Many pregnant women with diabetes present at booking with poor glycaemic control, despite the fact that this increases the risk of miscarriages, congenital abnormalities, stillbirths, macrosomic babies and early deliveries (Janz et al, 1995; Evers et al, 2004). Generally glycaemic control is improved during the pregnancy, but this is often not sustained following childbirth (Gold et al, 1998). This prospective study used a phenomenological approach to explore how identity was linked to the improvement, and deterioration, of blood glucose control in women with type 1 diabetes. Eleven women agreed to take part (ages ranged from 25 to 42 years). Diagnosis of diabetes ranged from 5 to 26 years. Interviews were conducted during the first and third trimesters of pregnancy and approximately 6 to 12 months after childbirth. Women's accounts show that pregnancy for women with diabetes is extremely hard work. The accounts also reveal the dilemmas they faced on a daily basis and the juggling acts they had to perform to achieve ‘good’ diabetic control (3.5–7.0mmols/l in pregnancy). The ways in which salient identities, in particular, that of being a mother influenced how women cared for their diabetes are highlighted. HbA1cs reduced during pregnancy and rose after childbirth in most cases. The findings have significantly impacted on practice.

A qualitative study was undertaken to investigate the perceptions and experiences of insulin-treated people with diabetes mellitus. Seven people were randomly selected from an opportunistic sample and interviewed either at home or on hospital premises. The subjects comprised four women and three men (age range 20-72 years). The study found that hypoglycaemia plays a significant role in the lives of these subjects and that concern over having a hypoglycaemic attack is constantly present. All subjects had suffered at least one attack which had potentially serious consequences and six did not always recognize the warning signs of an impending insulin reaction. Only one of the subjects said they would be happy to live alone.

This study investigates the effects of hypoglycaemia on the working, social and personal lives of young people aged 16-30 years (mean age 23.9 years) who have insulin-treated diabetes mellitus. A total of 52 questionnaires were returned from a sample size of 70 subjects. Quantitative and qualitative analysis revealed that young people's lives are disrupted to varying degrees by hypoglycaemia. Hypoglycaemia and the complications of diabetes were found to be a source of concern to the subjects in the study, although 19 (36.5%) rarely carried out any self-monitoring. A more flexible approach to diabetic management is indicated, together with an agreed consensus of diabetic control between patients and professionals.

We studied the pharmacokinetics of cefoperazone 2 g i. v. every 12 h for 7 days in 12 patients on hemodialysis with normal hepatic function. The half-life of indocyanine green was determined in each patient via ear oximetry. Serum levels of cefoperazone during dialysis were well described by a two-compartment multidose infusion model. From this model we determined the steady state volume of distribution (Vdss), elimination phase half-life during dialysis T_½D) and off hemodialysis (T_½), and the corresponding elimination rate constants (KeD and Ke). Multiple correlations between pharmacokinetic parameters, liver function, and physical characteristics of the patients were evaluated.The T_½ of cefoperazone was 2.9 h off compared to 2.3 h during hemodialysis. The corresponding elimination rate constants were Ke = 0.45/h versus KeD = 0.80/h. Cefoperazone clearances were 78 ml/min off dialysis compared to 140 ml/min during hemodialysis. Vdss was 0.20 liters/kg. The indocyanine green half-life ranged from 1.8 to 4.6 min with a mean of 2.7 min. The ages of the patients correlated with the beta phase half-life (r = 0.68, p = 0.015). We found no significant correlations among the other parameters including hepatic enzymes and indocyanine green half-life. Thus, hemodialysis approximately doubles the elimination rate constant (clearance), but, assuming drug redistribution kinetics remain unchanged, only shortens half-life by about 20%. Scheduling of a 12-hour dosing regimen to coincide with the end of hemodialysis should obviate any need for alteration of dose. Cefoperazone is thus unique among cephalosporins, since the half-life does not change appreciably with end-stage renal disease or dialysis. It may be used safely in appropriate patients with any degree of renal failure or on dialysis without change in dose.

Investigations were carried out by means of a questionnaire sent to 70 general practices to discover the number of identified persons with diabetes attending GP surgeries in Stockport. In addition, it was hoped to find out how many mini clinics were already in existence and how many GP's were interested in starting their own clinics for people with diabetes. The survey yielded a 70% response rate on the questionnaires. There were 10 mini clinics in existence and 24 practices interested in starting their own clinics.