Clinical Characteristics of Type 1 Diabetic Patients With and Without Severe Hypoglycemia O R I G I N A L A R T I C L EOBJECTIVE -To investigate the frequency of severe hypoglycemia (SH) and hypoglycemic coma and to identify clinical and behavioral risk indicators in a nonselected population of type 1 diabetic patients. RESEARCH DESIGN AND METHODS-This study involved a retrospective clinical survey of 195 consecutive patients using a questionnaire addressing the frequency of SH (i.e., help from others required) and hypoglycemic coma during the previous year, general characteristics, behavior, hypoglycemia awareness, and the Hypoglycemia Fear Survey. Data regarding diabetes, treatment, long-term complications, comorbidity, and comedication were obtained from the patients' medical records.RESULTS -A total of 82% of subjects were receiving intensive insulin treatment, and mean ± SD HbA 1c was 7.8 ± 1.2%. Mean duration of diabetes was 20 ± 12 years. The occurrence of SH (including hypoglycemic coma) was 150 episodes/100 patient-years and affected 40.5% of the population. Hypoglycemic coma occurred in 19% of subjects (40 episodes/100 patient-years). CONCLUSIONS -SH and hypoglycemic coma are common in a nonselected population with type 1 diabetes. The presence of long-term complications, a threshold for symptoms of Ͻ3 mmol/l, alcohol use, and (nonselective) ␤-blockers were associated with SH during the previous year. If prospectively confirmed, these results may have consequences for clinical practice.

Slower absorption from deltoid and femoral administrations resulted in an increased duration of action for both regular insulin and insulin lispro when compared to abdominal administration. However, notable increases in the onset of action were only apparent with regular insulin. The consistency with insulin lispro response from abdominal and extremity injection sites allows more potential sites for subcutaneous injection with an assured rapid response.

No abstract

No abstract

Data are n or means ± 2SD. *P = 0.059; †P = 0.069; ‡P = 0.003. 1198DIABETES CARE, VOLUME 23, NUMBER 8, AUGUST 2000 Letters with homozygous or heterozygous HbS, HbC, HbG, and Hb Hamadan (3,5). Variably decreased or increased results are found with HbE and increased quantities of HbF, including HPFH.Of the subjects, 43% were non-Caucasian. There was no difference in frequency of hemoglobinopathy between Caucasians and non-Caucasians. At this institution, only women with an abnormal glucose tolerance test during pregnancy or with pregestational diabetes have HbA 1c measurements performed during pregnancy. For women with abnormal glucose tolerance, figures for 1998 show that 41% were non-Caucasian.Because of the importance placed on HbA 1c in the management of diabetes, it is important to consider hemoglobinopathy in patients when the HbA 1c value does not correlate with clinical expectations. If the value is artificially low, these patients may be at higher risk for complications of diabetes than the HbA 1c result would suggest, and they may require alterations in therapy.It is well recognized that subjects with diabetes may underreport hBGL. However, it seems unlikely that they would report levels higher than they find during home monitoring. Thus, if the HbA 1c value is lower than expected, based on the results of hBGL, HbEPG should be performed. In subjects with a hemoglobinopathy, use of fructosamine to monitor diabetes may be more reliable.It is reasonable to expect that otherwise clinically silent hemoglobinopathies may be present with greater frequency than currently realized. If discrepant results are found on an HbA 1c assay (either higher or lower than expected), hemoglobinopathy should be considered as a possible cause. JENNY E. GUNTON, MBBS AIDAN MCELDUFF, MBBS, FRACP, PHD Upper gastrointestinal symptoms, such as postprandial nausea, vomiting, bloating, early satiety, fullness, and abdominal discomfort, are commonly found in patients with either type 1 or type 2 diabetes (1,2). Diabetic gastropathy has been found in ϳ50% of patients with type 1 diabetes and in ϳ30% of patients with type 2 diabetes (2). In addition to problems concerning quality-of-life issues (3), diabetic gastropathy may cause erratic and unpredictable blood glucose levels by reducing the effectiveness of dietary regimen and the absorption of oral medications, thereby causing difficulties in timing insulin peak with meals (3-6). However, no study has reported the effects of treatment for diabetic gastropathy on glycemic control, except for a preliminary observation of 8 Japanese subjects (6).Various prokinetic agents, including the dopamine D2 antagonists metoclopramide and domperidone (3,4), the motilin agonist erythromycin (5), and a cholinergic mimetic cisapride (2) have been used to treat diabetic gastropathy. In the present study, we examined the effect of mosapride, a new prokinetic drug (a selective serotonin 5-HT4 receptor agonist) (7), on glycemic control in patients with type 2 diabetes presenting with upper gastrointest...

No abstract