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  • 1990-1994  (3)
  • hypoglycaemia  (2)
  • Benzodiazepine prescribing  (1)
  • 1
    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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    Paper (German National Licenses)
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  • 2
    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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  • 3
    Electronic Resource
    Electronic Resource
    Prevalence and treatment of insomnia in general practice (1993)
    Springer
    European archives of psychiatry and clinical neuroscience 242 (1993), S. 329-336 
    Details
    ISSN: 1433-8491
    Keywords: Insomnia ; General practice ; Benzodiazepine prescribing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of the study was to assess prevalence and treatment modalities of insomnia in general practice. To investigate the course of insomnia, a longitudinal study design was adopted. Two thousand five hundred and twelve patients (age 18–65 years) were investigated with a questionnaire in general practice (T1). Four months later (T2) and again 2 years later (T3) a questionnaire was sent to all patients who had complained about severe insomnia at the time of the first inquiry. To assess insomnia, operationalized diagnostic criteria were applied (DSM-III-R). Eighteen point seven percent suffered from severe, 12.2% suffered from moderate and 15% suffered from mild insomnia. In the course of 2 years insomnia appeared as a chronic health problem. A high comorbidity of severe insomnia was found with chronic somatic and psychiatric disorders, especially with depression. Of the severely insomniac patients, 23.9% used prescribed hypnotics habitually, mainly benzodiazepines. The use of prescribed hypnotics remained rather stable during the whole study period. More than half of the patients reported a daily use of the hypnotics for 1–5 years or longer, but only 22% of the severely insomniac patients reported at the time of the third inquiry a significant improvement of insomnia due to the administration of sleeping pills. Thus, the long-term administration of benzodiazepine hypnotics seems to be an inadequate treatment strategy in chronic insomnia. Whether the occurrence of rebound insomnia after benzodiazepine withdrawal may be one of the main factors for chronic hypnotic use requires discussion. Although insomnia may be an important symptom of many somatic and psychiatric disorders, the general practitioner was unaware in more than half of the cases that the patients suffered from a sleep problem. Severe insomniac patients displayed a higher mean number of medical consultations compared with good sleepers or patients with mild insomnia, indicating that insomnia constitutes a significant burden for the primary care physicians.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02190245
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    Paper (German National Licenses)
    Fulltext
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