scholarly journals Can Anti-Hypertensives Cause Hypoglycaemia? - A Rare Presentation of Recurrent Hypoglycaemia Secondary to an ACE-Inhibitor

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A370-A370
Author(s):  
Ashutosh Kapoor ◽  
Moulinath Banerjee ◽  
Aye Aye Thant ◽  
Adhithya Sankar
Keyword(s):  
Blood Glucose ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Hepatic Glucose Production ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Rare Presentation ◽  
First Case ◽  
History Of ◽  
Recurrent Hypoglycaemia

Abstract Introduction: Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed Anti-hypertensives which are first line treatments in patients with Diabetes. We report a rare but significant side-effect of ACE inhibitor treatment, relevant to Diabetic and non-diabetic patients alike. Case Details: We report the case of a 79 year male, with a background of Hypertension (HTN), established on Ramipril and Bendroflumethiazide, who was admitted following an episode of unresponsiveness secondary to Hypoglycaemia, which was initially presumed secondary to Alcohol, the intake of which was minimal. He did not have a history of Diabetes Mellitus. 7 weeks later, he had a similar presentation and as found to be profoundly Hypoglycaemic. On arrival, his observations were unremarkable except for CBG 1.9 and GCS of 14/15, which responded well to IM glucagon, and IV Dextrose. Relevant investigations revealed significantly impaired renal functions and normal CT imaging. There was no history of alcohol intake or intoxication. Management: Following acute management and stabilisation, he was admitted under the Endocrine and Diabetes team, who suspended his regular medications, including his ACE-I. As an inpatient, he underwent extensive biochemical investigations which were unremarkable followed by a prolonged 72 hours fasting test and an Oral Glucose Tolerance Test, wherein no significant drop in Blood Glucose was noted in both. Subsequently, there were no further episodes of hypoglycaemia and he remained asymptomatic whilst off his ACE-I and he was safely discharged. He was followed up in our Endocrine clinic and was found to have no episodes of Hypoglycaemia since discharge and remained asymptomatic. Discussion: We report the rare presentation of recurrent hypoglycaemia in a non- diabetic secondary to ACE-I. Hypoglycaemia may be defined by the Whipple’s triad, a classical triad of hypoglycaemic symptoms, low Blood Glucose levels and relief of symptoms following ingestion of glucose. The mechanism by which ACE-I treatment leads to hypoglycaemia remains unclear. It has been postulated that ACE-I related alterations in the Kininogen-Kinin system, are associated with hypoglycaemia. This mechanism may lead to an increase in Insulin sensitivity, mediated by increased muscle tissue uptake and diminished hepatic glucose production. Another proposed mechanism is the suppressive effect that ACE-inhibitors exhibit on the peripheral sympathomimetic overactivity, thus causing Hypoglycaemia. Exacerbating factors comprise of concurrent renal impairment, as in this case. The first case of ACE-I induced Hypoglycaemia was reported in 1985, with the usage of Captopril. To the best of our knowledge, this is one of the rare peculiar cases wherein an ACE-I has been implicated as the underlying aetiology causing Hypoglycaemia in a Non-Diabetic.

Prolapsed Nasal Polyp Causing Acute Airway Obstruction: An Exceptional Presentation

ORL ◽  
2021 ◽  
pp. 1-3
Author(s):  
Krupa R. Patel ◽  
Ashton E. Lehmann ◽  
Aria Jafari ◽  
Daniel L. Faden
Keyword(s):  
Airway Obstruction ◽  
Nasal Polyp ◽  
Nasal Polyposis ◽  
Upper Airway ◽  
Rare Presentation ◽  
First Case ◽  
Acute Airway Obstruction ◽  
History Of ◽  
Sinonasal Symptoms ◽  
Or History

Although nasal polyposis is a common clinical entity, there is limited literature describing the rare presentation of sudden prolapse of a massive nasal polyp resulting in an airway emergency in an adult. We present the first case report to our knowledge of a patient without any preceding sinonasal symptoms or history of anticoagulation who experienced acute upper airway obstruction due to sudden hemorrhage and prolapse of a large nasal polyp. Based on our experience treating this patient, we discuss special considerations in all phases of care to ensure safe and effective management of such an exceptional clinical scenario.

scholarly journals Daily Fasting Blood Glucose Rhythm in Male Mice: A Role of the Circadian Clock in the Liver

Endocrinology ◽  
2015 ◽  
Vol 157 (2) ◽  
pp. 463-469 ◽  
Author(s):  
Hitoshi Ando ◽  
Kentaro Ushijima ◽  
Shigeki Shimba ◽  
Akio Fujimura
Keyword(s):  
Blood Glucose ◽  
Circadian Clock ◽  
Mrna Expression ◽  
Hepatic Glucose Production ◽  
Critical Role ◽  
Fasting Blood Glucose ◽  
Glucose Production ◽  
Diabetic Patients ◽  
Dark Phase ◽  
Dawn Phenomenon

Abstract Fasting blood glucose (FBG) and hepatic glucose production are regulated according to a circadian rhythm. An early morning increase in FBG levels, which is pronounced among diabetic patients, is known as the dawn phenomenon. Although the intracellular circadian clock generates various molecular rhythms, whether the hepatic clock is involved in FBG rhythm remains unclear. To address this issue, we investigated the effects of phase shift and disruption of the hepatic clock on the FBG rhythm. In both C57BL/6J and diabetic ob/ob mice, FBG exhibited significant daily rhythms with a peak at the beginning of the dark phase. Light-phase restricted feeding altered the phase of FBG rhythm mildly in C57BL/6J mice and greatly in ob/ob mice, in concert with the phase shifts of mRNA expression rhythms of the clock and glucose production–related genes in the liver. Moreover, the rhythmicity of FBG and Glut2 expression was not detected in liver-specific Bmal1-deficient mice. Furthermore, treatment with octreotide suppressed the plasma growth hormone concentration but did not affect the hepatic mRNA expression of the clock genes or the rise in FBG during the latter half of the resting phase in C57BL/6J mice. These results suggest that the hepatic circadian clock plays a critical role in regulating the daily FBG rhythm, including the dawn phenomenon.

scholarly journals An evolving spectrum of diabetes in a woman with GCK-MODY

2019 ◽  
Vol 2019 ◽  
Author(s):  
Aoife Garrahy ◽  
Matilde Bettina Mijares Zamuner ◽  
Maria M Byrne
Keyword(s):  
Blood Glucose ◽  
Fasting Glucose ◽  
Autoimmune Diabetes ◽  
Post Partum ◽  
Fasting Blood Glucose ◽  
Oral Glucose ◽  
List Type ◽  
Latent Autoimmune Diabetes ◽  
Frequent Episodes ◽  
First Case

Summary Coexistence of autoimmune diabetes and maturity-onset diabetes of the young (MODY) is rare. We report the first case of coexisting latent autoimmune diabetes of adulthood (LADA) and glucokinase (GCK) MODY. A 32-year-old woman was treated with insulin for gestational diabetes at age 32 years; post-partum, her fasting blood glucose was 6.0 mmol/L and 2-h glucose was 11.8 mmol/L following an oral glucose tolerance test, and she was maintained on diet alone. Five years later, a diagnosis of LADA was made when she presented with fasting blood glucose of 20.3 mmol/L and HbA1C 125 mmol/mol (13.6%). GCK-MODY was identified 14 years later when genetic testing was prompted by identification of a mutation in her cousin. Despite multiple daily insulin injections her glycaemic control remained above target and her clinical course has been complicated by multiple episodes of hypoglycaemia with unawareness. Although rare, coexistence of latent autoimmune diabetes of adulthood and monogenic diabetes should be considered if there is a strong clinical suspicion, for example, family history. Hypoglycaemic unawareness developed secondary to frequent episodes of hypoglycaemia using standard glycaemic targets for LADA. This case highlights the importance of setting fasting glucose targets within the expected range for GCK-MODY in subjects with coexisting LADA. Learning points: We report the first case of coexisting latent autoimmune diabetes of adulthood (LADA) and GCK-MODY. It has been suggested that mutations in GCK may lead to altered counter-regulation and recognition of hypoglycaemia at higher blood glucose levels than patients without such mutation. However, in our case, hypoglycaemic unawareness developed secondary to frequent episodes of hypoglycaemia using standard glycaemic targets for LADA. This case highlights the importance of setting fasting glucose targets within the expected range for GCK-MODY in subjects with coexisting LADA to avoid hypoglycaemia.

scholarly journals Diabetes mellitus and impaired glucose tolerance in urban adult population

2014 ◽  
Vol 60 (2) ◽  
pp. 118-124 ◽  
Author(s):  
Walter Rodrigues Júnior ◽  
Sandra Cristina Nicodemo Gaban ◽  
Elenir Rose Jardim Cury Pontes ◽  
Celso Correia Souza ◽  
Lilian Patussi Gimenes ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Adult Population ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Mato Grosso ◽  
Strict Adherence ◽  
Family History Of Diabetes

Objective: Estimating the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the urban population aged between 30 and 69 years in the municipality of Campo Grande, state of Mato Grosso do Sul, Brazil. Methods: Population-based cross-sectional study conducted between October/2009 and February/2011. The investigation included the determination of fasting glucose and participants with blood glucose ≥ 200 mg/dL were considered diabetic. Nondiabetic patients, which showed blood glucose ≥ 100 mg/dL and < 200 mg/dL, underwent an oral glucose tolerance test (OGTT) to investigate whether they had DM or IGT. Results: 1.429 individuals participated in this investigation. The general prevalence, adjusted for sex and age, were: 12.3% for DM (95%CI: 10.5 to 13.9%) and 7.1% for IGT (95%CI: 5.7 to 8.4%). There was a higher prevalence of DM with increasing age in people with low educational level, family history of diabetes, overweight, obesity and central obesity. Among diabetic patients (n = 195), 25% were unaware they had the disease and were diagnosed through investigation. Among patients who already knew they had DM (n = 146), 37% were unaware of the potential chronic complications. Conclusion: This study confirms the increased prevalence of DM in Brazil and emphasizes the need for early diagnosis, as well as the importance of strict adherence to medical treatment in order to prevent its much feared complications.

Human and porcine insulins are equally effective in the regulation of glucose kinetics of diabetic patients during exercise

1984 ◽  
Vol 107 (4) ◽  
pp. 500-505 ◽  
Author(s):  
Veikko A. Koivisto ◽  
Risto Pelkonen ◽  
Esko A. Nikkilä ◽  
Lise G. Heding
Keyword(s):  
Blood Glucose ◽  
Hepatic Glucose Production ◽  
Glucose Production ◽  
Insulin Binding ◽  
Porcine Insulin ◽  
Diabetic Patients ◽  
Glucose Kinetics ◽  
Exercise Tests ◽  
Metabolic Conditions ◽  
Insulin Dependent Diabetic

Abstract. The rate of hepatic glucose production (Ra) and peripheral utilization (Rd) was determined in 8 insulin-dependent diabetic subjects in basal state and during 40 min cycle ergometric exercise. The patients were treated with continuous sc infusion of either semisynthetic human or porcine (Actrapid®) insulin. Basal rate of glucose production was comparable during human (2.29 ± 0.19 mg/kg/min) and porcine (2.18 ± 0.12 mg/kg/min) insulin therapy. In response to exercise, Ra rose 30 to 40% (P < 0.05), to 2.85 ± 0.35 vs 3.18 ± 0.42 mg/kg/min, similarly during both studies. The peak rise in Rd (to 3.20 ± 0.32 during human vs 3.78 ± 0.44 mg/kg/min during porcine insulin) was comparable in both groups and not significantly different from the rise in Ra. Consequently, blood glucose levels remained unchanged. During the exercise tests, the metabolic conditions were stable and comparable in both studies, as indicated by similar levels of blood glucose, plasma free insulin HbA1, serum lipids and insulin binding to erythrocytes. In conclusion, semisynthetic human insulin is equally effective as porcine insulin in regulating glucose kinetics in the basal state and during exercise.

Comparison of the Effects of Mitiglinide and Glibenclamide Administered in Combination with the Dipeptidyl Peptidase-IV Inhibitor Sitagliptin in Rats with Streptozotocin-Nicotinamide-Induced Type 2 Diabetes

Drug Research ◽  
2017 ◽  
Vol 67 (07) ◽  
pp. 396-403 ◽  
Author(s):  
Kenji Akahane ◽  
Kazuma Ojima ◽  
Ayaka Yokoyama ◽  
Toshihiro Inoue ◽  
Sumiyoshi Kiguchi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase Iv ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Dpp Iv

Abstract We compared the individual effects of mitiglinide and glibenclamide administered in combination with the dipeptidyl peptidase-IV (DPP-IV) inhibitor sitagliptin on plasma DPP-IV activity and blood glucose levels in rats with streptozotocin-nicotinamide-induced type 2 diabetes (STZ-NA rats). We examined the inhibitory activity of mitiglinide and glibenclamide as well as their combination with sitagliptin on plasma DPP-IV activity in STZ-NA rats. The oral glucose tolerance test (OGTT) was used to compare effects of mitiglinide, glibenclamide, and their combination with sitagliptin on blood glucose levels in STZ-NA rats. Mitiglinide and glibenclamide did not inhibit rat DPP-IV and did not influence the inhibitory effect of sitagliptin on rat plasma DPP-IV activity. In STZ-NA rats, plasma glucose levels were stronger suppressed by a combination of mitiglinide and sitagliptin than by either drug used alone. However, no clear effect of the combination of glibenclamide and sitagliptin was observed. These results indicate that the combination of mitiglinide and sitagliptin has a lower risk of hypoglycemia in the rats with induced type 2 diabetes compared with the combination of glibenclamide and sitagliptin. The combination of mitiglinide and sitagliptin can be a promising combination for the treatment of diabetic patients.

scholarly journals In Hospital Outcome of Myocardial Infarcton in Nondiabetic Patients with High on Admission Blood Glucose Level

1970 ◽  
Vol 3 (2) ◽  
pp. 143-148
Author(s):  
M Ullah ◽  
LA Sayami ◽  
MR Khan ◽  
A Jahan ◽  
Z Rahman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Blood Sugar ◽  
Blood Sugar Level ◽  
Diabetic Patients ◽  
Hospital Outcome ◽  
Coronary Syndrome ◽  
History Of ◽  
St Elevation ◽  
The Impact

Background: Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). Our aim was to evaluate the impact of admission hyperglycemia on in hospital outcome of non-diabetic patients admitted for acute coronary syndromes. Methods: The retrospective study was conducted in National Institute of Cardiovascular Diseases among the patients with acute myocardial infarction without history of diabetes. 50 patients with ST elevation MI (STEMI) with complications, 50 patients with STEMI without complications, 50 patients with non-ST elevation MI (NSTEMI) with complications and 50 patients without complications were included in the study. Every patient got the treatment as per protocol of the institute. On admission blood glucose of the patients was recorded. Level of blood glucose was correlated with the frequency of complications. Results : Average on admission blood sugar level was higher in patients who developed complications with STEMI (11.4 vs 8.78 mmol/L). On admission blood sugar level was also significantly higher in patients with NSTEMI with complications (10.6 vs 8.6 mmol/L). The frequency of individual complications had no significant relation with the blood sugar level. Conclusion : Higher level of admission blood glucose is related to poor in hospital outcome in both STEMI & NSTEMI even in nondiabetic patients. It may be used as a predictor of poor outcome of patients with myocardial infarction. Keywords: STEMI; NSTEMI; Blood glucose. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9183 Cardiovasc. J. 2011; 3(2): 143-148

scholarly journals Triple Valvulopathy and Jaccoud’s Arthropathy: A Case Report and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-2
Author(s):  
Ali Naderi Mahabadi ◽  
Bassam Alhaddad ◽  
Stanley Ballou
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Heart Valves ◽  
Fatal Outcome ◽  
Disease Recurrence ◽  
Point Of View ◽  
Systemic Lupus ◽  
Rare Presentation ◽  
First Case ◽  
History Of

Cardiac involvement is fairly common in patients with systemic lupus erythematosus (SLE). It may involve all layers of the heart and coronary arteries as well as the heart valves. We report an extremely rare presentation of valvulitis and valvular dysfunction associated with systemic lupus erythematosus. This is the first case of lupus valvulitis which required three mechanical prosthetic valve replacements with disease recurrence leading to a fatal outcome. This is, in our point of view, the consequence of aggressive natural history of the disease and perhaps late diagnosis and treatment of underlying SLE which was unsuccessful.

scholarly journals Glycemic Status During Acute Coronary Syndrome of Non-Diabetic Patients

KYAMC Journal ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 697-699
Author(s):  
Md Zillur Rahman ◽  
Nazmun Nahar ◽  
Md Azizul Hoque ◽  
Md Moksedur Rahman ◽  
Md Daharul Islam ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Blood Glucose ◽  
Glucose Tolerance ◽  
Fasting Blood Glucose ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Acute Hyperglycemia ◽  
Coronary Syndrome ◽  
Study Population ◽  
Glucose Abnormalities

The risk of diabetes mellitus and coronary heart disease is high among South-Asian population. In this study, our objective was to measure blood glucose level during acute coronary syndrome of previously known nondiabetic patients that will give the information about the frequency of acute hyperglycemia in acute coronary syndrome (ACS) among Bangladeshi population. It is an observational cross sectional study performed in Rajshahi Medical College Hospital (RMCH). A total of 248 non-diabetic subjects with ACS got admitted into hospital. Fasting blood glucose (FBS) and standard oral glucose tolerance test (OGTT ) within 3 days of ACS were done. This study was done to find out glucose abnormalities among ACS patients. Out of 248 study population, 135 (54.44%) had glucose abnormalities. Male was 87.10% (216). Among male, IGT (prediabetic) was 31.94% (69) and diabetic 24.54% (53). Mean age (±SD) of our study population was 51.71±11.84 years. Normal glucose tolerance (NGT) was found in 45.6% (113) cases, IGT (prediabetic) and diabetic were detected among 30.6% (76) and 23.8% (59) cases respectively. Non-diabetic Bangladeshi patients showed a high prevalence of hyperglycemia in acute coronary syndrome (ACS). We should create awareness about a new risk factor- acute hyperglycemia during acute coronary syndrome and take appropriate and effective measures to reduce morbidity as well as mortality as a consequence of acute hyperglycemia during ACS with or without diabetes.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 697-699

scholarly journals A rare presentation of Austrian syndrome with septic arthritis in an immunocompetent female

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Ayman Battisha ◽  
Bader Madoukh ◽  
Ahmed Altibi ◽  
Omar Sheikh
Keyword(s):  
Septic Arthritis ◽  
Case Reports ◽  
Chronic Alcoholism ◽  
Immunocompetent Patient ◽  
Rare Presentation ◽  
Case Presentation ◽  
First Case ◽  
Viral Influenza ◽  
History Of ◽  
High Index Of Suspicion

Abstract Background Austrian syndrome, which is also known as Osler’s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications. Case presentation A case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented. She developed bacterial pneumonia, endocarditis with mitral and aortic vegetations and perforation, meningitis, and right sternoclavicular septic arthritis. Two prior case reports have described sternoclavicular septic arthritis as part of Austrian syndrome. Our case is the third case; however, it is the first case to have this tetrad in an immunocompetent patient with no risk factors, i.e., males, chronic alcoholism, immunosuppression, and splenectomy. Conclusions Clinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients.

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