Le diabète insulinodépendant

in Revue Médicale de Liège (1996), 51(11), 684-94

Par son caractère chronique et la gravité de ses complications à long terme, le diabète insulino-dépendant (DID) constitue une véritable leçon de modestie pour le médecin à la fin de ce siècle. Le DID est ... [more ▼]

Par son caractère chronique et la gravité de ses complications à long terme, le diabète insulino-dépendant (DID) constitue une véritable leçon de modestie pour le médecin à la fin de ce siècle. Le DID est un modèle de maladie autoimmune spécifique d'organe et même d'une cellule particulière, la cellule ß insulino-sécrétrice des îlots de Langerhans dans le pancréas. Parler de maladie autoimmune signifie aussi rupture de la tolérance immunitaire vis-à-vis d'un composant du Soi. La connaissance des mécanismes responsables de la tolérance de la cellule ß et la compréhension des phénomènes génétiques et environnementaux impliqués dans sa rupture permettront la mise au point d'une prévention efficace, voire d'une éradication complète du DID. La vaccination 'tolérogène' basée sur la connaissance des antigènes thymiques responsables de l'éducation immunitaire au Soi constitute une de ces voies d'avenir prometteuse. [less ▲]

Un diabete peut en cacher un autre.

in Revue Médicale de Liège (2002), 57(5), 267-9

The abrupt interruption of insulin therapy in a severely obese diabetic woman submitted to a protein-sparing modified fast in a metabolic ward led to a severe ketoacidosis. This complication occurred ... [more ▼]

The abrupt interruption of insulin therapy in a severely obese diabetic woman submitted to a protein-sparing modified fast in a metabolic ward led to a severe ketoacidosis. This complication occurred because the patient had type 1 rather than type 2 diabetes, and the diagnosis of ketoacidosis was delayed because of confusion between ketonuria resulting from insulin deprivation and ketonuria associated with carbohydrate and energy restriction. This case report illustrates the danger of accepting an apparently obvious diagnosis which might be in fact erroneous. More particularly, it points out the importance of a correct differential diagnosis between C-peptide positive insulin-requiring type 2 diabetes and C-peptide negative (insulin-dependent) type 1 diabetes. [less ▲]

Diabete sucre iatrogene: l'exemple des anti-psychotiques atypiques.

in Revue Médicale de Liège (2005), 60(5-6), 455-60

As an example of iatrogenic diabetes, we discuss the problem of diabetes mellitus in patients receiving atypical antipsychotics. The risk of diabetes mellitus appears to be different according to various ... [more ▼]

As an example of iatrogenic diabetes, we discuss the problem of diabetes mellitus in patients receiving atypical antipsychotics. The risk of diabetes mellitus appears to be different according to various molecules with, by decreasing order, clozapine, olanzapine, risperidone and quetiapine, and finally amisulpride, aripiprazole and ziprasidone. A careful analysis of published case reports and series indicates the existence of two different problems: 1) the rather common development of impaired glucose tolerance or diabetes mellitus (often associated with metabolic syndrome) related to weight gain in individuals at risk for type 2 diabetes; and 2) the occurrence of rare cases of acute metabolic episodes with severe ketoacidosis and/or pancreatitis whose pathophysiological mechanisms remain largely unknown. Generally speaking, the pathophysiology involves both increased insulin resistance and deficient insulin secretion. Cautious metabolic monitoring of patients receiving atypical antipsychotics is recommended, and the selection of the appropriate drug should be influenced by the metabolic profile of the various molecules and the metabolic risk of the patients who should be treated with atypical antipsychotics. [less ▲]

Le diabete sucre: une maladie exemplative a bien des egards. Preambule.

in Revue Médicale de Liège (2005), 60(5-6), 269-72

Diabète, hypertension artérielle et angiopathie: comparaison chez les patients diabétiques insulino-dépendants et non insulino-dépendants.

in Archives des Maladies du Coeur et des Vaisseaux (1991), 84(suppl 1), 35

Le diabete: de la connaissance clinique a la preoccupation de sante publique.

in Journal de la Société de Biologie (2007), 201(2), 133-40

Diabetes mellitus is a chronic disease whose prevalence is increasing worldwide. It remains associated with a high risk of severe complications, essentially micro- and macro-vascular complications. Type 1 ... [more ▼]

Diabetes mellitus is a chronic disease whose prevalence is increasing worldwide. It remains associated with a high risk of severe complications, essentially micro- and macro-vascular complications. Type 1 diabetes is an auto-immune disease that leads to the destruction of insulin-secreting B cells and therefore requires an intensive optimised exogenous insulin therapy. Type 2 diabetes is a polygenic disease whose expression is favoured by inadequate lifestyle, leading to obesity. It combines a relative insulin secretory defect and insulin resistance, the latter being associated with various other cardiovascular risk factors. Treatment consists of lifestyle modifications first, then the prescription of various glucose-lowering oral drugs and finally, when requested, insulin therapy. A multi-risk intervention is mandatory to improve the cardiovascular prognosis. The prevention of diabetes and its complications is a major public health objective. [less ▲]

Diabetes mellitus in the elderly: insulin resistance and/or impaired insulin secretion?

in Diabètes & Métabolism (2005), 31 Spec No 2

Elderly people are more glucose intolerant and insulin resistant than young individuals, and many of them will develop type 2 diabetes. It remains, however, controversial whether this decrease in function ... [more ▼]

Elderly people are more glucose intolerant and insulin resistant than young individuals, and many of them will develop type 2 diabetes. It remains, however, controversial whether this decrease in function is due to an inevitable consequence of "biological aging" or due to environmental or lifestyle variables. Indeed, increased adiposity/altered fat distribution, decreased fat free mass/abnormal muscle composition, poor dietary habits and physical inactivity all contribute to reduce insulin sensitivity. Insulin resistance in elderly people appears to predominate in skeletal muscle, whereas hepatic glucose output seems to be almost unaffected. Several abnormalities in islet beta-cell and insulin secretion were also pointed out in elderly people such as increased amyloid deposition and decreased amylin secretion, impaired insulin secretion pulsatility, decreased insulin sensitivity of pancreatic beta-cells to insulinotropic gut hormones and diminished insulin response to non-glucose stimuli such as arginine. Controversial results were reported concerning the effects of aging on absolute insulin secretion in response to oral or intravenous glucose. However, insulin secretion appears to decrease with age, with significantly diminished beta-cell sensitivity and acute insulin response to glucose, provided it is analyzed relative to concomitant decreased insulin sensitivity. Thus, there is an interplay between decreased insulin secretion and increased insulin resistance that largely explains the abnormal glucose metabolism seen in elderly. Weight loss, especially reduction of abdominal adiposity, and increased physical activity may contribute to improve insulin sensitivity and glucose tolerance, and prevent the development of type 2 diabetes in elderly people. [less ▲]

Diabetogenic coxsackievirus B4 modifies cytokine secretion by human thymic epithelial cells

in Diabetologia (2000), 43 (Suppl. 1)

"Diabolo Manques" - Une exploration à la découverte de soi - Rapport d'évaluation de la première année

Report (2000)

"Diabolo-Manques" - Une exploration à la découverte de soi - L'évaluation d'un programme de prévention des assuétudes en Province de Liège

Report (2006)