Parallel, they presented reduction in peptdeo-C of jejum, increase in the dose of insulina and the HbA1c in relation to those during the first year of diagnosis. Other studies in this felt they had shown a heterogeneidade in the results, perhaps related to the level of the glicmico control of the patients. Therefore all the studies, however, suggest that the glicotoxicidade is responsible for a great parcel of LAUGHS in the DM1. (DINIZ, 2002) Corroborating with this hypothesis, a recent study, using the technique of clamp euglicmico, it showed a significant correlation enters the resistance to the insulina and the degree of hiperglicemia (glicotoxicidade) evaluated by the value of the HbA1c in patients with DM1 of recent diagnosis. In the study of the DCCT (Diabetes Control and Complications Trial), the values of HbA1c, gotten in the adolescents, had been on average 1% superior to the obtained one in the adults, as much in the group in conventional treatment as in intensive, although to be receiving more insulina (units for kilo of weight). The triad high values of HbA1c, necessities of bigger insulina and exaggerated profit of weight in the DM1, suggests that the managed insulina is being little effective in controlling the glicemia (resistance to the insulina). BRAZIL (2002) tells that diabetes mellitus type 1 is a syndrome of multiple etiology, resultant of the relative or absolute deficiency in the production of insulina for the pncreas and/or of the incapacity of this hormone to exert its effect adequately, resulting in chronic hiperglicemia and alteration in the metabolism of the carboidratos of lipdios and proteins, being able, in the long run, to occur disfunes in some agencies. One of the important hormonais factors that lead to the increase of the resistance to the insulina in the DM1 is the growth hormone secretion exaggerated during the puberty. The insulina, managed subcutaneously, exceeds the circulation vestibule, what it provokes a reduction in its intra-heptico effect.
The cranianas injuries that can increase of size, as hematomas and edema can cause cerebral compression that I eat consequncia promotes the increase of the intracraniana pressure (PIC). The PIC can provoke the death of the fabric cerebral for pressure and displacement of encfalo. Therefore the necessity to after control the PIC during the acute period TCE (JUNQU; BRUNA; MATAR, 2001). 2.7TRATAMENTO TCE the basic treatment to the patient victim of TCE consists of the clinical or surgical treatment. It has indication of surgical treatment in the cases where Tomografia Computadorizada (TC) in the sample the presence of hematoma and edema. As the dimension of the problem is necessary a descompressiva craniectomia.
The clinical treatment consists of the basic support of life. In the initial neurological evaluation of a patient with TCE Escala de Coma de Glasgow (ECG) for its easy application must be emphasized. How much lesser the points in the ECG, worse prognostic and greater mortality (CINTRA, 2005). The punctuation together with the neuropsicolgicos results of motor level, memory and constructive capacity, can predict the quality of life of the affected patient. The duration of the state of also eats has preditivo value on the alterations of memory (JUNQU; BRUNA; MATAR, 2001). The respiratory insufficience occurs in about 20% of the patient victims of TCE. The orotraqueal intubao is indicated to keep the prvias aerial ways and is installed the ventilation mechanics (VM) in the cases where the patient to present intracraniana hipertenso or reduction of the conscience level. The ventilatrio support has as main purpose the prevention of the hypoxaemia, keeping the satisfactory levels of oxygen in all the fabrics (CINTRA, 2005). It is of extreme importance to keep the hemodinmica stability in the TCE, being prevented hypoxaemia, keeping levels of arterial pressure, temperature and volemia.