Lege Artis Medicinae

[Pregnancy and insulin resistance: theoretical and clinical issues]

BARANYI Éva, WINKLER Gábor

FEBRUARY 21, 2008

Lege Artis Medicinae - 2008;18(02)

[During pregnancy, metabolic changes occur physiologically, which are enhanced by the presence of gestational or praegestational diabetes. The basis of these changes is the increasing insulin resistance throughout pregnancy, which in diabetics may result in hyperglycaemia with undesirable clinical consequences and complications. These complications can be prevented in diabetic pregnant women by maintaining the physiological metabolic state typical of healthy pregnant women. Thus the aim of the treatment is to achieve a normoglycaemic state throughout pregnancy. In most cases this is only possible by the use of insulin, along with appropriate dietary measures. Intensive insulin regimes are successfully used in the metabolic control of pregnant diabetic women, and the use of insulin analogues and insulin pump may also be considered.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Cardiovascular protection with telmisartan]

NAGY Viktor

Lege Artis Medicinae

[The End of the Story]

MAKÓ János

Lege Artis Medicinae

[Management of bleeding from oesophageal and gastric varices]

JÓZSA Andrea, SZÉKELY Iván, SIMON János, MÁHR Árpád, HORVÁTH László, HORVÁTH Andrea, FEJES Roland, SZÉKELY András, SZABÓ Tamás, MADÁCSY László

[INTRODUCTION – Variceal haemorrhage from the oesophageal or gastric wall is a major cause of death in patients with chronic liver disease. Over the past two decades many new treatment modalities have been introduced in the management of variceal bleeding, such as emergency endoscopy, band ligation and postintervention observation of the bleeding patients in subintensive care units. This study presents the results of state-of-the-art therapy applied in our department, comparing them to published data. PATIENTS AND METHODS – Clinical records of patients with variceal haemorrhage admitted to our department between January 1st 2001 and December 31st 2004 were reviewed. Six-week mortality, incidence of recurrent bleeding, transfusion requirement and length of hospital stay were the main parameters analysed. RESULTS – A total of 228 admissions (191 patients) due to variceal bleeding were recorded in the study period. Cirrhosis was of alcoholic origin in 92% of patients. Upper endoscopy was performed in 94% of patients within 4 hours and endoscopic therapy was also applied in all but 7 patients. Octreotide was administered in 4 patients, and portosystemic shunt was performed in 1 patient. Primary endoscopic haemostasis was achieved in 85% of cases, while rebleeding rate was 31%. The mean length of total hospital stay was 10.6 days, including an average of 2.6 days in subintensive care units. The mean transfusion requirement was 3.75 units of packed red cells. Six-week mortality rate was 14.9%. CONCLUSION – In comparison to international data, the six-week mortality rate among our patients was substantially lower than that in earlier reports, and nearly equals with recent leading results.]

Lege Artis Medicinae

[Adenoma of the adrenal cortex imitating renal cancer]

SEJBEN István, GÖCZŐ Katalin, SZABÓ Zoltán, CSERNI Gábor

Lege Artis Medicinae

[Microscopic colitis]

BARTA Zsolt

All articles in the issue

Related contents

Lege Artis Medicinae

[Connection between fetal development and adult diseases - Long acting effects of stress affecting the mother and the fetus]

MOLNÁR Ildikó

[The stress responses affecting the mother and the fetus have a life-long consequence in the manifestation of adult metabolic disorders. The perinatal stress inducing fetal adaptation contributes to alterations in tissue structures and hormone regulations as well as could lead to intrauterine growth retardation. The newborns with low birth weight are associated with the glucocorticoid, adrenaline and insulin resistance making them postnatal susceptible to obesity, diabetes type 2 and hypertonia. The number of newborns with low birth weight increase, therefore the prevention of adult diseases originating from perinatal misprogramming represents a frequent challenge for health services and society.]

Clinical Neuroscience

[BRAIN INSULIN SIGNALLING IN THE REGULATION OF ENERGY BALANCE AND PERIPHERAL METABOLISM]

MICHAELA Diamant

[The unparalleled global rates of obesity and type 2 diabetes, together with the associated cardiovascular morbidity and mortality, are referred to as the "diabesity pandemic". Changes in lifestyle occurring worldwide, including the increased consumption of high-caloric foods and reduced exercise, are regarded as the main causal factors. Central obesity and insulin resistance have emerged as important linking components. Understanding the aetiology of the cluster of pathologies that leads to the increased risk is instrumental in the development of preventive and therapeutic strategies. Historically, skeletal muscle, adipose tissue and liver were regarded as key insulin target organs involved in insulinmediated regulation of peripheral carbohydrate, lipid and protein metabolism. The consequences of impaired insulin action in these organs were deemed to explain the functional and structural abnormalities associated with insulin resistance. The discovery of insulin receptors in the central nervous system, the detection of insulin in the cerebrospinal fluid after peripheral insulin administration and the well-documented effects of intracerebroventricularly injected insulin on energy homeostasis, have identified the brain as an important target for insulin action. In addition to its critical role as a peripheral signal integrating the complex network of hypothalamic neuropeptides and neurotransmitters that influence parameters of energy balance, central nervous insulin signalling is also implicated in the regulation of peripheral glucose metabolism. This review summarizes the evidence of insulin action in the brain as part of the multifaceted circuit involved in the central regulation of energy and glucose homeostasis, and discuss the role of impaired central nervous insulin signalling as a pathogenic factor in the obesity and type 2 diabetes epidemic.]

Journal of Nursing Theory and Practice

[The nursing challenges related to gestational diabetes]

MENG Zsuzsa, VÁRADYNÉ HORVÁTH Ágnes, OLÁH András

[Aim of the study: To assess how age and BMI affect the result of the OGTT, and to study the data on blood sugar levels. Methodology and sample: Retrospective, quantitative, cross sectional, with non-random sampling. GDM patients aged 16- 50 years were surveyed (n=123 persons), with analysis of the data relating to multiparas (n=51) and primiparas (n=72). The research took the form of an analysis of medical and nursing documents. Results: In a study of the BMI and the 2-hour OGTT results, and in a study of age and BMI, signifi cance was observed in the case of the multiparas. Comparing the 0’ OGTT values with the empty-stomach blood sugar results from the 1st control test following the diagnosis of GDM, signifi cance was observed in both groups. Conclusions: Based on the fi ndings of the research it can be concluded that a higher BMI is generally associated with more advanced age, and that it has an unfavourable impact on the results of the OGTT. It is necessary to repeat the reclassifi cation in the later stage of the pregnancy, in the 6th week following birth, and upon cessation of breastfeeding.]

Lege Artis Medicinae

[Many faces of thyroid hormone deficiency]

MOLNÁR Ildikó

[The timely detection of thyroid hormone deficiency is crucial to inhibit the dangerous consequences of related diseases, such as obesity, cardiovascular diseases, type 2 diabetes mellitus, breast cancer, bone wasting, menstruation disturbance, and goitrogenesis. Subclinical hypothyroidism (<10 mU/l TSH) can initiate the above mentioned symptoms and diseases, therefore its early detection and treatment is necessary. The manuscript details from a practical point of view the causes leading to thyroid hormone deficiency, their consequences and gives recommendation for starting the treatment. The increased occurrence of breast and colorectal cancers associated with thyroid hormone deficiency is explained, and the attention to concomitantly elevated prolactin levels is called. Finally, the paper gives proposals for the clinical practice, when we should think of thyroid hormone deficiency and reports on the algorithm of the treatment of subclinical hypo­thyroidism recommended by the European Thyroid Association (ETA) in 2013.]

Lege Artis Medicinae

[INSULIN RESISTANCE: FOCUS ON THE ADIPOSE TISSUE]

URICH Elemér

[Insulin resistance is defined as a state of subnormal biological response to normal quantity of insulin. This phenomenon was first described by Hinsworth and Kerr in 1939, however it has come to the centre of interest only in the last two decades. It is the central pathogenetic factor of type 2 diabetes and the more complex clinical entity of metabolic syndrome, consequently also referred to as insulin resistance syndrome. In the background of insulin resistance alterations of the adipose tissue can be observed which clinically means obesity in most of the cases, however, this issue cannot be simplified to obesity only as increase in adipose tissue growth may be beneficial in certain cases. Current article discusses the explanation of this paradox and the pathophysiologic link between adipose tissue and insulin resistance. It also reviews the therapeutic aspects of insulin resistance emphasizing the role of thiazolidinedione type drugs having recently joined the therapeutic palette.]