0
selected
-
1.
Continuous spectrum of glucose dysmetabolism due to the KCNJ11 gene mutation-Case reports and review of the literature.
He, B, Li, X, Zhou, Z
Journal of diabetes. 2021;(1):19-32
Abstract
The KCNJ11 gene encodes the Kir6.2 subunit of the adenosine triphosphate-sensitive potassium (KATP ) channel, which plays a key role in insulin secretion. Monogenic diseases caused by KCNJ11 gene mutation are rare and easily misdiagnosed. It has been shown that mutations in the KCNJ11 gene are associated with neonatal diabetes mellitus (NDM), maturity-onset diabetes of the young 13 (MODY13), type 2 diabetes mellitus (T2DM), and hyperinsulinemic hypoglycemia. We report four patients with KCNJ11 gene mutations and provide a systematic review of the literature. A boy with diabetes onset at the age of 1 month was misdiagnosed as type 1 diabetes mellitus (T1DM) for 12 years and received insulin therapy continuously, resulting in poor glycemic control. He was diagnosed as NDM with KCNJ11 E322K gene mutation, and glibenclamide was given to replace exogenous insulin. The successful transfer time was 4 months, much longer than the previous unsuccessful standard of 4 weeks. The other three patients were two sisters and their mother; the younger sister was misdiagnosed with T1DM at 13 years old, while the elder sister was diagnosed with diabetes (type undefined) at 16 years old. They were treated with insulin for 3 years, with poor glycemic control. Their mother was diagnosed with T2DM and achieved good glycemia control with glimepiride. They were diagnosed as MODY13 because of the autosomal dominant inheritance of two generations, early onset of diabetes before 25 years of age in the two sisters, and the presence of the KCNJ11 N48D gene mutation. All patients successfully transferred to sulfonylureas with excellent glycemic control. Therefore, the wide spectrum of clinical phenotypes of glucose dysmetabolism caused by KCNJ11 should be recognized to reduce misdiagnosis and implement appropriate treatment.
-
2.
Clinical Features of Type B Insulin Resistance in Japanese Patients: Case Report and Survey-Based Case Series Study.
Hirota, Y, Suwanai, H, Yamauchi, T, Kadowaki, T
Journal of diabetes research. 2020;:4359787
Abstract
Type B insulin resistance (TBIR) is an extremely rare disease characterized by marked hyperglycemia and insulin resistance and often coexists with autoimmune diseases. The characteristics, symptoms, blood glucose patterns, comorbidities, and treatments of TBIR all vary and are not defined. In this study, we described a case of TBIR that developed 6 months after DPP-4 inhibitor administration and immediately after the patient caught a cold. Treatment using prednisolone and insulin-like growth factor-1 was effective. We also conducted an observational survey-based case series study in a Japanese cohort comprising 21 cases. The average age of onset of TBIR was 62.3 ± 14.8 (17-84) years, and 61.9% of subjects were male. The majority of patients (90.4%) were 50 years old and over. During the study period, there was a high percentage (85.7%) of episodes of hypoglycemia, which was the trigger for diagnosis in more than 50% of cases. Glycemic patterns included 7 cases of hyperglycemia (33.3%), 10 cases of hypoglycemia (47.6%), and 4 cases of both hyperglycemia and hypoglycemia (19.1%). In the hypoglycemic group, 90.0% of patients were male. Furthermore, 71.4% of cases were antinuclear antibody positive, and 81.0% of cases were complicated with autoimmune disease. Systemic lupus erythematosus (38.1%) and Sjögren's syndrome (23.8%) were relatively common as coexisting autoimmune diseases. Treatment was based on prednisolone use, which was used in 88.9% of patients. On the other hand, the effect of IGF-1 was limited. Overall, the prognosis of TBIR was good.
-
3.
A potential diagnostic problem on the ICU: Euglycaemic diabetic Ketoacidosis associated with SGLT2 inhibition.
Sanusi, I, Sarnowski, A, Russell-Jones, D, Forni, LG
Journal of critical care. 2020;:19-22
Abstract
Sodium glucose cotransporter 2 (SGLT2) inhibitors are the latest class of oral hypoglycaemic agents approved to treat type II diabetes. Their use is increasing and as such more patients will present to critical care whilst on this treatment. However, there have been several case reports of euglycaemic diabetic ketoacidosis associated with the use of these agents. Under such circumstances the blood glucose is often normal or only moderately elevated and hence the diagnosis may be delayed resulting in inappropriate therapy. In this review we describe a case of SGLT2 mediated ketoacidosis who presented to our intensive care unit, discuss the proposed pathophysiology behind this development of ketoacidosis as well as its potential prevention, management and treatment.
-
4.
Diabetic ketoacidosis in acromegaly; a rare complication precipitated by corticosteroid use.
Weiss, J, Wood, AJ, Zajac, JD, Grossmann, M, Andrikopoulos, S, Ekinci, EI
Diabetes research and clinical practice. 2017;:29-37
Abstract
Diabetic ketoacidosis has been described in the literature as a rare possible initial presentation of acromegaly before a diagnosis of acromegaly is eventually made. Indeed, diabetic ketoacidosis is a recognised complication of acromegaly. There are a number of factors that can predispose patients with acromegaly to diabetes as well as to diabetic ketoacidosis. These include high levels of growth hormone and insulin-like growth factor 1 in acromegaly and the effect on glycaemia by medications used in the management of acromegaly. Ketoacidosis has been described in patients with acromegaly even without the presence of an underlying autoimmune diabetes. Patients with acromegaly and ketoacidosis often respond to treatment and may not require long-term insulin.
-
5.
The Interplay Between Diabetes and Pancreatitis: Two Case Reports of Sudden, Natural Deaths and a Review of the Literature.
Butler, DC, Emanuel, AJ, Self, SE, Batalis, NI
Journal of forensic sciences. 2017;(2):519-524
Abstract
Diabetes mellitus (DM) is a common disease involving insulin resistance or deficit that, when left unchecked, may cause severe hyperglycemia and subsequent end-organ damage. Acute pancreatitis (AP) is inflammation of the pancreas that can lead to significant morbidity and mortality. AP and DM both account for a significant amount of sudden deaths, and rarely both disease processes may be present in the same decedent, causing some difficulty in wording the cause of death statement. Although much research has been directed at studying the causes and risk factors for AP and DM, there is a complex interplay between these diseases that is not fully understood. This study presents two autopsy cases of sudden, natural deaths that illustrate this interplay, along with a review of the literature. An algorithm for differentiating AP and DM is then discussed in the context of the presented cases as a proposed aid for forensic pathologists in the certification of such deaths.
-
6.
Verification of glycemic profiles using continuous glucose monitoring: cases with steroid use, liver cirrhosis, enteral nutrition, or late dumping syndrome.
Kishimoto, M, Noda, M
The journal of medical investigation : JMI. 2015;(1-2):1-10
Abstract
Glycemic control is often difficult to achieve in patients with diabetes, especially in the presence of comorbid diseases or conditions such as steroid-use or liver cirrhosis, or in patients receiving enteral nutrition. Moreover, reactive hypoglycemia due to late dumping syndrome in people having undergone gastrectomy is also a matter of concern. Empirically and theoretically, the typical glycemic profiles associated with these conditions have been determined; however, what actually happens during a 24-h span is still somewhat obscure. In order to verify and provide information about the 24-h glycemic profiles associated with these conditions, 8 patients with the 4 above-mentioned conditions were monitored using a continuous glucose monitoring system (CGMS). For all 8 patients, CGMS provided detailed information regarding the 24-h glycemic profiles. The CGM results showed typical glycemic patterns for each condition, and we were moreover able to observe the effects of various practical treatments. Based on these cases, we conclude that the CGMS is highly useful for determining the glycemic patterns of patients with the aforementioned conditions in a practical setting; and this system may be used to monitor the treatment success of such cases.
-
7.
Diabetic ketoacidosis in a 9 month old child and the journey to 4 years.
Chapp-Jumbo, AU, Ijeoma, S
Acta bio-medica : Atenei Parmensis. 2014;(3):285-8
Abstract
We report a case of diabetes mellitus in a 9-month-old male, a product of a non-consanguinous marriage with no family history of diabetes mellitus. He presented initially with ketoacidosis in our emergency room and recovered from coma after 48 hours but was discharged after 14 days. He is now 4 years old and doing well and caregivers are coping even with the challenges of caring for a very young diabetic child. This article will help to build up the data bank for diabetes in infancy and childhood in our environment as well as highlight the challenges faced by both caregivers and physicians in the management of very young diabetics irrespective of socioeconomic status.
-
8.
[Antidiabetic drug therapy in overweight and obese adults with type 2 diabetes].
de Heer, J, Parhofer, K
MMW Fortschritte der Medizin. 2013;(7):43-6
-
9.
Managing diabetes in the middle-aged patient when loss of glycemic control occurs.
Peters, A
The Diabetes educator. 2012;(4 Suppl):13S-21S; quiz 22S
Abstract
PURPOSE The purpose of this article is to review the treatment of a patient with type 2 diabetes who is commonly seen in practice-specifically, a middle-aged obese patient with micro- and macrovascular complications whose A1C rises after therapeutic intervention. Discussion of glucose management, as well as hypertension, dyslipidemia, and obesity comorbidities, is included. CONCLUSION The key to successful treatment is individualization of targets and therapeutic choices. GLP-1 receptor agonists have been shown to be effective in the treatment of type 2 diabetes, including aiding with A1C reduction and weight loss. Using a combination of old and new treatments for the management of diabetes can help to improve outcomes.
-
10.
Optimizing diabetes management through glucose profiling: a case-based approach.
Streja, DA
Primary care diabetes. 2008;(4):167-73
Abstract
It is well documented that tight glucose control prevents the microvascular complications of diabetes, and many studies suggest that postprandial hyperglycemia may be associated with macrovascular complications. Maintaining target glucose values is challenging, as therapies are often not targeted to individual glucose excursion patterns. Postprandial SMBG values may be more tightly correlated to HbA1c than are fasting values. Studies of patients with pregnancies complicated by diabetes demonstrate that using SMBG around meals significantly improves glucose control and pregnancy outcomes. Adopting this model in type 2 diabetes may help achieve better glycemic control.