New onset diabetes associated with bovine growth hormone and testosterone abuse in a young body builder

2011 ◽  
Vol 30 (12) ◽  
pp. 2007-2012 ◽  
Author(s):  
Matthew J Geraci ◽  
Mario Cole ◽  
Peter Davis
Keyword(s):  
Insulin Resistance ◽  
Growth Hormone ◽  
Anabolic Steroids ◽  
Serum Glucose ◽  
Bovine Growth Hormone ◽  
Significant Past Medical History ◽  
Trenbolone Acetate ◽  
Onset Diabetes ◽  
Androgenic Anabolic Steroids ◽  
New Onset

Case: A 33-year-old male presented to the emergency department with complaints of polydipsia, polyuria, nausea, headaches, blurry vision and malaise. Lab work revealed a serum glucose level of 1166 mg/dl (64.8 mmol/L). The patient admitted to completing a cycle of androgenic anabolic steroids (AASs) for bodybuilding. His regimen consisted of supraphysiologic intramuscular injections of a bovine growth hormone, trenbolone acetate and testosterone. The patient received intravenous fluids and insulin to restore metabolic balance. Previously healthy with a non-contributory family history, he was diagnosed with new onset diabetes. Discussion: It has been demonstrated that AAS use, specifically growth hormone, can affect glucose homeostasis through increasing cellular insulin resistance and reducing glucose uptake. Excess growth hormone has been shown to cause symptoms of acromegaly which predisposes up to 40% of patients to diabetes. As trenbolone acetate is not indicated for human use and athletes are known to use supraphysiologic doses of this underground, performance enhancing drug, the correlation of the timing of events and the use of this veterinary growth hormone likely exacerbated an underlying condition or caused this new onset diabetes. Conclusion: We report a case of a young bodybuilder with no significant past medical history who was diagnosed with new onset diabetes associated with supraphysiologic self-injections of the bovine growth hormone, trenbolone acetate, combined with testosterone. AAS have the potential to induce or exacerbate diabetic conditions due to decreased glucose tolerance and increased insulin resistance.

Insulin Resistance as a Risk Factor for New-Onset Diabetes After Kidney Transplantation

2014 ◽  
Vol 46 (2) ◽  
pp. 537-539 ◽  
Author(s):  
K. Tokodai ◽  
N. Amada ◽  
I. Haga ◽  
T. Takayama ◽  
A. Nakamura ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Risk Factor ◽  
Kidney Transplantation ◽  
Onset Diabetes ◽  
New Onset

scholarly journals New Onset Diabetes after Transplant – Risk Factors, Clinical Profile and Outcome

2018 ◽  
Vol 2 (1) ◽  
pp. 35-40
Author(s):  
Sakthirajan R ◽  
Dhanapriya J ◽  
Dineshkumar T ◽  
Balasubramaniyan T ◽  
Gopalakrishnan N ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Family History ◽  
Fasting Blood Glucose ◽  
Hcv Infection ◽  
Clinical Profile ◽  
Family History Of Diabetes ◽  
Onset Diabetes ◽  
History Of ◽  
New Onset

Background: New onset diabetes after transplant (NODAT) remains one among the significant threats to both renal allograft and patient survival. The aim of this study was to analyse the clinical profile and risk factors for NODAT.Methods: This prospective observational study involved patients who underwent renal transplantation in our centre between 2010 and 2015.Results: During the mean follow up period of 18 ± 6 months, incidence of NODAT was 26.6% and the cumulativeincidence was highest in the first year after transplant. Recipient age, pre transplant impaired fasting glucose, Hepatitis C virus (HCV) infection, family history of diabetes, tacrolimus, post transplant hypertriglyceridemia and metabolic syndrome were found to be statistically significant risk factors for NODAT. In Cox multivariate regression analysis, age and family history of diabetes were found to be independent risk factors for NODAT. Fasting C-peptide level underlines insulin resistance as predominant mechanism for NODAT in two third of patients. There were higher incidence of urinary tract infection in the NODAT patients. NODAT was found to be an independent risk factor for fungal infection and 10 year cardiovascular risk in the renal recipients. There was no significant impact of NODAT on short term graft and patient survival.Conclusion: Age, pre-transplant fasting blood glucose, family history of diabetes, HCV infection and tacrolimus were found to be the important risk factors, with insulin resistance as the predominant mechanism for NODAT.

scholarly journals Positive association between the ratio of triglycerides to high-density lipoprotein cholesterol and diabetes incidence in Korean adults

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Joungyoun Kim ◽  
Sang-Jun Shin ◽  
Ye-Seul Kim ◽  
Hee-Taik Kang
Keyword(s):  
Insulin Resistance ◽  
High Density Lipoprotein ◽  
National Health ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Korean Adults ◽  
Onset Diabetes ◽  
New Onset

Abstract Background Insulin resistance is associated with the incidence of diabetes and cardiovascular diseases such as myocardial infarction. The ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) (TG/HDL-C ratio) is positively correlated with insulin resistance. This study aimed to investigate the relationship between the TG/HDL-C ratio and the incidence of diabetes in Korean adults. Methods This retrospective study used data from the National Health Insurance Service-National Health Screening Cohort. The TG/HDL-C ratio was divided into three tertiles, the T1, T2, and T3 groups, based on sex. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetes using multivariate Cox proportional hazards regression analyses. Results A total of 80,693 subjects aged between 40 and 79 years were enrolled. The median follow-up period was 5.9 years. The estimated cumulative incidence of diabetes in the T1, T2, and T3 groups was 5.94%, 8.23%, and 13.50%, respectively, in men and 4.12%, 4.72%, and 6.85%, respectively, in women. Compared to T1, the fully adjusted HRs (95% CIs) of the T2 and T3 groups for new-onset diabetes were 1.17 (1.06–1.30) and 1.47 (1.34–1.62), respectively, in men and 1.20 (1.02–1.42) and 1.52 (1.30–1.78), respectively, in women. Conclusions Increased TG/HDL-C ratio was significantly associated with a higher risk of new-onset diabetes in both sexes.

scholarly journals Severe, New-Onset Diabetes Mellitus Triggered by COVID-19 Infection Followed by Euglycemia Upon Recovery: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A400-A400
Author(s):  
Ian Yu ◽  
Anne Sutherland ◽  
Monica C Abreu Diaz ◽  
Lissette Maria Cespedes
Keyword(s):  
Diabetes Mellitus ◽  
Serum Glucose ◽  
Tube Placement ◽  
Hypoglycemic Agents ◽  
Laboratory Evaluation ◽  
Insulin Regimen ◽  
Metabolic Complications ◽  
Onset Diabetes ◽  
New Onset Diabetes Mellitus ◽  
New Onset

Abstract Background: New-onset diabetes mellitus (DM) and severe metabolic complications in association with COVID-19 has been reported in the literature. Studies indicate a bidirectional relationship between COVID-19 and DM. Not only does severe DM lead to an increased risk for COVID-19 complications, but COVID-19 infection itself may precipitate new-onset DM. Clinical Case: A 45-year-old male with no known past medical history and normal body mass index presented after being found unresponsive at home. One week prior to admission, he tested positive for SARS-CoV-2 virus. On admission, laboratory evaluation showed: serum glucose 1090 mg/dl [70–109 mg/dL], anion gap 31 [<12], serum sodium 159 meq/L [133–145 meq/L], serum bicarbonate 18 meq/L [23–30 meq/L], creatinine 2.9 mg/dL [0.7–1.2 mg/dL], serum osmolality 438 mosm/k [280–295 mosm/k], venous pH 7.29 [7.32–7.42], venous bicarbonate 20 mmol/L [24–28 mmol/L], lactic acid 5.0 mmol/L [0.5–2.2 mmol/L], serum acetone positive 1+, urine ketone 20, hemoglobin 16.1 g/dL [14–18.0 g/dL] and HbA1c 13.5% [4.8–5.9%]. A diagnosis of diabetes with hyperosmolarity was made and he was admitted to the medical intensive care unit for treatment. Rapid resolution of hyperglycemia and hyperosmolarity was achieved with insulin infusion and intravenous fluids. He was transitioned to subcutaneous insulin on hospital day 2 and glycemic control was maintained using a basal/bolus insulin regimen. However, he experienced a prolonged two-month hospitalization due to complications including acute respiratory distress syndrome requiring mechanical ventilation and tracheostomy placement, pleural effusions with need for chest tube placement, and acute renal failure requiring short-term hemodialysis support. He was discharged to a rehabilitation facility on insulin glargine 15 units daily. Two-months after discharge, no weight changes were noted. Insulin was discontinued due to fasting serum glucose around 100 mg/dL and HbA1c 5.9%. Six-weeks later, a random serum glucose was 135 mg/dL and HbA1c 6.6%. He remains off glucose-lowering medications to date. Conclusion: We report an interesting case of new-onset diabetes with hyperosmolarity associated with COVID-19 infection with rapid achievement of euglycemia upon resolution of viral infection. Our case adds to growing evidence demonstrating a possible diabetogenic effect due to COVID-19 infection. There is also a complex interplay between SARS-CoV-2 virus and DM leading to a higher risk for complications. Questions remain regarding the long-term effects of COVID-19 on glucose metabolism. Patients with similar clinical presentations warrant close follow-up since it may be possible to de-escalate or discontinue hypoglycemic agents.

Abstract MP32: The Level Of Adherence To The Dietary Approaches To Stop Hypertension Diet Is Associated With The Severity Of Insulin Resistance Among Community-Dwelling Heart Failure Patients: A National Health And Nutrition Examination Survey Analysis

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Yuta Ishikawa ◽  
Emma M Laing ◽  
Alex K Anderson ◽  
Donglan Zhang ◽  
Rupal Trivedi-Kapoor ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
National Health ◽  
Community Dwelling ◽  
Nutrition Examination Survey ◽  
Severe Insulin Resistance ◽  
Health And Nutrition ◽  
Onset Diabetes ◽  
History Of ◽  
New Onset

Introduction: Heart failure (HF) patients are at risk of new-onset diabetes. In non-HF populations, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has shown to be associated with the delayed onset of insulin resistance; however, such effect remains unknown in HF patients without history of diabetes. Methods: Using data from 1999-2016 National Health and Nutrition Examination Survey cycles, we included 348 HF participants (20+ years) without history of diabetes or diabetes medication use and with data on at least one 24-hour dietary recall. Participants were classified by DASH dietary index score quartiles: quartile 1 indicated lowest DASH index scores and lowest DASH adherence, whereas quartile 4 indicated highest DASH index scores and highest DASH adherence. The severity of insulin resistance was examined using the Homeostatic Model Assessment of Insulin Resistance and was further classified by tertiles, where the upper tertile showed the most severe insulin resistance. Associations between the severity of insulin resistance and DASH dietary adherence and its linear trends were examined using logistic regression models. Results: Participants had a mean age of 65±1 (SE) years, 44.2% were female, and 10.5% were non-Hispanic black. The age-, gender-, and race/ethnicity-adjusted odds ratio for the most severe insulin resistance group in participants with highest DASH adherence was 0.32 (95% CI, 0.11-0.99), compared to participants with lowest DASH adherence. A significant trend of more severe insulin resistance was observed as participants showed less adherence to the DASH diet (p=0.02). Conclusion: Adherence to a DASH dietary pattern was associated with improved insulin resistance among community-dwelling HF patients in the U.S. Heart healthy dietary patterns may protect HF patients against new-onset diabetes. Future research is needed to test dietary interventions aimed at the prevention of HF complications and comorbidities.

scholarly journals Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation

2012 ◽  
Vol 26 (3) ◽  
pp. 273-280 ◽  
Author(s):  
Pramod Nagaraja ◽  
Vinod Ravindran ◽  
Gareth Morris-Stiff ◽  
Kesh Baboolal
Keyword(s):  
Insulin Resistance ◽  
Kidney Transplantation ◽  
Onset Diabetes ◽  
New Onset

scholarly journals Association of Region‐Specific Cardiac Adiposity With Dysglycemia and New‐Onset Diabetes

2021 ◽  
Author(s):  
Kuo‐Tzu Sung ◽  
Jen‐Yuan Kuo ◽  
Chun‐Ho Yun ◽  
Yueh‐Hung Lin ◽  
Jui‐Peng Tsai ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adipose Tissue ◽  
Visceral Adipose Tissue ◽  
Epicardial Adipose Tissue ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Onset Diabetes ◽  
Visceral Adipose ◽  
Periaortic Fat ◽  
New Onset

Background Visceral adipose tissue is assumed to be an important indicator for insulin resistance and diabetes beyond overweight/obesity. We hypothesized that region‐specific visceral adipose tissue may regulate differential biological effects for new‐onset diabetes regardless of overall obesity. Methods and Results We quantified various visceral adipose tissue measures, including epicardial adipose tissue, paracardial adipose tissue, interatrial fat, periaortic fat, and thoracic aortic adipose tissue in 1039 consecutive asymptomatic participants who underwent multidetector computed tomography. We explored the associations of visceral adipose tissue with baseline dysglycemic indices and new‐onset diabetes. Epicardial adipose tissue, paracardial adipose tissue, interatrial fat, periaortic fat, and thoracic aortic adipose tissue were differentially and independently associated with dysglycemic indices (fasting glucose, postprandial glucose, HbA1c, and homeostasis model assessment of insulin resistance) beyond anthropometric measures. The superimposition of interatrial fat and thoracic aortic adipose tissue on age, sex, body mass index, and baseline homeostasis model assessment of insulin resistance expanded the likelihood of baseline diabetes (from 67.2 to 86.0 and 64.4 to 70.8, P for ∆ ꭕ 2 : <0.001 and 0.011, respectively). Compared with the first tertile, the highest interatrial fat tertile showed a nearly doubled risk for new‐onset diabetes (hazard ratio, 2.09 [95% CI, 1.38–3.15], P <0.001) after adjusting for Chinese Visceral Adiposity Index. Conclusions Region‐specific visceral adiposity may not perform equally in discriminating baseline dysglycemia or diabetes, and showed differential predictive performance in new‐onset diabetes. Our data suggested that interatrial fat may serve as a potential marker for new‐onset diabetes.

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