Irritable bowel syndrome

uncontrolled diabetes with heavy ketonuria (2+ or more) and plasma bicarbonate at or below 18 mmol/L. Patients were identified with the central computer-registry system in which is stored a record of diagnosis for all admitted patients. Relevant clinical variables were extracted from the case records, and the results are shown in the table. During the study period, 347 admissions due to diabetic ketoacidosis in 184 patients were registered. Younger patients with IDDM were characterised by a high recurrence rate (defined as the number of admissions divided by the number of patients during the study period), thus indicating that a small subgroup of patients had repeated admissions because of diabetic ketoacidosis. The tendency to this brittle diabetes improved at the age of 25 years or older, with a nearly 50% reduction in the rate of recurence among older patients. The severity of diabetic ketoacidosis was assessed by plasma bicarbonate, which was much lower in the two youngest age-groups than in the older age-groups. Furthermore, younger patients had worse glycaemic control according to HBA1c than the older groups. However, in general, HBA1c was fairly high in all age-groups. The precipitating factors were subdivided into organic and nonorganic, infections being the major organic precipitant. The non-organic group included self-reported treatment error and unknown causes. A major proportion of diabetic ketoacidosis in the group of unknown causes was probably due to treatment error. In accordance with Morris and colleagues’ results, the younger age-groups were heavily represented in the non-organic group, whereas organic precipitants, such as infections, were in greater proportion in the older age-groups. The high recurrence rate and severe acidosis in the younger age-groups strongly suggest the influence of psychosocial factors; 46% of patients aged younger than 25 years were on social welfare or were unemployed. The inverse relation between age and unknown cause of diabetic ketoacidosis in our study together with Morris and colleagues’ results, suggest that noncompliance is a major difficulty in the care of young diabetic patients. Special attention should be paid to improved education (diabetic self-care) in these young patients to overcome noncompliance.