[The 117th Internal Medicine Seminar (The 3rd Internal Medicine Seminar in Ostrava). Diabetes mellitus at the threshold of the 21st century. Ostrava, 30 November 2000].

Vnitr Lek 2001, 47(5):275-336

[Diabetology at the threshold of the 21st century].

M Anděl

Vnitr Lek 2001, 47(5):277-280

Scientific advances in the 19th and 20th centuries led to the discovery of insulin, the fundamental therapeutic means for treatment of diabetes mellitus type 1 at the onset of the twenties, to the introduction of sulfonylurea derivatives and biguanides in the fifties and sixties. The discovery of the principle of radioimmunoassay at the end of the fifties made it possible to investigate insulin secretion and to achieve a more accurate understanding of the pathogenesis of type 1 and 2 diabetes. Understanding of insulin resistance made it possible to introduce an euglycaemic hyperinsulin clamp at the end of the seventies. Insulin resistance was presented...

[Diabetes mellitus--a risk factor for cardiovascular diseases].

J Skrha

Vnitr Lek 2001, 47(5):281-284

Hyperglycemia besides typical changes of lipids, especially of LDL and HDL-cholesterol and triglycerides, arterial hypertension and smoking is another factor causing greater morbidity and mortality of diabetic patients with cardiovascular disease. Significant association was found between the insulin resistance and atherosclerosis. Some studies evaluating the tight relationship between diabetes and cardiovascular diseases are selected in this overview and they demonstrate the necessity of the complex therapeutic and preventive approaches.

[Current and future aspects of oral antidiabetic agents in type 2 diabetes].

J Rybka

Vnitr Lek 2001, 47(5):285-290

Type 2 diabetes mellitus is characterized by insulin deficiency but in particular by insulin resistance. Patients where it is not possible to achieve positive results within 4-12 weeks by optimalization of the lifestyle are candidates for treatment with oral antidiabetics. At present the following main groups of oral antidiabetics are discussed: insulin secretagogues (SU derivatives and methiglinide derivatives), biguanides (Metformin), alpha-glucosidase inhibitors (acarbose, miglitol) and insulin sensitizers (thiazolindiones). Traditional SU therapy improves the insulin plasma levels by releasing insulin from the pancreas. This implies further stress...

[Role of insulin therapy in the treatment of type 2 diabetes].

O Skarpová

Vnitr Lek 2001, 47(5):291-292

[Education of diabetics--an essential part of therapy].

M Kvapil

Vnitr Lek 2001, 47(5):293-297

[The phenomenon of unawareness of hypoglycemia].

M Mokán

Vnitr Lek 2001, 47(5):298-303

The incidence of hypoglycaemic episodes in patients with type 1 diabetes mellitus (DM1) is frequent. They experience 1-2 symptomatic hypoglycaemias per week. 10-20% of the patients suffer from at least one severe hypoglycaemia per year. The incidence of severe hypoglycaemia in a group of intensely treated patients is about three times as high as compared with standard treatment and 55% of all episodes occur during sleep. Prevention of hypoglycaemia, and restoration of euglycaemia resp. include disappearance of metabolic effects of insulin and activation of glucose contraregulating systems among which there is a certain hierarchy. The phenomenon of...

[Care of diabetics in an acute state].

R Mottl, A Smahelová, Z Zadák

Vnitr Lek 2001, 47(5):304-306

[Microalbuminuria--a risk factor for diabetic nephropathy and cardiovascular disease].

P Pontuch

Vnitr Lek 2001, 47(5):307-310

In developed countries diabetics patients are the most numerous group with renal replacement therapy (USA 34%). The main and diagnostically irreplaceable criterion of incipient diabetic nephropathy is microalbuminuria which is usually associated with hypertension and poor glycaemic compensation. With advancing microalbuminuria progresses diabetic retinopathy and neuropathy. The increased transcapillary albumin escape rate and changes of some haemocoagulation factors in diabetics patients with microalbuminuria indicate that endothelial dysfunction is involved. In type 1 diabetes microalbuminuria is an indicator of increased mortality in which participate...

[The diabetic foot syndrome--one of the most serious complications in diabetics].

A Jirkovská

Vnitr Lek 2001, 47(5):311-314

The diabetic foot syndrome is defined according to WHO as ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischaemia and infection. It is the most frequent cause of hospitalization of diabetic patients. It is one of the economically most demanding complications of diabetes. According to international consensus on the diabetic foot syndrome should be organized at the level of general practitioners as well as at the level of special diabetological centres. The basic organizational unit of multidisciplinary team care of patients with the diabetic foot syndrome is foot clinic. The...

[Stress-induced hypertension and diabetes mellitus].

M Soucek, T Kára

Vnitr Lek 2001, 47(5):315-319

Hypertension and diabetes are the basic risk factors of atherosclerosis and its complications. At present new associations are sought which will enable us to describe more satisfactorily the mutual relationship of hypertension, metabolic disorders and cardiovascular disease. One of the systems involved in all substantial physiological processes is the autonomic nervous system. Stimulation of the sympathetic nervous system by chronic stress causes in addition to an elevated pulse rate and cardiac minute output also activation of another important pressor mechanism--the renin-angiotensin-aldosterone system. Increased activity of the sympathetic nervous...

[Special aspects of diagnosis and therapy of diabetes in liver diseases].

R Chlup, J Ehrmann

Vnitr Lek 2001, 47(5):320-323

The core of this review are questions dealing with links between diabetes mellitus and liver diseases. Based on the literature and on their own observations the authors conclude that a liver disease may induce and/or worsen the development of type-2 diabetes mellitus (so called hepatogenic diabetes) and vice versa, a diabetes may result in a liver damage, e.g. simple steatosis or even non-alcoholic-steatohepatitis. The diagnosis of diabetes in hepatopathy is defined according to the same criteria as in patients without any hepatic involvement. The treatment is based on adequate food intake without alcohol and on restricted physical activity. Complementary...

[Are ultrasonic images in diabetics different?].

A Martínek, P Klvana, P Marten, M Lesková, J Dvorácková

Vnitr Lek 2001, 47(5):324-329

The authors evaluated the results assembled in 5397 patients where between Jan. 1 1999 and Oct. 31 2000 sonographic examinations of the abdominal cavity and retroperitoneum were made with the objective to assess whether there are any statistically significant differences of results in diabetic patients, as compared with a group without this disease. The group of patients was divided into a sub-group of 4287 patients without diabetes and a sub-group of 1100 diabetics. For statistical evaluation of the significance of differences in the incidence of the investigated parameters Fisher's exact test was used. The image of "light liver" was significantly...

[Transcutaneous oximetry in the diagnosis of ischemic disease of the lower extremities in diabetics].

R Urbanová, A Jirkovská, V Wosková, P Wohl

Vnitr Lek 2001, 47(5):330-332

In diabetic patients with ischaemia of the lower extremities and mediocalcinosis the diagnosis of ischaemia is still difficult. One of the methods which give an objective idea of the microcirculation is transcutaneous oximetry. In the submitted paper the authors explain the principle and problems of assessment with recommendations for the practical application of the method, in particular in indication for angiography of the lower extremities in the presence of the diabetic foot syndrome with regard to probable spontaneous healing of defects and application of the method for following up the effect of revascularization operations.

[Preoperative and postoperative care in diabetics].

J Rybka, J Mistrík, M Szabó

Vnitr Lek 2001, 47(5):333-336

The submitted paper should serve as a basis for recommended procedures of preoperative and postooperative care of diabetics. It contains the algorithm of preoperative preparation of diabetics focused on quantification of the risk of surgery. The diabetologist is the consultant of the surgeon who participates in the preparation of the patient for urgent as well as elective surgery. The procedures differ with regard to the type of diabetes. The authors mention in more detail the problem of preoperative care of operated diabetics and finally also monitoring and therapy of diabetics during the postoperative period.