scholarly journals Hyperglycemic hyperosmolar state in an adolescent with type 1 diabetes mellitus

2019 ◽  
Vol 2019 ◽  
Author(s):  
Suguru Watanabe ◽  
Jun Kido ◽  
Mika Ogata ◽  
Kimitoshi Nakamura ◽  
Tomoyuki Mizukami
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Blood Sugar ◽  
Insulin Treatment ◽  
Clinical History ◽  
Body Type ◽  
Hyperglycemic Hyperosmolar State ◽  
Sugar Levels

Summary Hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) are the most severe acute complications of diabetes mellitus (DM). HHS is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis. A 14-year-old Japanese boy presented at the emergency room with lethargy, polyuria and polydipsia. He belonged to a baseball club team and habitually drank sugar-rich beverages daily. Three weeks earlier, he suffered from lassitude and developed polyuria and polydipsia 1 week later. He had been drinking more sugar-rich isotonic sports drinks (approximately 1000–1500 mL/day) than usual (approximately 500 mL/day). He presented with HHS (hyperglycemia (1010 mg/dL, HbA1c 12.3%) and mild hyperosmolality (313 mOsm/kg)) without acidosis (pH 7.360), severe ketosis (589 μmol/L) and ketonuria. He presented HHS in type 1 diabetes mellitus (T1DM) with elevated glutamate decarboxylase antibody and islet antigen 2 antibody. Consuming beverages with high sugar concentrations caused hyperglycemia and further exacerbates thirst, resulting in further beverage consumption. Although he recovered from HHS following intensive transfusion and insulin treatment, he was significantly sensitive to insulin therapy. Even the appropriate amount of insulin may result in dramatically decreasing blood sugar levels in patients with T1DM. We should therefore suspect T1DM in patients with HHS but not those with obesity. Moreover, age, clinical history and body type are helpful for identifying T1DM and HHS. Specifically, drinking an excess of beverages rich in sugars represents a risk of HHS in juvenile/adolescent T1DM patients. Learning points: Hyperglycemic hyperosmolar state (HHS) is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis. The discrimination between HHS of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in initial presentation is difficult. Pediatrician should suspect T1DM in patients with HHS but not obesity. Age, clinical history and body type are helpful for identifying T1DM and HHS. Children with T1DM are very sensitive to insulin treatment, and even appropriate amount of insulin may result in dramatically decreasing blood sugar levels.

scholarly journals Effects of intraperitoneal insulin versus subcutaneous insulin administration on sex hormone-binding globulin concentrations in patients with type 1 diabetes mellitus

2016 ◽  
Vol 5 (3) ◽  
pp. 136-142 ◽  
Author(s):  
M Boering ◽  
P R van Dijk ◽  
S J J Logtenberg ◽  
K H Groenier ◽  
B H R Wolffenbuttel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Insulin Treatment ◽  
Sex Hormone Binding Globulin ◽  
Insulin Administration ◽  
Hormone Binding ◽  
Intraperitoneal Insulin ◽  
The Difference

Aims Elevated sex hormone-binding globulin (SHBG) concentrations have been described in patients with type 1 diabetes mellitus (T1DM), probably due to low portal insulin concentrations. We aimed to investigate whether the route of insulin administration, continuous intraperitoneal insulin infusion (CIPII), or subcutaneous (SC), influences SHBG concentrations among T1DM patients. Methods Post hoc analysis of SHBG in samples derived from a randomized, open-labeled crossover trial was carried out in 20 T1DM patients: 50% males, mean age 43 (±13) years, diabetes duration 23 (±11) years, and hemoglobin A1c (HbA1c) 8.7 (±1.1) (72 (±12) mmol/mol). As secondary outcomes, testosterone, 17-β-estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were analyzed. Results Estimated mean change in SHBG was −10.3nmol/L (95% CI: −17.4, −3.2) during CIPII and 3.7nmol/L (95% CI: −12.0, 4.6) during SC insulin treatment. Taking the effect of treatment order into account, the difference in SHBG between therapies was −6.6nmol/L (95% CI: −17.5, 4.3); −12.7nmol/L (95% CI: −25.1, −0.4) for males and −1.7nmol/L (95% CI: −24.6, 21.1) for females, respectively. Among males, SHBG and testosterone concentrations changed significantly during CIPII; −15.8nmol/L (95% CI: −24.2, −7.5) and −8.3nmol/L (95% CI: −14.4, −2.2), respectively. The difference between CIPII and SC insulin treatment was also significant for change in FSH 1.2U/L (95% CI: 0.1, 2.2) among males. Conclusions SHBG concentrations decreased significantly during CIPII treatment. Moreover, the difference in change between CIPII and SC insulin therapy was significant for SHBG and FSH among males. These findings support the hypothesis that portal insulin administration influences circulating SHBG and sex steroids.

Evidence-based insulin treatment in type 1 diabetes mellitus

2009 ◽  
Vol 86 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Iben Brock Jacobsen ◽  
J.E. Henriksen ◽  
O. Hother-Nielsen ◽  
W. Vach ◽  
H. Beck-Nielsen
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Insulin Treatment ◽  
Evidence Based

Growth Trajectory in Children with Type 1 Diabetes Mellitus: The Impact of Insulin Treatment and Metabolic Control

2018 ◽  
Vol 89 (3) ◽  
pp. 172-177 ◽  
Author(s):  
Carla Bizzarri ◽  
Tiziana Antonia Timpanaro ◽  
Maria Cristina Matteoli ◽  
Ippolita Patrizia Patera ◽  
Marco Cappa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Adult Height ◽  
Insulin Treatment ◽  
Final Height ◽  
Hdl Cholesterol ◽  
Target Height ◽  
Puberty Onset

Background: Linear growth was reported to be negatively affected by type 1 diabetes mellitus (T1DM), in relation to disease duration and poor metabolic control. It is unclear whether a subtle growth failure still persists despite the optimization of therapy. Our aim was to analyse pubertal growth, adult height, and metabolic profile in a cohort of children with T1DM undergoing intensive insulin treatment by multiple daily injections or continuous subcutaneous insulin infusion (CSII). Methods: One-hundred and four children (51 males) with prepubertal onset of T1DM were prospectively followed up to final height attainment. Results: Age at puberty onset was 11.7 ± 1.1 years in males and 10.9 ± 1.3 in females. Age at adult height attainment was 16.4 ± 1.6 years in males and 14.1 ± 1.8 years in females. Pubertal height gain was 24.4 ± 4.9 cm in males and 19.0 ± 3.8 cm in females. HbA1c, HDL cholesterol, and triglyceride levels increased during puberty. HDL cholesterol levels were higher in patients treated with CSII. Height standard deviation score (SDS) at diagnosis (0.52 ± 1.04) was higher than target height SDS (0.01 ± 1.07), but declined afterwards, and both height SDS at puberty onset (0.22 ± 1.1) and adult height SDS (–0.1 ± 1.02) were not significantly different from target height SDS. BMI SDS showed a positive trend from diagnosis to puberty onset and stabilized later (–0.04 ± 1.4 at T1DM onset, 0.55 ± 2.1 at puberty onset, and 0.53 ± 2.1 at adult height attainment). Conclusions: Although subtle abnormalities of growth still persist, the modern advancements of insulin therapy are able to normalize puberty and final height of children with T1DM.

scholarly journals Glycemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Thomas Ngwiri ◽  
Fred Were ◽  
Barbara Predieri ◽  
Paul Ngugi ◽  
Lorenzo Iughetti
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Children And Adolescents ◽  
Clinical History ◽  
Sub Saharan Africa ◽  
Poor Control ◽  
Few Data

Background. Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder in children and adolescents worldwide. While data about prevalence, treatment, and complications are recorded in many countries, few data exist for Sub-Saharan Africa. The aim of this study was to determine the degree of control in patients with T1DM aged 1–19 years over a 6-month period in 3 outpatient Kenyan clinics. It also sought to determine how control was influenced by parameters of patient and treatment.Methods. Eighty-two children and adolescents with T1DM were included in the study. Clinical history regarding duration of illness, type and dose of insulin, and recent symptoms of hypoglycemia/hyperglycemia were recorded. Glycaemia, HbA1c, and ketonuria were tested. HbA1c of 8.0% and below was defined as the cut-off for acceptable control.Results. The median HbA1c for the study population was 11.1% (range: 6.3–18.8). Overall, only 28% of patients had reasonable glycemic control as defined in this study. 72% therefore had poor control. It was also found that age above 12 years was significantly associated with poor control.Conclusions. African children and with T1DM are poorly controlled particularly in adolescents. Our data strongly support the necessity of Kenya children to receive more aggressive management and follow-up.

Use of glycosylated hemoglobin and C-peptide levels in the diagnosis and prevention of type 1 diabetes mellitus as an immune-related adverse event secondary to treatment with immunotherapy in solid tumors.

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 97-97
Author(s):  
Alejandro J. Olivares Hernández ◽  
Roberto Andrés Escala Cornejo ◽  
Luis Figuero Pérez ◽  
Rosario Vidal ◽  
Elena Escalera Martín ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Adverse Event ◽  
Type 1 Diabetes Mellitus ◽  
Solid Tumors ◽  
Glycosylated Hemoglobin ◽  
C Peptide ◽  
Related Adverse Event ◽  
Sugar Levels

97 Background: Type 1 diabetes mellitus (T1D) as an immune-related adverse event (irAE) is found in 0.5-5% of all patients treated with immunotherapy (IT) and it is associated with life-threatening complications. However, there are no official guidelines that suggest methods for the prevention and monitoring of T1D during treatment with IT. The algorithms described in the literature only assess the fasting blood sugar levels for prevention and monitoring. The objective of this review is to find factors that establish a relationship with the appearance of T1D as an irAE and to put forward a new algorithm for prevention and monitoring based on those findings. Methods: We carried out a clinical review of the cases published in the literature on T1D secondary to IT between 2012 and 2019. Through a statistical analysis, the relevant clinical characteristics will be determined, together with the factors related to the appearance of T1D, which will make it possible to put forward a new algorithm for the prevention and monitoring of T1D during treatment with IT for solid tumors. Results: Eighty one cases were reported. Of the reported cases, 90% were associated with Nivolumab or Pembrolizumab. The median age was 67 years (23-84 years), and the patients were predominantly men. The average number of administered doses was 5.3 with a lapse of 14.6 weeks from the administration of the first dose until diagnosis. In 48 cases (59%) the levels of C-peptide were low or undetectable, and the glycosylated hemoglobin (HbA1c) levels were elevated by an average of 8.8% (73 mmol/mol). Anti-β-cell antibodies were found in less than half of the patients (44). Diabetic ketoacidosis was observed at diagnosis in 61 patients (75%). Conclusions: Based on the results of our review, we propose including the levels of C-peptide and HbA1C in the usual protocol for the management of adverse events related to IT. Our algorithm suggests that the levels must be determined prior to the IT, after the first 2 cycles, and then every 2 months. This algorithm will enable the prevention, early diagnosis and monitoring of T1D during treatment with IT.

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