flow may be described by an ordinary differential equation with solutions in terms of simple, classical functions. By identifying a small parameter, say ∊, defining the semi-long bowl approximation, and assuming a power series expansion in ∊, a sequence of asymptotic approximations to the master potential is obtained. Not surprisingly, the leading order term involves the well known ‘long bowl’ solution. Using the so-called ‘solving’ property of the 1-D pancake Green's function,2 we determine the next higher order solution. This recursive process is carried out on the computer to find all the terms up to O(∊4).Consequently, the solution of some complex rotating, viscous, heat conducting flow problems that normally require large mainframe computers can be better understood.
    Additional Material: 1 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/fld.1650060607
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Finite element analysis of flow in a gas-filled rotating annulusBased on work performed at Oak Ridge Gaseous Diffusion Plant, operated by Martin Marietta Energy Systems, Inc, for the U.S. Department of Energy under U.S. Government contract DE-AC05-840R21400. (1987)
    Chichester : Wiley-Blackwell
    International Journal for Numerical Methods in Fluids 7 (1987), S. 215-231 
    Details
    ISSN: 0271-2091
    Keywords: Finite Element Method ; Rotating Fluid Mechanics ; Slip Flow ; Engineering ; Engineering General
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Mechanical Engineering, Materials Science, Production Engineering, Mining and Metallurgy, Traffic Engineering, Precision Mechanics
    Notes: Linearized multidimensional flow in a gas centrifuge can be described away from the ends by Onsager's pancake equation. However a rotating annulus results in a slightly different set of boundary conditions from the usual symmetry at the axis of rotation. The problem on an annulus becomes ill-posed and requires some special attention. Herein we treat axially linear inner and outer rotor temperature distributions and velocity slip. An existence condition for a class of non-trivial, one-dimensional solutions is given. New exact solutions in the infinite bowl approximation have been derived containing terms that are important at finite gap width and non-vanishing velocity slip. The usual one-dimensional, axially symmetric solution is obtained as a limit. Our previously reported finite element algorithm has been extended to treat this new class of problems. Effects of gap width, temperature and slip conditions are illustrated. Lastly, we report on the compressible, finite length, circular Couette flow for the first time.
    Additional Material: 8 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/fld.1650070303
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    Paper (German National Licenses)
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