RESUMEN
BACKGROUND: A 26-year-old man with Type 1 diabetes presented with an overdose of 4800 units of the long-acting insulin analogue, glargine (Lantus). Glucose supplementation of approximately 800 g/day was associated with acute hepatic injury. METHODS: On day 4, a depot of insulin was excised from the patient's abdominal wall; this was followed by a reduction in his glucose requirements and improvement in liver function. CONCLUSIONS: This report highlights the risk of acute hepatic injury during the treatment of insulin overdose and the importance of careful glucose supplementation. It also demonstrates how earlier excision of an insulin depot could potentially prevent this problem and hasten recovery.
Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Glucosa/efectos adversos , Hipoglucemia/inducido químicamente , Hipoglucemia/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Insulina de Acción Prolongada/efectos adversos , Insulina/análogos & derivados , Hígado/efectos de los fármacos , Abdomen/cirugía , Adulto , Remoción de Dispositivos , Sobredosis de Droga , Glucosa/administración & dosificación , Humanos , Hipoglucemiantes/administración & dosificación , Inyecciones Subcutáneas , Insulina/administración & dosificación , Insulina/efectos adversos , Insulina Glargina , Insulina de Acción Prolongada/administración & dosificación , Hígado/cirugía , Masculino , Resultado del TratamientoRESUMEN
This review explores the history, methods and evidence surrounding the various surgical therapeutic options which are available for patients with end-stage heart failure.
Asunto(s)
Cardiomioplastia/métodos , Insuficiencia Cardíaca , Trasplante de Corazón/métodos , Corazón Auxiliar , Insuficiencia de la Válvula Mitral/cirugía , Revascularización Miocárdica/métodos , Manejo de la Enfermedad , Progresión de la Enfermedad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Humanos , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/fisiopatología , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/cirugía , Evaluación de Procesos y Resultados en Atención de Salud , Selección de Paciente , Índice de Severidad de la Enfermedad , Remodelación VentricularRESUMEN
BACKGROUND: There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care. AIM: To determine levels of confidence of doctors in training in the management of diabetes and establish their training needs in this area of clinical practice. DESIGN: A national online survey of trainee doctors in the UK using a pre-validated questionnaire. METHODS: A four-point confidence rating scale was used to rate confidence in the management of diabetes and comparators. A six-point scale was used to quantify how often trainees would contribute to the management of patients with diabetes and trainees were asked about their training in managing diabetes. RESULTS: A total of 2149 doctors completed the survey. The percentage 'fully confident' in diagnosing diabetes was 27%, diagnosing and managing hypoglycaemia 55%, diagnosing and managing diabetic ketoacidosis 43%, managing intravenous (IV) insulin 27%, prescribing IV fluids for patients with diabetes 39% and altering diabetes therapy prior to surgery/other procedure 18%. In comparison, 66% and 65% were 'fully confident' in the management of angina and asthma, respectively (P < 0.05). Forty-one percent would take the initiative to optimize glycaemic control for patients under their care >80% of the time. Respectively, 19% and 35% of respondents reported that their undergraduate and postgraduate training had prepared them adequately to optimize treatment of diabetes. The majority (>70%) wanted further training in managing all aspects of diabetes care. CONCLUSIONS: Trainee doctors in the UK lack confidence in the management of diabetes, are unlikely to take the initiative to optimize glycaemic control and report a need for further training.