Psychological comorbidity in diabetes mellitus—need for early recognition and treatment

Background: The acute metabolic complications of diabetes consist of diabetic ketoacidosis (DKA), hyperosmolar non-ketotic coma (HNC), lactic acidosis (LA), and hypoglycemia. All of these are associated with significant morbidity and mortality. These can easily be prevented by early recognition and prompt management. Therefore, this study was conducted to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II.Methods: This observational, analytical study was conducted on 100 patients aged more than 18 years admitted in the ICU with acute complication of Diabetes mellitus Type II. Medical history was recorded. Physical examination and investigations were done and recorded.Results: The mean age of the study population was 55.26±13.13 years. Hypoglycemia was more common (63%) than DKA (37%). Fever and sweating had the overall highest incidence (and were more in patients with hypoglycemia) while stupor, nausea and abdominal pain had the lowest incidence (and were more in patients with DKA). On examination, only one patient of DKA was drowsy. Mean temperature, pulse and respiratory rate were higher in the patients having DKA while blood pressure was higher in patients having hypoglycemia.Conclusions: It can be effectively concluded from the present study that DKA and hypoglycaemia have a broad spectrum of clinicopathological features. But the incidences vary widely. This may help in early recognition of the impending complication and thereby enabling prompt management of the same, reducing the associated morbidity and mortality.

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Coexistence of diabetic ketoacidosis and thyrotoxicosis: a jeopardy of two endocrine emergencies

BMJ Case Reports ◽

10.1136/bcr-2021-243534 ◽

2021 ◽

Vol 14 (6) ◽

pp. e243534

Author(s):

Soban Ahmad ◽

Amman Yousaf ◽

Shoaib Muhammad ◽

Fariha Ghaffar

Keyword(s):

Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Clinical Presentation ◽

Early Recognition ◽

Favourable Outcome ◽

Adverse Outcomes ◽

Thyroid Storm ◽

Graves Disease ◽

Thyroid Disorders ◽

History Of

Simultaneous occurrences of diabetic ketoacidosis (DKA) and thyroid storm have long been known, but only a few cases have been reported to date. Both these endocrine emergencies demand timely diagnosis and management to prevent adverse outcomes. Due to the similarities in their clinical presentation, DKA can mask the diagnosis of thyroid storm and vice versa. This case report describes a patient with Graves’ disease who presented to the emergency department with nausea, vomiting and abdominal pain. He was found to have severe DKA without an explicit history of diabetes mellitus. Further evaluation revealed that the patient also had a concomitant thyroid storm that was the likely cause of his DKA. Early recognition and appropriate management of both conditions resulted in a favourable outcome. This paper emphasises that a simultaneous thyroid storm diagnosis should be considered in patients with DKA, especially those with a known history of thyroid disorders.

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Early recognition of autonomic dysfunction in microalbuminuria: significance for cardiovascular mortality in diabetes mellitus?

Diabetologia ◽

10.1007/bf00404336 ◽

1994 ◽

Vol 37 (8) ◽

pp. 788-796 ◽

Cited By ~ 31

Author(s):

H. M�lgaard ◽

P. D. Christensen ◽

K. Hermansen ◽

K. E. S�rensen ◽

C. K. Christensen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Autonomic Dysfunction ◽

Cardiovascular Mortality ◽

Early Recognition

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Mucormycosis with extensive cranial nerve involvement as the first presentation of diabetes mellitus: A case report

Qatar Medical Journal ◽

10.5339/qmj.2021.61 ◽

2021 ◽

Vol 2021 (3) ◽

Author(s):

Mouna Al Saad ◽

Ahmad Rimawi ◽

Ahmad Saadeh ◽

Amin Shehadeh

Keyword(s):

Diabetes Mellitus ◽

Hemoglobin A1c ◽

Facial Nerve Palsy ◽

Early Recognition ◽

Nasal Congestion ◽

Severe Disease ◽

Cranial Nerves ◽

Cranial Nerve Involvement ◽

Acute Bacterial Sinusitis ◽

Frozen Orbit

Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.

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Diabetes mellitus and periodontal disease

Medicinski pregled ◽

10.2298/mpns0912534k ◽

2009 ◽

Vol 62 (11-12) ◽

pp. 534-538

Author(s):

Ljiljana Kesic ◽

Dragan Petrovic ◽

Radmila Obradovic ◽

Jovanka Gasic ◽

Kosta Todorovic

Keyword(s):

Diabetes Mellitus ◽

Periodontal Disease ◽

Early Recognition ◽

Microbial Flora ◽

Good Treatment ◽

Pathogenic Mechanisms ◽

The Subject

Introduction. This review highlights the relations between diabetes mellitus and periodontal disease, as well as the pathogenic mechanisms which are still the subject of investigations. The possible pathogenic mechanisms important for developing periodontal disease in the diabetics are: vascular gingival changes, the disorders in the metabolism of the collagen, disorders in the function of the polimorphonuclear leukocytes and specific microbial flora in the parodontal pockets. Conclusion. It is clear that adequate early recognition and good treatment are very important and significant for treatment of diabetic periodontal disease.

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Monogenic diabetes: a new pathogenic variant of HNF1A gene

BMJ Case Reports ◽

10.1136/bcr-2019-231837 ◽

2021 ◽

Vol 14 (1) ◽

pp. e231837

Author(s):

Raquel Vilela Oliveira ◽

Teresa Bernardo ◽

Sandrina Martins ◽

Ana Sequeira

Keyword(s):

Diabetes Mellitus ◽

Genetic Test ◽

Early Recognition ◽

Single Gene ◽

Signs And Symptoms ◽

Oral Glucose ◽

Maturity Onset Diabetes ◽

Onset Diabetes ◽

Fast Absorption ◽

Hnf1a Gene

Maturity onset diabetes of the young defines a diabetes mellitus subtype, with no insulin resistance or autoimmune pancreatic β-cells dysfunction, that occurs by mutation in a single gene. A 13-year-old girl hospitalised due to hyperglycemia plus glycosuria without ketosis, and with normal glycated haemoglobin of 6.8%. She started a sugar-free fast-absorption diet and no insulin therapy was required. Fasting glucose was normal, but 2 hours after lunch she presented hyperglycemia as after 2 hours of an oral glucose tolerance test, with 217 mg/dL. Family history was positive for type 2 diabetes mellitus with an autosomal dominant pattern. She was discharged with fast-absorption sugar-free diet and low-dose of sulfonylurea. A genetic test was performed detecting a mutation in heterozygosity of HNF1A gene, compatible with the diagnosis of maturity onset diabetes of the young 3 (MODY3), not reported in the literature. Early recognition of signs and symptoms increase awareness of MODY. Genetic test allows confirmation and leads to optimised treatment.

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Necrotizing Fasciitis of Thoracic and Abdominal Wall with Emphysematous Pyelonephritis and Retroperitoneal Abscess

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_56_17 ◽

2018 ◽

Vol 8 ◽

pp. 7 ◽

Cited By ~ 2

Author(s):

Sanjay Mhalasakant Khaladkar ◽

Kunaal Mahesh Jain ◽

Rajesh Kuber ◽

Sidappa Gandage

Keyword(s):

Diabetes Mellitus ◽

Necrotizing Fasciitis ◽

Abdominal Wall ◽

Early Recognition ◽

Subcutaneous Tissue ◽

Left Kidney ◽

Gas Production ◽

Retroperitoneal Abscess ◽

Emphysematous Pyelonephritis ◽

Thoracic And Abdominal

Emphysematous pyelonephritis is a life-threatening severe form of pyelonephritis usually occurring in patients with diabetes mellitus with or without obstructive uropathies in whom there is necrotizing infection leading to the gas production of an unclear mechanism involving the renal parenchyma and the collecting system. Necrotizing fasciitis is characterized by progressive necrosis of fat and fascia due to deep-seated infection of subcutaneous tissue. It has a fulminant course with considerable mortality. Diabetes Mellitus is a common predisposing factor. The combined occurrence of emphysematous pyelonephritis and necrotizing fasciitis is extremely unusual. Early recognition and management is mandatory to avoid mortality. We report a case of a 53-year-old female, a known case of Type II diabetes mellitus, who presented with necrotizing fasciitis of thoracic and abdominal wall with emphysematous pyelonephritis in the left kidney with a retroperitoneal abscess.

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Pheochromocytoma related intracerebral hemorrhage, hypertrophic obstructive cardiomyopathy and diabetes mellitus

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20211065 ◽

2021 ◽

Vol 8 (4) ◽

pp. 611

Author(s):

Arundhati Diwan ◽

Chandrakant Chavan ◽

Varsha Jagtap ◽

Preeti Dave ◽

Sampada Karne ◽

...

Keyword(s):

Diabetes Mellitus ◽

Intracerebral Hemorrhage ◽

Neuroendocrine Tumors ◽

Early Recognition ◽

Young Patients ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Clinical Complications ◽

Catecholamine Excess

Pheochromocytomas are rare catecholamine secreting neuroendocrine tumors that can cause intracerebral hemorrhage sometimes and can very rarely cause cardiomyopathy simulating hypertrophic obstructive cardiomyopathy. We report a case of combination of these rare clinical complications occurring in a patient with pheochromocytoma. This case illustrates importance of early recognition of classic symptoms of catecholamine excess in young patients with hypertension.

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