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Aim of the Study: The pattern of the complications observed in the foetus and newborn of diabetic mothers has been changed owing to improvement of care and treatment. Due to the introduction of the Saint Vincent Declaration goals, the improvement in prognosis of diabetic mothers has been noted. The goals are being pursued in our country. The aim of the study was to evaluate whether there is an association between maternal glycated haemoglobin, cord blood insulin level and general condition in infants of diabetic mothers., Material and Methods: In the study 158 newborns of diabetic mothers (86 G1, 56 G2, 16 P) and 171 newborns of the healthy mothers were evaluated. In the newborns of diabetic mothers venous cord blood samples were collected at delivery and analyzed for insulin and fructosamine level in relation to the maternal glycated haemoglobin., Results: The mean birth weight was significantly different between the control group 2885 +/- 905 g and the diabetic group 3199 +/- 617 g. The positive correlation between cord blood insulin level and birth weight in the diabetic group was observed; that indicates the higher fetal insulinemia influence on increased birth weight. Neither the correlation between birth weight and fructosamine nor birth weight and glycated haemoglobin were found. The mean glycated hemoglobin level was 5.17% (G1 5.15%, G2 5.18%, P 5.30%)., Conclusions: There is an association between cord blood insulin level in infants of diabetic mothers and birth weight. Increased insulin level is correlated with hypoglycemia. The incidence of cesarean section, macrosomia, hypoglycemia, hyperbilirubinemia in the study group was not different in comparison to control subject.

Insulin-treated diabetes influences motor vehicle driving mainly through the possibility to induce hypoglycemia in patients. However, there has never been any consistent evidence to suggest that patients with insulin-treated diabetes cause significantly more accidents than the general population. Diabetes and its complications have very various individual courses in patients, because of that candidates for driver's license should always be qualified individually. Drivers with diabetes complications, especially the elderly, quite often themselves limit driving. The programme facilitating the diagnosis of early hypoglycemic symptoms--Blood Glucose Awareness Training--decreases road traffic collision number.

Objective: The incidence of sensorineural hearing impairment among premature infants--survivors of intensive care--is high. The purpose of this study was to identify the risk factors of hearing impairment in this group of children., Methods: Prospective cohort study (2.10.96-17.11.02). A total of 218 premature infants with birth weight 520-3000 g (Me-1300 g) and gestational age 22-36 weeks (Me-30) were tested by ABR and divided into 2 groups: with hearing impairment n = 18 and control n = 200. The logistic regression analysis was performed to identify the independent risk factors of hearing impairment., Results: Significant risk factors of hearing impairment were: gestation age (OR: 0.7; 95% CI: 0.6-0.97), hyperbilirubinemia qualified for exchange transfusion (OR: 13; 95% CI: 2.9-64), severe general condition and prolonged use of katecholamines > 8 days (OR: 18; 95% CI: 3.6-96), treatment with amikacin > 15 days (OR: 8; 95% CI: 1.6-43), hypoglycaemia < or = 2.46mmol/l (OR: 6; 95% CI: 1.2-23). Mechanical ventilation > 14 days was an additional risk factor associated with gestational age (OR: 8; 95% CI: 1.1-65). The model evaluated by logistic regression could predict 13 out of 18 hearing impairment cases (72%)., Conclusion: The independent risk factors of hearing impairment in premature infants are: low gestational age or associated with it prolonged mechanical ventilation, hyperbilirubinemia, severe general condition, hypoglycaemia and prolonged treatment with amikacin.

Unlabelled: The aim of the study was to evaluate carbohydrate metabolism in patients hospitalised because of acute intoxication with xenobiotics., Material and Methods: An analysis of 3628 patients (1553 females and 2075 males; age: 40.6 +/- 15.9 y) hospitalized at the Ward of Toxicology and Environmental Diseases because of acute poisoning in 2004-2006 was done. The patients with diabetes mellitus diagnosed prior to hospitalisation were excluded from the analysis. The blood ethanol concentration was measured, medication drugs and/or psychoactive substance screening test were performed in all patients on admission. Fasting glucose level on admission and control level on second or third day of hospitalisation were determined. Risk ratio of hyperglycaemia according to toxic agent was assessed using multiple regression model considering age, gender, and the patient education., Results: In 18.2% (398 males and 254 females) of the patients the blood glucose level on admission was > or = 7.8 mmol/l; in u 3.6% (78 males and 50 females) > or = 11.1 mmol/l. In 24 (0.6%) of the patients glycaemia on admission was < or = 3.5 mmol/l. Control fasting glucose level of > or = 7.0 mmol/l was determined in 115 males and 76 female patients. 42% elevation in risk of hyperglycaemia was noted in acute carbon monoxide poisoning (OR = 1.42; 95% PU: 1.11-1.82). In ethanol intoxicated patients 12% drop in risk of hyperglycaemia was noted (OR = 0.88; 95% PU: 0.72-1.07). Benzodiazepine poisoning diminished risk of hyperglycaemia in 36% (OR=0.64; 95%PU: 0.48-0.84). Risk of hyperglycaemia in poisoning by medicines co-ingested with ethanol was always lower compared to poisoning with the single agent., Conclusion: A higher risk of hyperglycaemia was related to acute carbon monoxide poisoning whereas lower risk of hyperglycaemia was attributed to benzodiazepines and alcohol. A frequency of hypoglycaemia in the group of poisoned patients was much more lower compared to hyperglycaemia.

Diabetes mellitus is a progressive and complex disorder that is difficult to treat effectively in the long- term. The number of people with diabetes and other glucose impairments is increasing due to population growth, aging, urbanization, and physical inactivity. In Poland, it has been estimated that there are about two million people with diabetes, half of them are not aware of their illness. Hypoglycemia is the most common and potentially most serious adverse effect of pharmacotherapy in diabetes, regardless of the model of treatment. The potential risk factors for severe hypoglycemia in subjects with treated diabetes are: physical activity, lifestyle circumstances, irregular eating habits, drug interaction or shift work. Therefore, there is an urgent need to set criteria and recommendations for medical certification of individuals working or taking up the job connected with public safety, where diabetes could have a particularly important and dangerous impact.

Continuous subcutaneous insulin infusion (CSII) is used in selected type 1 diabetic subjects to achieve strict blood glucose control. A quarter of a century after its introduction, worldwide use of CSII is increasing. Review of controlled trials shows that, in most patients, mean blood glucose concentrations and glycated hemoglobin percentages are either slightly lower or similar on CSII versus multiple insulin injections. However, hypoglycemia is markedly less frequent than during intensive injection therapy. Ketoacidosis occurs at the same rate. Nocturnal glycemic control is improved with insulin pumps, and automatic basal rate changes help to minimize a pre-breakfast blood glucose increase (the "dawn phenomenon") often seen with injection therapy. Patients with "brittle" diabetes characterized by recurrent ketoacidosis are often not improved by CSII, although there may be exceptions. Insulin pump therapy has been shown to be beneficial in pediatric patients with type 1 diabetes. Our experience with insulin pump therapy in young children, has been positive. Our young patients have had a reduction in HbA1c, mean blood glucose levels, and glycemic excursion; a decrease in episodes of severe hypoglycemia; and an increase in family functioning around diabetes. We believe the success of pump program in young patients can be attributed to the fact that we have employed appropriate criteria for patient selection and have a standardized method to initiate pump therapy and to follow and support our patients/ families. Experience with insulin-pump therapy indicates that candidates for CSII must be strongly motivated to improve self-monitoring of blood glucose, they must also understand and demonstrate use of the insulin pump.

The authors have evaluated seven years' period of the intensive care of pregnant women suffering from diabetes mellitus. In the analysed period 175 patients suffering from diabetes gave birth to babies, and that was 0.69% of all the labours. The most frequent type of diabetes was gestational diabetes mellitus (53.7%), and diabetes of B type (23.5). Diabetes of G-1 type occurred in as many as 44% of the examined women. In the tested group of women the indication to conducting a cesarean section occurred in 16.6% of cases. It was found that the babies born by the mothers suffering from diabetes had in their early neonatal period the following biochemical disorders: hypoglycemia--37.7%, hyperbilirubinemia--17.4%, anemia--8.7% and hypocalcemia--5.8% of cases. Monitoring of pregnancy, the time and the way of its termination should be selected individually for each women suffering from diabetes mellitus.