scholarly journals Extremely high-dose insulin requirement in a diabetic patient with COVID-19: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
François R. Jornayvaz ◽  
Benjamin Assouline ◽  
Jérôme Pugin ◽  
Karim Gariani
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Patient ◽  
Insulin Requirement ◽  
Diabetic Patients ◽  
High Dose ◽  
Intravenous Insulin ◽  
Patients With Diabetes ◽  
Mechanical Ventilation Support ◽  
High Insulin

Abstract Background Detailed description of hyperglycemia management in diabetic patients infected with SARS-CoV-2 remain limited, although patients with diabetes show higher complication and mortality rate than patients without diabetes. Transient non-severe increased insulin requirement in patients hospitalized for medical conditions such as sepsis or myocardial infarction is a well-known phenomenon. However, extremely high-dose insulin requirement remains a very rarely reported entity. Here, we report the case of an extreme and transitory insulin requirement episode in a type 2 diabetic patient presenting an acute respiratory distress syndrome caused by SARS-CoV-2. Case presentation A 57-year-old man resident in Geneva, Switzerland, previously known for type 2 diabetes for 3 years was admitted for an aggravation of his dyspnea. His type 2 diabetes was treated only with metformin and his latest Hb1Ac was 6.1%. Chest CT SCAN showed a bilateral multilobar ground-glass opacification. Twenty-four hours after his admission he presented a worsening of dyspnea and severe hypoxemia requiring a transfer to the intensive care unit rapidly followed by oro-tracheal intubation for mechanical ventilation support. A bronchoalveolar lavage was performed and test of SARS-CoV-2 by RT-qPCR assay was positive. At day 3, he presented a rapidly progressive insulin requirement at a rate of up to 50 units/hour intravenous insulin aspart. Despite the high insulin doses, he maintained an elevated plasma glucose level at 270 mg/dL on average. His extremely high-dose insulin requirement “resolved” at day 9, and the insulin infusion rate was rapidly reduced. Conclusions This case may reflect a specific and profound impact of SARS-CoV-2 on metabolic homeostasis, in particular in diabetic patients that appear more prone to complications of COVID-19 infection. Yet, the mechanisms behind this remain to be elucidated. The optimal management of hyperglycemia of diabetic patients infected with SARS-CoV-2 has yet not be defined, however insulin remain the mainstay of treatment approach. Report of extreme dysregulation of chronic conditions such as diabetes in patients with COVID-19 may help clinicians to better take care of patients during the pandemic of SARS-CoV-2. To the best of our knowledge this is the first description of extremely high-dose insulin requirement in patient with COVID-19.

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

2011 ◽  
Vol 101 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Aynur Gulcan ◽  
Erim Gulcan ◽  
Sukru Oksuz ◽  
Idris Sahin ◽  
Demet Kaya
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Essential Components ◽  
Patients With Diabetes ◽  
Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

scholarly journals Evaluation of Serum High Sensitivity C-reactive Protein (hs-CRP) In Type-2 Diabetic Patient

1970 ◽  
Vol 11 (1) ◽  
pp. 20-23
Author(s):  
AKM Fazlul Haque ◽  
ARM Saifuddin Ekram ◽  
Quazi Tarikul Islam ◽  
Md Sarwar Jahan ◽  
Md Zahirul Haque
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Patient ◽  
Healthy Subjects ◽  
High Sensitivity ◽  
Diabetic Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp ◽  
Type 2 Diabetic

Type-2 diabetes may remain in subclinical form for years before diagnosis. This quiescence of type-2 diabetes is a great concern for health care providers. The earliest change of the type-2 diabetes is the insulin resistance, which is associated with the increased macrovascular risk due to induction of chronic inflammation in the vessels of the body which leads to atherosclerotic change in the vessels. High sensitivity CRP (hs-CRP) is the measure of C-reactive protein with greater accuracy and the lower limit of its assay is .01 mg/L which is more than 100 times as sensitive as the usual CRP measurement (lower limit 5 mg/L). The median level of hs-CRP from blood samples of apparent healthy subjects is 0.8 mg/L. For this, physician uses the hs-CRP parameter as a marker of chronic inflammation in apparently normal healthy individuals, specially for the assessment of atherosclerosis, which is a chronic inflammatory procedure from the very beginning, in type-2 diabetic, obese and hypertensive patients. This vascular atherosclerosis assessment help them to calculate the cardiovascular as well as cerebrovascular risk of those patients. To help the type-2 diabetic patients from the very begining in respect of the prognostic view of the macrovascular risk, estimations of serum hs-CRP in the early stage of these patient may be a enthusiastic one. This descriptive study was carried out by choosing 70 diabetic patient who had no other comorbidity or any complications of diabetes and 35 healthy subjects who were neither diabetic nor had any diseases. Both the groups were non-smoker and non-alcoholic and non-hypertensive, hs-CRP level was measured in both the groups along with the HbA1c%. The mean hs-CRP in diabetic group was 1.13 mg/L and in normal healthy subjects was 0.39 mg/L. This higher level of mean hs-CRP (1.13 mg/L) in diabetic patients is statisticaly significant (P<0.01) compared with that of the normal healthy subjects mean hs-CRP (0.39 mg/L). This mean level of hs-CRP in normal healthy subjects was below the lower level of cardiovascular risk (1 mg/L). Keywords: High sensitivity CRP, C-reactive protein, diabetes DOI:10.3329/jom.v11i1.4263 J Medicine 2010: 11: 20-23

scholarly journals Impact of Bromocriptine-QR Therapy on Glycemic Control and Daily Insulin Requirement in Type 2 Diabetes Mellitus Subjects Whose Dysglycemia Is Poorly Controlled on High-Dose Insulin: A Pilot Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Erin D. Roe ◽  
Bindu Chamarthi ◽  
Philip Raskin
Keyword(s):  
Type 2 Diabetes ◽  
Pilot Study ◽  
Glycemic Control ◽  
Dopamine D2 Receptor ◽  
D2 Receptor ◽  
Insulin Requirement ◽  
High Dose ◽  
Open Label ◽  
Release Formulation

Background. The concurrent use of a postprandial insulin sensitizing agent, such as bromocriptine-QR, a quick release formulation of bromocriptine, a dopamine D2 receptor agonist, may offer a strategy to improve glycemic control and limit/reduce insulin requirement in type 2 diabetes (T2DM) patients on high-dose insulin. This open label pilot study evaluated this potential utility of bromocriptine-QR.Methods. Ten T2DM subjects on metformin (1-2 gm/day) and high-dose (TDID ≥ 65 U/day) basal-bolus insulin were enrolled to receive once daily (morning) bromocriptine-QR (1.6–4.8 mg/day) for 24 weeks. Subjects with at least one postbaselineHbA1cmeasurement (N=8) were analyzed for change from baselineHbA1c, TDID, and postprandial glucose area under the curve of a four-hour mixed meal tolerance test (MMTT).Results. Compared to the baseline, averageHbA1cdecreased 1.76% (9.74±0.56to7.98±0.36,P=0.01), average TDID decreased 27% (199±33to147±31,P=0.009), and MMTT AUC60–240decreased 32% (P=0.04) over the treatment period. The decline inHbA1cand TDID was observed at 8 weeks and sustained over the remaining 16-week study duration.Conclusion. In this study, bromocriptine-QR therapy improved glycemic control and meal tolerance while reducing insulin requirement in T2DM subjects poorly controlled on high-dose insulin therapy.

scholarly journals Study on Thyroid Dysfunction in Patients with Type-2 Diabetes

2020 ◽  
Vol 7 (52) ◽  
pp. 3142-3147
Author(s):  
Senthil Chander ◽  
Kalpana Dev Venkatesan ◽  
Christina Mary Paul
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
General Medicine ◽  
Diabetic Patients ◽  
Endocrine Disorders ◽  
Cross Sectional ◽  
Patients With Diabetes

BACKGROUND Diabetes mellitus is one of the leading endocrine disorders worldwide. Thyroid dysfunction is a common endocrine disorder affecting the general population next to diabetes. The objective of this study was to determine the prevalence of thyroid dysfunction among patients with Type 2 diabetes. METHODS This analytical cross sectional study was conducted from June 2019 to Dec 2019. One hundred and fifty type–2 diabetes patients who attended the outpatient clinic of General Medicine Department, ACS Medical College and Hospital were included in the study. A detailed history and examination was done after getting informed consent. Blood samples were collected and sent to the laboratory for the evaluation of thyroid profile. RESULTS Thyroid dysfunction was found in 27 % of the patients with diabetes. Subclinical hypothyroidism was the most common thyroid dysfunction reported (14.7 %) followed by clinical hypothyroidism (10 %), subclinical hyperthyroidism (2 %) and clinical hyperthyroidism (0.6 %). CONCLUSIONS Thyroid dysfunction is common in patients with type-2 diabetes. A substantial proportion of the diabetic patients with thyroid dysfunction have subclinical hypothyroidism. Unidentified thyroid dysfunction could negatively impact diabetes and its complications. Therefore, early and routine screening of thyroid is recommended in all patients with diabetes to reduce the burden of the disease. KEYWORDS Type-2 Diabetes Mellitus, Thyroid Dysfunction, Hypothyroidism

scholarly journals Dinamika massy tela u bol'nykh sakharnymdiabetom 2 tipa v techenie pervogo godainsulinoterapii

2010 ◽  
Vol 7 (4) ◽  
pp. 13-19 ◽  
Author(s):  
T Sh Dzhavakhishvili ◽  
T I Romantsova ◽  
O V Roik
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Insulin Therapy ◽  
Insulin Requirement ◽  
Insulin Analogues ◽  
First Year ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

The aim of this study was to determine changes in weight and insulin requirements in insulin-treated type 2 diabetic patients with normal and elevated body mass index (BMI) during the first year after initiating the insulin therapy with insulin analogues or human insulins, respectively. Materials and methods: a total of 157 patients with insulin naive type 2 diabetes were included in the study. The patients were divided in two groups. First group consisted of subjects [mean age 57 (45 to 73), duration of diabetes of 10 years (4 to 16)] prescribed a long-acting basal (glargine, detemir), premixed (biphasic insulin Aspart 30, Humalog Mix 25) or short-acting (aspart, lispro) insulin analogues. Patients from second group [mean age 59 (46 to 75), duration of diabetes for 10 years (5 to 15)] were treated with intermediate- acting basal (Protophane, Humulin NPH), premixed (biphasic human insulin 30, Humulin M3) and regular (Actrapid, Humulin R) human insulins. Each of these two groups was divided into three subgroups depending on the baseline body mass index (BMI) of the patients: 18,5-24,9; 25-29 and ≥30. At the beginning of insulin therapy and 12 months later, we compared HbA1c, BMI, waist circumference and required insulin doses in each group. Results: our study results showed that under comparable metabolic control the risk for weight gain and increase in insulin requirement is similar in insulin-treated type 2 diabetic patients with normal and elevated BMI. Use of insulin analogues for treatment of type 2 diabetes patients with normal and elevated BMI results in better glycaemic control, less weight gain, smaller increase in insulin requirement and waist circumference compared to human insulins during the first year of insulin therapy.

scholarly journals 564 Cardiac magnetic resonance myocardial feature tracking for optimized risk assessment after acute myocardial infarction in patients with type 2 diabetes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J T Kowallick ◽  
S J Backhaus ◽  
T Stiermaier ◽  
T Lange ◽  
J L Navarra ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Acute Myocardial Infarction ◽  
Magnetic Resonance ◽  
Feature Tracking ◽  
Multivariable Analysis ◽  
Diabetic Patients ◽  
Patients With Diabetes

Abstract Objective Type 2 diabetes mellitus (T2DM) associates with worse cardiovascular outcome following acute myocardial infarction (AMI) as compared to non-diabetic patients. Since the mechanisms behind these observations are not fully understood we aimed to quantify the underlying pathophysiology on ventricular and atrial levels and study their prognostic implications using cardiovascular magnetic resonance (CMR) quantitative feature-tracking (FT) and tissue characterization. Research Design and Methods: A total of 1147 consecutive patients with AMI (n = 265 with diabetes; n = 882 without diabetes) undergoing cardiac magnetic resonance (CMR) imaging in median 3 days after AMI were included in this multicenter study. Left ventricular (LV) function and volumetry included LV ejection fraction (LV-EF), global longitudinal (GLS), radial (GRS) and circumferential strain (GCS) as well as left atrial (LA) strain and strain rate parameters of LA reservoir, conduit and booster pump function. LV damage assessment included infarct size (IS), edema and microvascular obstruction (MO). The clinical study endpoint was the rate of major adverse cardiovascular events (MACE) at 12 months. Results T2DM patients had impaired LA reservoir (19.8 vs. 21.2%, p &lt; 0.01) and conduit strains 7.6 vs. 9.0%, p &lt; 0.01) but no differences in ventricular function or myocardial damage. They were at higher risk of MACE than non-diabetic patients (10.2% vs. 5.8%, p &lt; 0.01) with the majority of MACE occurring in patients with LVEF ≥ 35%. Whilst LVEF was an independent predictor of adverse events in non-diabetic patients (p = 0.04 on multivariable analysis), LV GLS as well as LA strain emerged as independent predictors of poor prognosis in patients with diabetes (p &lt; 0.02 on multivariable analysis). Considering patients with diabetes and LVEF ≥35% (n = 237), GLS and LA reservoir strain below median were significantly associated with higher 12-month event rates. Conclusions In patients with diabetes, LA and LV longitudinal strain permit optimized risk assessment early after reperfused AMI with incremental prognostic value over and above LVEF.

COMPARATIVE HEMATOLOGICAL STUDY OF TYPE 2 DIABETIC AND NON-DIABETIC PATIENTS IN ERODE DISTRICT, TAMIL NADU

2021 ◽  
pp. 29-30
Author(s):  
Murugesan Thinakaran ◽  
Thangadurai Chitra
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Tamil Nadu ◽  
Haematological Parameters ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Hematological Indices ◽  
Patients With Diabetes ◽  
Type 2 Diabetic

Background And Objectives: Previous studies have shown that hematological alterations are a common nding in patients with diabetes. To aim of our study was to explore the hematological indices in type 2 diabetic patients compared with non-diabetic individual. Establish the role of haematological parameters as an early prevention strategy. Materialand Method: Two hundred and forty-six subjects were recruited for this study, one hundred and fourteen with type 2 diabetes and One hundred and thirty-two non-diabetes, were evaluated for haematological parameters using hematologic analyzer. All the information's about the disease was collected with the knowledge of the patients form the concern hospital and laboratory. Results And Conclusions: Results were compared with the same measurements in 132 subjects without diabetes mellitus. The haematological prole associated with Type2 diabetic patients signicantly reduced Hb, RBCs, PCV and MCV than Non diabetes. Increased MCHC and WBCs were noted in Type2 diabetes. Our ndings suggest the need of screening for routine hematological tests in type 2 diabetes mellitus

scholarly journals Smoking Counteracts the Favorable Effect of Exercise Training on Endothelial Function in Patients with Type 2 Diabetes

2013 ◽  
Vol 4 ◽  
pp. JCM.S11152 ◽  
Author(s):  
Shinji Sato ◽  
Noriko Nakayama ◽  
Shingo Otsuki ◽  
Shiro Tanaka ◽  
Hajime Nakamura ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Exercise Training ◽  
Endothelial Function ◽  
Favorable Effect ◽  
Diabetic Patients ◽  
Post Exercise ◽  
Home Based ◽  
Patients With Diabetes ◽  
Smoking Group

Background Exercise training can improve endothelial function in patients with diabetes. We hypothesized that the favorable effect of exercise training on endothelial function in patients with diabetes is counteracted by cigarette smoking. Purpose To assess whether there is a difference in the effect of exercise on endothelial function in smokers and non-smokers with type 2 diabetes. Methods We performed a 3-month controlled trial in 27 never-smoking and 17 smoking individuals with type 2 diabetes who participated in a home-based walking program. The percentage decrease in post-exercise ankle-brachial pressure index (ABI), which is an index of endothelial function, was assessed at baseline and after 3 months. Results Compared to the smoking group, the never-smoking group showed a more significant improvement in post exercise ABI during the 3 months of home-based training (interaction, P < 0.01). Conclusions These results indicate that smoking may counteract the favorable effects of exercise training on endothelial function. Endothelial function plays an important role in the prevention of cardiovascular disease among patients with diabetes. Therefore, a Certified Diabetes Educator should strongly advise diabetic patients not to smoke.

scholarly journals Optimal Exercise Time to Control Glucose in type 2 Diabetes

2019 ◽  
pp. 1-10
Author(s):  
M. O. Ohemeng ◽  
D. Otoo ◽  
E. K. Donkoh ◽  
H. Andoh
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Patient ◽  
Glucose Level ◽  
Cross Sectional Study ◽  
The Body ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Exercise Time ◽  
Effect Of Glucose

Diabetes is a lifelong disease that affect the way the body regulates blood glucose. Type 2 diabetes occurs when β cells do not produce enough insulin to regulate glucose in the blood. In this paper the authors used exercise as a tool to predict the optimal effect of glucose regulation in a diabetic patient using simulation. Computer simulations were performed on the proposed mathematical model to determine the number of heartbeats a diabetic patient need to train in other to regulate the glucose level to normalcy. This cross-sectional study took place at Sunyani Regional Hospital, one of the 10 regions in Ghana, between September 2018 and May 2019. The simulations show the effects of different rate of exercise on glucose level. The results shows that the optimal heartbeat for a diabetic patients is 140 beats per minute corresponding to a rate of 0.8. If this is done continuously for at least 3 times in a week, the glucose level could be regulated to normal within 50 weeks.

scholarly journals Study Comparing the Liver Enzymes in Hypertensive and Normotensive Patients with Type 2 Diabetes

2021 ◽  
Vol 8 (7) ◽  
pp. 207-211
Author(s):  
Rishad Ahmed
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Liver Enzymes ◽  
Good Control ◽  
Diabetic Patients ◽  
Uncontrolled Diabetes ◽  
Elevated Liver Enzymes ◽  
Patients With Diabetes ◽  
Altered Liver

Objective: There were few clinical trials which indicate altered liver biochemical findings in diabetic patients, but through investigation to compare the liver enzymes in-between hypertensive and normotensive patients with type 2 diabetes was not evaluated. Thus main objective of current study was to compare the liver enzymes in hypertensive and normotensive patients with type 2 diabetes. Materials and Methods: This was a retrospective observational study conducted in a tertiary medical teaching hospital in Kolkata. Hospital OPD reports and patients clinical case records were used to fetch the required data in a predesigned clinical record pro forma. Result: Total 180 patients were participated in this observational retrospective trial where 33% patient were normotensive but having T2DM and 67% patients were hypertensive with T2DM. There were no statistically significant differences between the study variables among both the groups. However elevated level of GGT, ALT and AST were observed in T2DM normotensive patients as compare to T2DM hypertensive patients. abnormal liver functions were recorded in patients with uncontrolled diabetes as compared to patients with good control (p<0.05). Conclusion: The current study concluded that elevated liver enzymes like bilirubin, GGT, SGOT and SGPT were common among diabetes mellitus patients and comparable with patients with hypertensive as well as normotensive patients with diabetes mellitus. Keywords: Liver enzymes, T2DM, hypertension.

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