Structural Changes of the Brain in Diabetes

Hypertension and hyperlipidaemia are common in diabetes and cerebrovascular disease is a recognised macrovascular complication. Atheromatous cerebral artery occlusion involving major vessels, embolism from cervical arteries, and lacunar strokes are more extensive and occur at an earlier age in diabetic patients compared with the non-diabetic population (McCall, 1992 Mankovsky and Ziegler, 2004). It is uncertain whether microvascular disease affects the brain. Following the death of a group of...

Organisation of Clinical Care

Kitzmiller Baby Ultrasound

In many centres clinical care is delivered by a multidisciplinary combined obstetric diabetic team with very regular out-patient reviews to assess metabolic control and obstetric progress Figure 10.1 . Home blood glucose monitoring results are assessed and insulin regimen and dietary intake modified to optimise glycaemic control and HbA1c Figure 10.2 . Most women present for booking at around eight weeks gestation when an early scan will provide an accurate estimate of gestational age. This is...

Counterregulation During Hypoglycaemia

The potentially serious effects of hypoglycaemia on cerebral function mean that not only are stable blood glucose concentrations maintained under physiological conditions, but also if hypoglycaemia occurs, mechanisms have developed to combat it. In clinical practice, the principal causes of hypoglycaemia are iatrogenic as side-effects of insulin and sulphony-lureas used to treat diabetes and excessive alcohol consumption. Insulin secreting tumours such as insulinoma are rare. The mechanisms...

Factors Predisposing Patients to Severe Hypoglycaemia in Intensified Insulin Therapy

The relationship between impaired symptomatic awareness of hypoglycaemia and an increased rate of severe hypoglycaemia is well established Hepburn et al., 1990 Gold et al., 1994 Clarke et al., 1995 , although affected patients in these studies were not subject to strict glycaemic control. The association between counterregulatory failure and increased risk of severe hypoglycaemia is also well recognised Ryder et al., 1990 . Indeed, counterregulatory failure was proposed as a predictor of risk...

Effect of Hypoglycaemia on Cerebral Blood Flow and Structure

Mri Brain Stem

Hypoglycaemia promotes a redistribution of regional cerebral blood flow Tallroth et al., 1992 MacLeod et al., 1994 Kennan et al., 2005 which may encourage localised neuronal ischaemia, particularly if the cerebral macro- or microcirculation is already compromised in subjects with type 1 diabetes. Using techniques such as Single Photon Emission Tomography, the blood flow to the frontal lobes has been shown to be increased during acute hypoglycaemia in non-diabetic subjects Tallroth et al., 1992...

Human Insulin

For 60 years after its discovery, insulin for therapeutic use was obtained from the pancreata of cattle and pigs. With the development of recombinant DNA technology it was possible to 'genetically engineer' molecules and insulin was the first protein to be made in this way, becoming available for the treatment of humans in the 1980s. Several of the existing animal insulin formulations were withdrawn, principally for commercial reasons, and human insulin rapidly became the most commonly...