Insulin resistance.

Abstract

Crush Injuries of Chest-Bargh et al.]BRITISH of paradox and reduction in residual deformity. It reduces pain and allows humane sedation without fear of respiratory depression. If a trained medical and nursing staff and proper facilities-that is, a respiratory unit-are available, and they Should be, the hazards of I.P.P.V. are negligible.Though blood-gas analysis is not used as the main indication for I.P.P.V., it has been found to be of great value in the management of a patient on a ventilator. This is particularly so in the " difficult " patient-that is, one with chronic lung disease or a low compliance from any other cause. Here frequent adjustments of inspiratory flow rates and inflation pressures may be necessary to achieve adequate ventilation, and the results of blood analysis are then invaluable. It is also very useful in the interpretation of certain clinical signs. For example, if varying levels of consciousness are occurring, are these due to a concurrent head injury or to hypoxia and acidosis ? Or, if the patient's blood pressure is falling, is this due to excessive ventilation or hypovolaemia ? In the patient with renal failure is the restlessness respiratory or renal in origin ? In these situations blood-gas studies may be the only means of deciding.As the management of the respiatory problems improves the mortality rate will depend more and more on the severity of the associated injuries. For this reason patients in this series have been classified according to the sites of injury-that is, thoracic only or thoracic together with other major injuries. Furthermore, as patients die from dysfunctions rather than injuries, we have attempted to quantitate these dysfunctions.Ten patients died. In four of these (Cases 27, 31, 71, and 128) death resulted from dysfunctions which could not be influenced by I.P.P.V. Three deaths (Cases 125, 193, and 199) were due to failure of respiration with which I.P.P.V. with pure oxygen failed to cope. The remaining three deaths (Cases 57, 66, and 122) were due to multiple factors, of which respiratory dysfunction contributed its share.It is impossible to compare the results in this series with the results of current authors (Reid and Baird, 1965 ;Lloyd et al., 1965; Campbell, 1966). The indications for I.P.P.V. are different, and, furthermore, the mortality rate will, in part, depend on the presence of other serious injuries-for example, head or abdominal visceral injuries. However, if the results of this series are compared with those recorded by Griffiths in 1960 a marked improvement in the mortality rate is obvious. This is largely due to the efficient management of the respiratory problem. SummarySixty-four patients with severe crush injuries of the chest are reviewed. They have been classified according to the anatomical site of injury. The great majority of patients received I.P.P.V., the indications for this being on clinical rather than biochemical features-particularly the persistence of dyspnoea and paradoxical respiration after the correction of airway obst...

Circulating insulin-binding antibodies

“…Their predictions were [4]; first, that antibodies might, if present in high titre, cause resistance to insulin; secondly, that the release of antibody bound insulin at inopportune times might cause hypoglycaemia; and, thirdly that circulating insulin-antibody complexes might cause vascular damage and contribute to the complications seen in long standing diabetics. Resistance caused by insulin binding antibodies has never been common [8] in spite of the fact that virtually all patients treated with insulin develop antibodies. Hypoglycaemia, caused by the release of antibody bound insulin, was described in an insulin-treated patient who had a very high titre of insulin-binding antibody and who suffered repeated hypoglycaemic episodes, sometimes days after receiving insulin [9].…”

“…Other types of insulin-antibody complex have been demonstrated in guinea pigs and in patients with very high antibody titres [44,45]; with these large complexes clearance by the reticuloendothelial system would be expected together with an increased requirement for insulin (i. e., resistance). Steroids block the clearance of complexes and are effective in the treatment of insulin resistance of this type [8]. In most patients antibody titres are fairly stable over long periods of time.…”

Anaphylaxis and Red Cell Survival Studies in a Child With Insulin‐resistant Diabetes Mellitus

“…2 and Table 1). Prednisoneresponsive diabetics are insulin-resistant patients who require less insulin while undergoing steroid therapy (16). The patient under study required more insulin while receiving prednisone, and his anti-insulin antibody was PCA negative.…”

Insulin antibodies

“…Since then there have been many other reports dealing mainly with corticosteroids (e.g. Shipp et al, 1965;Oakley, Jones & Cunliffe, 1967). These authors point out that steroids are most likely to reduce the insulin requirement when the patient has required a high dose of insulin for a long time, has had marked fluctuations in blood sugar level, has shown allergy to insulin, when the passive cutaneous anaphylaxis test in a guinea-pig is positive and when there are no associated pathological conditions known to be able to produce insulin resistance.…”