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Heterotaxy syndrome with agenesis of dorsal pancreas and diabetes mellitus: case report and review of the literature.
Riguetto, CM, Pelichek, S, Moura Neto, A
Archives of endocrinology and metabolism. 2019;(4):445-448
Abstract
Heterotaxy syndrome (HS) is a rare congenital condition with multifactorial heritance, characterized by an abnormal arrangement of thoraco-abdominal organs and vessels. Patients present with multiple cardiac, gastrointestinal, hepatosplenic, pancreatic, renal, neurological and skeletal disorders without any pathognomonic alteration. Despite the described increased risk of diabetes mellitus (DM) in patients with altered pancreatic anatomy, just one case was reported in Korea regarding the association of HS and DM in a 13-year-old girl. Our report refers to a 40-year-old female Brazilian patient with a history of DM and HS with polysplenia and agenesis of dorsal pancreas without cardiac abnormalities. She presented a worsening glycemic control associated with weight gain and signs of insulin resistance. After a proper clinical management of insulin and oral medications, our patient developed an improvement in glycemic control. Although it is a rare disease, HS with polysplenia and pancreatic disorders can be associated with an increased risk of DM. This case highlights the importance of investigating DM in patients with HS, especially those with pancreatic anatomical disorders, for proper clinical management of this rare condition.
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2.
Factors complicating the diabetes management of visitors to Japan: advices from a Japanese National Center for overseas medical staff.
Kishimoto, M, Noda, M
The journal of medical investigation : JMI. 2016;(1-2):15-8
Abstract
Linguistic, cultural, and geographical differences might challenge the management of diabetes patients travelling in a culturally and linguistically homogeneous country. This article presents an instructive case and identifies various factors that can help in effective diabetes management of such cases. A Russian female patient aged 23 came to Japan and visited our hospital for a second opinion regarding glycemic control. She was diagnosed with type 1 diabetes at age three and started insulin injections and diet therapy with carbohydrate counting methods. Her HbA1c level was 11.0% with multiple daily insulin injections. She showed neuropathy, nephropathy, and blindness due to her progressed retinopathy. Because of the language barrier, suggestions for lifestyle modification were not effectively conveyed to the patient. We analyzed possible barriers to effective diabetes management in such foreign patients. In addition to language barriers and difficulties in diet therapy, dissimilar diabetes treatment guidelines, inadequate healthcare insurance, and stress-inducing conditions can be barriers to effective diabetes management. Foreign diabetes patients might face several barriers in effective management while travelling in Japan. Use of medical interpreters, adequate medical insurance, and trained medical staff will help in overcoming these barriers.
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3.
Overcoming Challenges With Statin Therapy.
Spence, JD, Dresser, GK
Journal of the American Heart Association. 2016;(1)
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4.
Recessive SLC19A2 mutations are a cause of neonatal diabetes mellitus in thiamine-responsive megaloblastic anaemia.
Shaw-Smith, C, Flanagan, SE, Patch, AM, Grulich-Henn, J, Habeb, AM, Hussain, K, Pomahacova, R, Matyka, K, Abdullah, M, Hattersley, AT, et al
Pediatric diabetes. 2012;(4):314-21
Abstract
Permanent neonatal diabetes mellitus (PNDM) is diagnosed within the first 6 months of life, and is usually monogenic in origin. Heterozygous mutations in ABCC8, KCNJ11, and INS genes account for around half of cases of PNDM; mutations in 10 further genes account for a further 10%, and the remaining 40% of cases are currently without a molecular genetic diagnosis. Thiamine-responsive megaloblastic anaemia (TRMA), due to mutations in the thiamine transporter SLC19A2, is associated with the classical clinical triad of diabetes, deafness, and megaloblastic anaemia. Diabetes in this condition is well described in infancy but has only very rarely been reported in association with neonatal diabetes. We used a combination of homozygosity mapping and evaluation of clinical information to identify cases of TRMA from our cohort of patients with PNDM. Homozygous mutations in SLC19A2 were identified in three cases in which diabetes presented in the first 6 months of life, and a further two cases in which diabetes presented between 6 and 12 months of age. We noted the presence of a significant neurological disorder in four of the five cases in our series, prompting us to examine the incidence of these and other non-classical clinical features in TRMA. From 30 cases reported in the literature, we found significant neurological deficit (stroke, focal, or generalized epilepsy) in 27%, visual system disturbance in 43%, and cardiac abnormalities in 27% of cases. TRMA should be considered in the differential diagnosis of diabetes presenting in the neonatal period.
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5.
[Severe hypoglycemias in a diabetic man by surreptitious self-injections of an insulin analogue].
Rouvellat, C, Chourrout, P, Escourolle, H, Hamdi, S
Annales de biologie clinique. 2012;(3):335-40
Abstract
A 44 years-old diabetic male patient was admitted several times to the emergency department of Albi Hospital (France) for nocturnal hypoglycemias with losses of consciousness. The initial blood analysis, performed on a Cobas(®) analyzer, retrieved low levels of insulinemia. This patient was treated by analogues of insulin and did not present any comorbidities. Moreover, an extensive check-up did not retrieve any evident cause for these hypoglycemias. After a severe hypoglycemic coma that occurred during the last hospitalization when insulinotherapy was interrupted, the staff suggested the possibility of a factice hypoglycemia by surreptitious administration of insulin. Hormonal assays were then performed on a Centaur(®) analyzer, which is able to recognize insulin aspart and glargine. They revealed elevated concentrations of insulin along with low levels of C-peptide. Such a blood profile is consistent with an exogenous administration of insulin or its analogues. On the basis of this biological clue, the patient was questioned again and he finally admitted self-injection of insulin aspart. This case gives us the opportunity to review the diabetic hypoglycemia, to point out the particularities of the blood assays of insulin analogues and to confirm the need of a close collaboration between clinic and laboratory staffs in the difficult cases of factice hypoglycemias.
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6.
Pneumatosis coli induced by acarbose administration for diabetes mellitus. Case report and literature review.
Furio, L, Vergura, M, Russo, A, Bisceglia, N, Talarico, S, Gatta, R, Tomaiuolo, M, Tomaiuolo, P
Minerva gastroenterologica e dietologica. 2006;(3):339-46
Abstract
The authors report a case report of rare disease interesting the digestive tract and often associated to the other gastrointestinal pathologies and/or pulmonary diseases and can be also associated to not gastrointestinal conditions such as collagen-vascular disease, transplantation, AIDS, use of corticosteroid and chemotherapy; other causes can be iatrogenic such as traumatic gastrointestinal endoscopy (a mucoses biopsy, a polipectomy) or the assumption of lattulosio; in 15-20% of cases the pneumatosis cystoides intestinalis is considered primitive. In the our case the Pneumatosis coli was associated to administration of acarbose; in international literature only four papers in the English language were reported. Our patient showed a strongly aspecific symptomatology and easily attributable in first line or to the pathology of base (diabetic patient) or to the assumption of the acarbose; from about 7-8 months she showed unexplained episodes of crampy abdominal pain, diarrhea with 3-4 defecations/die with semiliquid and normochromic stools, tenesmus and a not better specified loss of weight. The diagnosis was been performed by colonoscopy and confirmed by abdominal CT scan with water enema and histologically; we have used the traditional radiology only to exclude the involvement of other gastroenteric districts. The patient was been treated with O2-therapy associated to antibiotics treatment; the suspension of the causal factor, the acarbose, has been of not secondary importance; the complete resolution of disease was obtained after 15 days of therapy.
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7.
Inpatient management of diabetes.
McDonough, KA, DeWitt, DE
Primary care. 2003;(3):557-67
Abstract
Hyperglycemia is common in hospitalized patients with diabetes and contributes to poor outcomes in this population. Use of intravenous insulin protocols for patients who are unable to eat, continuation of usual insulin regimens for those who are eating, pre-meal insulin supplements for hyperglycemia, and avoidance of sliding-scale insulin can help the clinician improve glycemic control. Careful attention to management of diabetes in the hospitalized patient decreases the risk of ketoacidosis, fluid and electrolyte abnormalities, and infection; in critically ill postoperative patients, tight glucose control with insulin administration decreases the risk of death.
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8.
Working within boundaries: a patient-centered approach to lifestyle change.
Whittemore, R, Sullivan, A, Bak, PS
The Diabetes educator. 2003;(1):69-74
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9.
Postoperative management of the diabetic patient.
Hoogwerf, BJ
The Medical clinics of North America. 2001;(5):1213-28
Abstract
Diabetic patients are at increased risk for adverse outcomes of surgery. These adverse outcomes are related to pre-existing complications of diabetes, especially atherosclerotic disease, nephropathy (and perhaps increased susceptibility to other renal toxins), and peripheral and autonomic neuropathy. Hyperglycemia is associated with likely risks for poorer wound healing, increased susceptibility to infection, and probable loss of administered nutrients through glycosuria. Insulin use has the flexibility of timing and dose in the postoperative management of most diabetic patients. The combinations of intermediate-acting and long-acting insulins and short-acting insulins usually are related to the experience and preferences of the treating physicians and allied health professionals. Intravenous insulin (always R) may be limited to administration in the ICU because of the need for frequent blood glucose monitoring and rapidity of glucose response to intravenous insulin. The use of short-acting insulin analogues has been shown to work well as premeal insulin or for rapidly treating marked hyperglycemia in the outpatient setting. Meal delivery in the hospitalized patient may not be timed as precisely as in the home situation. Nurses may be responsible for many patients. The rapid-acting analogues may be associated with increased risk for hypoglycemia in the hospitalized patient if insulin cannot be given immediately before a meal. These rapid-acting insulin analogues usually are limited to circumstances in which the patient can determine the dose and self-administer just before ingestion of the meal. The long-acting insulin analogues may not afford enough flexibility in many situations in which daily dosages changes are occurring in intermediate-acting and long-acting insulins. Oral glucose-lowering agent use in the postoperative state usually is limited to selected patients, including patients who have been on such agents before surgery, who have only mild elevations of blood glucose, who are able to ingest oral medications, and who do not have significant comorbid conditions (or significant risk for such conditions) that may be contraindications to use of such agents (see Table 3). Sulfonylureas and other insulin secretagogues (e.g., meglitinide, nateglinide) lower glucoses acutely. The risk for hypoglycemia is slightly less with the nonsulfonylurea agents. Efficacy and side effects limit the use of carbohydrase inhibitors for hospitalized patients. The glucose-lowering effects of biguanides and thiazolidinediones usually are not rapid enough for hospitalized patients who have never taken these medications. For patients who have been on a biguanide or thiazolidinedione before admission, these agents often are restarted in the postoperative period when oral intake of medications is possible and hepatic and renal function are stable. The hospital period affords an opportunity to review long-term management issues related to diabetes and its complications. Instruction on the importance of medical nutrition therapy, glycemic control, management of hypertension, dyslipidemia, and aspirin use as well as basic guidelines for foot care should be carried out during the hospitalization and at the time of discharge. Similarly, appropriate arrangements for medical nutrition therapy, general diabetes education (especially for newly diagnosed diabetic patients), and regular medical follow-up are important to ensure long-term, excellent surgical and medical outcomes.