scholarly journals Acute diabetic neuropathy following improved glycaemic control: a case series and review

2020 ◽  
Vol 2020 ◽  
Author(s):  
N Siddique ◽  
R Durcan ◽  
S Smyth ◽  
T Kyaw Tun ◽  
S Sreenan ◽  
...  
Keyword(s):  
Glycaemic Control ◽  
Diabetic Neuropathy ◽  
Early Recognition ◽  
Sglt2 Inhibitor ◽  
Case Series ◽  
List Type ◽  
Lower Limb Pain ◽  
Acute Neuropathy ◽  
Patients With Diabetes ◽  
Over Time

Summary We present three cases of acute diabetic neuropathy and highlight a potentially underappreciated link between tightening of glycaemic control and acute neuropathies in patients with diabetes. Case 1: A 56-year-old male with poorly controlled type 2 diabetes (T2DM) was commenced on basal-bolus insulin. He presented 6 weeks later with a diffuse painful sensory neuropathy and postural hypotension. He was diagnosed with treatment-induced neuropathy (TIN, insulin neuritis) and obtained symptomatic relief from pregabalin. Case 2: A 67-year-old male with T2DM and chronic hyperglycaemia presented with left lower limb pain, weakness and weight loss shortly after achieving target glycaemia with oral anti-hyperglycaemics. Neurological examination and neuro-electrophysiological studies suggested diabetic lumbosacral radiculo-plexus neuropathy (DLPRN, diabetic amyotrophy). Pain and weakness resolved over time. Case 3: A 58-year-old male was admitted with blurred vision diplopia and complete ptosis of the right eye, with intact pupillary reflexes, shortly after intensification of glucose-lowering treatment with an SGLT2 inhibitor as adjunct to metformin. He was diagnosed with a pupil-sparing third nerve palsy secondary to diabetic mononeuritis which improved over time. While all three acute neuropathies have been previously well described, all are rare and require a high index of clinical suspicion as they are essentially a diagnosis of exclusion. Interestingly, all three of our cases are linked by the development of acute neuropathy following a significant improvement in glycaemic control. This phenomenon is well described in TIN, but not previously highlighted in other acute neuropathies. Learning points: A link between acute tightening of glycaemic control and acute neuropathies has not been well described in literature. Clinicians caring for patients with diabetes who develop otherwise unexplained neurologic symptoms following a tightening of glycaemic control should consider the possibility of an acute diabetic neuropathy. Early recognition of these neuropathies can obviate the need for detailed and expensive investigations and allow for early institution of appropriate pain-relieving medications.

scholarly journals Spurious HbA1c results in patients with diabetes treated with dapsone

2019 ◽  
Vol 2019 ◽  
Author(s):  
Khaled Aljenaee ◽  
Osamah Hakami ◽  
Colin Davenport ◽  
Gemma Farrell ◽  
Tommy Kyaw Tun ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Case Series ◽  
Glycated Haemoglobin ◽  
Glucose Measurement ◽  
List Type ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Capillary Glucose ◽  
Hba1c Levels

Summary Measurement of glycated haemoglobin (HbA1c) has been utilised in assessing long-term control of blood glucose in patients with diabetes, as well as diagnosing diabetes and identifying patients at increased risk of developing diabetes in the future. HbA1c reflects the level of blood glucose to which the erythrocyte has been exposed during its lifespan, and there are a number of clinical situations affecting the erythrocyte life span in which HbA1c values may be spuriously high or low and therefore not reflective of the true level of glucose control. In the present case series, we describe the particulars of three patients with diabetes who had spuriously low HbA1c levels as a result of dapsone usage. Furthermore, we discuss the limitations of HbA1c testing and the mechanisms by which it may be affected by dapsone in particular. Learning points: Various conditions and medications can result in falsely low HbA1c. Dapsone can lead to falsely low HbA1c by inducing haemolysis and by forming methaemoglobin. Capillary glucose measurement, urine glucose measurements and fructosamine levels should be used as alternatives to HbA1c for monitoring glycaemic control if it was falsely low or high.

Acute hyperglycaemia after COVID-19 vaccination in patients with stable diabetes: A Case Series (Preprint)

2021 ◽  
Author(s):  
Rahila Bhatti ◽  
Sara Adhami ◽  
Amar Khamis ◽  
Glenn Matfin
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Ambulatory Care ◽  
Care Setting ◽  
Fasting Blood Glucose ◽  
Case Series ◽  
Ambulatory Care Setting ◽  
Post Vaccination ◽  
Patients With Diabetes ◽  
History Of

BACKGROUND The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date 267,258 cases have been reported in the United Arab Emirates (UAE) with 766 deaths. In United States of America, the Centers for Disease Control and Prevention (CDC) has categorized diabetes in terms of ‘increased risk of severe illness’, if infected with COVID-19. With availability of COVID-19 vaccinations worldwide, patients with diabetes are usually in the highest priority group to be vaccinated.5 Currently 2 vaccines are available in the UAE. These are the Pfizer-BioNTech and Sinopharm vaccines. The Pfizer-BioNTech ribonucleic acid (RNA) vaccine is composed of nucleoside-modified messenger RNA (modRNA) encoding a mutated form of the spike protein of SARS-CoV-2, which is encapsulated in lipid nanoparticles. It is administered by two injections at least 21 days apart. In contrast, Sinopharm is a chemically inactivated whole virus vaccine. It is also given by two injections administered at least 21-28 days apart. OBJECTIVE To describe 2 cases of patients with diabetes with stable glycaemic control who developed hyperglycaemia post COVID-19 vaccination METHODS Case presentation of 2 patients with diabetes who were seen in ambulatory setting in terms of their blood sugars in a private hospital in Dubai. RESULTS Case 1: A 51-year-old Asian male with a history of type 2 diabetes was reviewed in the ambulatory care setting following COVID-19 vaccination. His recent glycaemic control was good with glycosylated haemoglobin (HbA1c) 3 months prior being 7.5%. His usual glucose lowering therapy was xultophy injection (fixed-ratio combination of insulin degludec and liraglutide) 14 units at night, in addition to oral metformin 1000 mg twice daily. He had a history of ischaemic heart disease which was stable on therapy. He took his first dose of Pfizer-BioNTech vaccine on 30th December 2020. His fasting blood glucose values before vaccination was 105 mg/dl and after taking 1st dose of vaccination was 185 mg/dl. Case 2: A 30-year-old female known to have type 1 diabetes was reviewed in the ambulatory care setting following COVID-19 vaccination. She is on continuous subcutaneous insulin infusion (CSII). Her HbA1c within last 3 months was 8.3%. She received Sinopharm vaccination on 18th January 2021. Her continuous glucose monitoring (CGM) data shows fasting blood glucose of 121 mg/dl day before vaccination. On the day of vaccination her fasting blood glucose was 233 mg/dl as her overnight blood sugars were high. Her fasting blood glucose increased to 216 mg/dl and stayed high throughout the day 1 post vaccination. On day 2 post vaccination it came down to 181 mg/dl and on day 3 it settled down to 127 mg/dl. CONCLUSIONS The purpose of this case series is to alert healthcare professionals regarding potential transient hyperglycaemia post-COVID-19 vaccination. The vaccination should be recommended for people with diabetes as benefits far outweighs the risk. However, patients should be educated in advance to keep a close eye on their blood glucose levels post vaccination and regarding sick-day rules. As ADA 2021 recommendations were developed before COVID-19 vaccines were widely available, no detailed information regarding COVID-19 vaccination is captured. 7

scholarly journals The use of SGLT2 inhibitors in achieving glycaemic control in maturity-onset diabetes of the young type 3

2021 ◽  
Vol 2021 ◽  
Author(s):  
Arunan Sriravindrarajah ◽  
Amelia Fernandes ◽  
Ted Wu ◽  
Samantha Hocking
Keyword(s):  
Glycaemic Control ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
List Type ◽  
Maturity Onset Diabetes ◽  
Rapid Improvement ◽  
Onset Diabetes ◽  
Type 3

Summary Maturity-onset diabetes of the young type 3 (MODY3) accounts for approximately 50% of cases of MODY. First-line treatment with sulfonylureas has been well established for individuals with MODY3. In contrast, the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors in the treatment of individuals with MODY3 remains unclear. This case illustrates the in vivo effect of an SGLT2 inhibitor in a 30-year-old woman with MODY3 with poor glycaemic control despite the treatment with supramaximal doses of sulfonylurea and metformin. The addition of a SGLT2 inhibitor resulted in a rapid improvement in glycaemic control without any hypoglycaemic episodes. This case suggests that SGLT2 inhibitors may be an effective and potent treatment option in addition to sulfonylureas for individuals with MODY3. Learning points Maturity-onset diabetes of the young type 3 (MODY3) arises from mutations in the hepatocyte nuclear factor-1alpha gene, which controls the expression of sodium-glucose co-transporter 2 (SGLT2) in the kidneys. Paradoxically, despite individuals with MODY3 having reduced expression of SGLT2, SGLT2 inhibitors induce higher glycosuria in individuals with MODY3 compared to individuals with type 2 diabetes mellitus. SGLT2 inhibitors may be an effective treatment for achieving glycaemic control in individuals with MODY3.

547-P: Associations between Bladder Symptoms and Diabetic Neuropathy in a Romanian Cohort of Patients with Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 547-P
Author(s):  
CAMELIA L. VONICA ◽  
COSMINA I. BONDOR ◽  
DIANA SIMA ◽  
DANIEL T. COSMA ◽  
IOAN ANDREI VERESIU ◽  
...  
Keyword(s):  
Diabetic Neuropathy ◽  
Patients With Diabetes ◽  
Bladder Symptoms

scholarly journals Morquio A syndrome and effect of enzyme replacement therapy in different age groups of Turkish patients: a case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sebile Kılavuz ◽  
Sibel Basaran ◽  
Deniz Kor ◽  
Fatma Derya Bulut ◽  
Sevcan Erdem ◽  
...  
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Clinical Data ◽  
Treatment Initiation ◽  
Case Series ◽  
Enzyme Replacement ◽  
Morquio A ◽  
Over Time ◽  
Morquio A Syndrome

Abstract Background This case series includes longitudinal clinical data of ten patients with Morquio A syndrome from south and southeastern parts of Turkey, which were retrospectively collected from medical records. All patients received enzyme replacement therapy (ERT). Clinical data collected included physical appearance, anthropometric data, neurological and psychological examinations, cardiovascular evaluation, pulmonary function tests, eye and ear-nose-throat examinations, endurance in the 6-min walk test and/or 3-min stair climb test, joint range of motion, and skeletal investigations (X-rays, bone mineral density). Results At the time of ERT initiation, two patients were infants (1.8 and 2.1 years), five were children (3.4–7.1 years), and three were adults (16.5–39.5 years). Patients had up to 4 years follow-up. Most patients had classical Morquio A, based on genotypic and phenotypic data. Endurance was considerably reduced in all patients, but remained relatively stable or increased over time in most cases after treatment initiation. Length/height fell below normal growth curves, except in the two infants who started ERT at ≤ 2.1 years of age. All patients had skeletal and/or joint abnormalities when ERT was started. Follow-up data did not suggest improvements in skeletal abnormalities, except in one of the younger infants. Nine patients had corneal clouding, which resolved after treatment initiation in the two infants, but not in the other patients. Hepatomegaly was reported in seven patients and resolved with treatment in five of them. Other frequent findings at treatment initiation were coarse facial features (N = 9), hearing loss (N = 6), and cardiac abnormalities (N = 6). Cardiac disease deteriorated over time in three patients, but did not progress in the others. Conclusions Overall, this case series with Morquio A patients confirms clinical trial data showing long-term stabilization of endurance after treatment initiation across ages and suggest that very early initiation of ERT optimizes growth outcomes.

scholarly journals Cyber operational risk scenarios for insurance companies

2019 ◽  
Vol 24 ◽  
Author(s):  
R. Egan ◽  
S. Cartagena ◽  
R. Mohamed ◽  
V. Gosrani ◽  
J. Grewal ◽  
...  
Keyword(s):  
Cyber Security ◽  
Operational Risk ◽  
Social Engineering ◽  
Insurance Companies ◽  
List Type ◽  
Operational Risks ◽  
Life Insurer ◽  
Cyber Risk ◽  
The Impact ◽  
Over Time

AbstractCyber Operational Risk: Cyber risk is routinely cited as one of the most important sources of operational risks facing organisations today, in various publications and surveys. Further, in recent years, cyber risk has entered the public conscience through highly publicised events involving affected UK organisations such as TalkTalk, Morrisons and the NHS. Regulators and legislators are increasing their focus on this topic, with General Data Protection Regulation (“GDPR”) a notable example of this. Risk actuaries and other risk management professionals at insurance companies therefore need to have a robust assessment of the potential losses stemming from cyber risk that their organisations may face. They should be able to do this as part of an overall risk management framework and be able to demonstrate this to stakeholders such as regulators and shareholders. Given that cyber risks are still very much new territory for insurers and there is no commonly accepted practice, this paper describes a proposed framework in which to perform such an assessment. As part of this, we leverage two existing frameworks – the Chief Risk Officer (“CRO”) Forum cyber incident taxonomy, and the National Institute of Standards and Technology (“NIST”) framework – to describe the taxonomy of a cyber incident, and the relevant cyber security and risk mitigation items for the incident in question, respectively.Summary of Results: Three detailed scenarios have been investigated by the working party:∙Employee leaks data at a general (non-life) insurer: Internal attack through social engineering, causing large compensation costs and regulatory fines, driving a 1 in 200 loss of £210.5m (c. 2% of annual revenue).∙Cyber extortion at a life insurer: External attack through social engineering, causing large business interruption and reputational damage, driving a 1 in 200 loss of £179.5m (c. 6% of annual revenue).∙Motor insurer telematics device hack: External attack through software vulnerabilities, causing large remediation / device replacement costs, driving a 1 in 200 loss of £70.0m (c. 18% of annual revenue).Limitations: The following sets out key limitations of the work set out in this paper:∙While the presented scenarios are deemed material at this point in time, the threat landscape moves fast and could render specific narratives and calibrations obsolete within a short-time frame.∙There is a lack of historical data to base certain scenarios on and therefore a high level of subjectivity is used to calibrate them.∙No attempt has been made to make an allowance for seasonality of renewals (a cyber event coinciding with peak renewal season could exacerbate cost impacts)∙No consideration has been given to the impact of the event on the share price of the company.∙Correlation with other risk types has not been explicitly considered.Conclusions: Cyber risk is a very real threat and should not be ignored or treated lightly in operational risk frameworks, as it has the potential to threaten the ongoing viability of an organisation. Risk managers and capital actuaries should be aware of the various sources of cyber risk and the potential impacts to ensure that the business is sufficiently prepared for such an event. When it comes to quantifying the impact of cyber risk on the operations of an insurer there are significant challenges. Not least that the threat landscape is ever changing and there is a lack of historical experience to base assumptions off. Given this uncertainty, this paper sets out a framework upon which readers can bring consistency to the way scenarios are developed over time. It provides a common taxonomy to ensure that key aspects of cyber risk are considered and sets out examples of how to implement the framework. It is critical that insurers endeavour to understand cyber risk better and look to refine assumptions over time as new information is received. In addition to ensuring that sufficient capital is being held for key operational risks, the investment in understanding cyber risk now will help to educate senior management and could have benefits through influencing internal cyber security capabilities.

CASE SERIES: A SPECTRUM OF FUNGAL INFECTIONS IN COVID-19

2021 ◽  
pp. 29-30
Author(s):  
Venkatesh B. C. ◽  
Rajendra Rao K. M. ◽  
K. N. Mohan Rao
Keyword(s):  
Diabetes Mellitus ◽  
Fungal Infections ◽  
Virus Disease ◽  
Case Series ◽  
Health Crisis ◽  
Major Health ◽  
Corona Virus ◽  
Patients With Diabetes ◽  
Causative Agents

Corona virus Disease 2019 (COVID-19) pandemic is causing a major health crisis across the globe. With the increasing number of fungal infections associated with COVID-19 being reported, it is imperative to understand the spectrum of such infections. Most documented cases have been reported in patients with diabetes mellitus or treatment with immunomodulators. The most common causative agents are Aspergillus, Candida or Mucorales. This series aims to portray the spectrum of fungal infections associated with COVID-19.

Caecal volvulus: untwisting the mystery

2021 ◽  
Vol 14 (3) ◽  
pp. e237165
Author(s):  
Martha Sara Kedrzycki ◽  
Jaya Roy Choudhury ◽  
Sherif Hakky
Keyword(s):  
Differential Diagnosis ◽  
Small Bowel ◽  
Closed Loop ◽  
Early Recognition ◽  
Case Series ◽  
University Hospital ◽  
Single Centre ◽  
Bowel Ischaemia ◽  
Prompt Treatment ◽  
Mobile Cecum

Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop obstruction, small bowel ischaemia and perforation. Early recognition and prompt treatment is key; however, due to the rarity of this pathology, it is seldom listed as a differential diagnosis. Here, we present a single-centre case series of two patients presenting with caecal volvulus to an Emergency Surgery Unit at a University Hospital.

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