scholarly journals Rabson-Mendenhall syndrome: a rare case of severe insulin resistance

2021 ◽  
Vol 12 (1) ◽  
pp. 83-87
Author(s):  
Farhana Afrooz ◽  
Faria Afsana ◽  
Mohammod Feroz Amin ◽  
Sadia Jabeen Mustafaa ◽  
Rushda Sharmin Binte Rouf ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Blood Glucose ◽  
Insulin Infusion ◽  
Glycosylated Hemoglobin ◽  
Insulin Dosage ◽  
High Dose ◽  
Intravenous Fluids ◽  
Skin Changes ◽  
Severe Insulin Resistance

Insulin resistance syndromes are a heterogeneous group of disorders with variable clinical phenotypes, associated with increased blood glucose and insulin levels. A 20-year-old female, diabetic for 12 years, reported with hyperglycemia not responding to high dose of insulin; therefore, insulin dosage was increased but did not lead to appropriate glycemic control. Investigations revealed hyperglycemia (random blood glucose 23 mmol/L) glycosylated hemoglobin (HbA1c) 9.2%. Ultrasonogram of the abdomen showed prominent ovaries with fatty liver. Echocardiography revealed mild mitral, pulmonary and tricuspid regurgitation and pulmonary hypertension. Based on the clinical features, skin changes and the onset of type 2 diabetes mellitus, Rabson-Mendenhall syndrome (RMS) was considered. In last admission, she was admitted for hyperglycemic control and treated with intravenous fluids, insulin infusion, metformin, pioglitazone, linagliptin, hydroxychloroquine, sulphonylurea, antibiotics. There is no complete cure for the condition and the current treatments are difficult and not very promising. BIRDEM Med J 2022; 12(1): 83-87

scholarly journals The Initial Assessment of Daily Insulin Dose in Chinese Newly Diagnosed Type 2 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Jing Ma ◽  
Huan Zhou ◽  
Hua Xu ◽  
Xie Chen ◽  
Xiangyu Teng ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glucose Level ◽  
Insulin Infusion ◽  
Insulin Dose ◽  
Newly Diagnosed ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
New Onset

Background. It has been well accepted that insulin therapy is the ideal treatment for newly diagnosed diabetic patients. However, there was no study about assessment of the initial insulin dosage in new onset Chinese patients with type 2 diabetes.Research Design and Methods. 65 newly diagnosed patients with type 2 diabetes (39 males/26 females; HbA1c ≥ 11.80 ± 0.22%) were investigated. All patients had random hyperglycaemia (at 21.8 ± 3.9 mmol/L) on the first day of admission and received insulin infusion intravenously (5 U/per hour). When the blood glucose level dropped to around 10 mmol/L, patients were then transferred to continuous subcutaneous insulin infusion (CSII). The reduction of blood glucose levels in response to per unit of insulin (RBG/RI) was recorded. The target glucose level was achieved in about 3 days. The total daily insulin dose (TDD) and basal insulin dose (TBD) were calculated.Results. TDD was 45.97 ± 1.28 units and TBD was 19.00 ± 0.54 units. TBD was about 40% of the total daily insulin requirement. There was a negative correlation between the ratio of RBG/RI and TDD.Conclusions. TDD was correlated with blood glucose reduction in response to intravenous insulin infusion in Chinese new onset patients with type 2 diabetes.

scholarly journals A Male with Extreme Subcutaneous Insulin Resistance: A Case Report

2016 ◽  
Vol 23 (2) ◽  
pp. 209-213 ◽  
Author(s):  
Zuhayer Ahmed ◽  
Indrajit Prasad ◽  
Hafizur Rahman ◽  
Jalil Ansari ◽  
Khaled Hassan
Keyword(s):  
Insulin Resistance ◽  
Blood Glucose ◽  
Underdeveloped Country ◽  
Hypoglycemic Agents ◽  
High Dose ◽  
Subcutaneous Insulin ◽  
Oral Hypoglycemic Agents ◽  
Glucose Levels ◽  
Medical Issues ◽  
Insulin Autoantibody

AbstractIntroduction: Though insulin has no upper limit in dosage, we do not encounter very high dose requirements too often. The reported case is the first in Bangladesh to require more than 1000 international units (IU) of subcutaneous insulin per day.Case presentation: A 44-year old male diabetic patient from Bangladesh presented with unusually uncontrolled diabetes mellitus due to extreme insulin resistance. Despite dramatic increase in insulin step by step up to 1110 IU of concomitant short and intermediate acting insulin per day by subcutaneous route, his blood glucose remained over 12 mmol/L persistently, in all the fasting, pre-prandial, postprandial and random samples. He was also treated with several oral hypoglycemic agents including metformin, vildagliptin, glimepiride, pioglitazone and miglitol along with insulin but blood glucose levels remained almost unchanged. However, intravenous infusion of insulin over 4 hours caused a plummet in the glucose level. His blood test for insulin autoantibody was negative.Conclusion: This paper provides a scope to review literatures on extreme subcutaneous insulin resistance and its management. It also reveals the limitations of management due to lack of facilities in an underdeveloped country, which hinders proper exploration to many medical issues.

Improvement in glycaemic parameters using SGLT-2 inhibitor and GLP-1 agonist in combination in an adolescent with diabetes mellitus and Prader-Willi syndrome: a case report

2020 ◽  
Vol 33 (7) ◽  
pp. 951-955 ◽  
Author(s):  
Toby Candler ◽  
David McGregor ◽  
Kruthika Narayan ◽  
Chris Moudiotis ◽  
Christine P. Burren
Keyword(s):  
Insulin Resistance ◽  
Blood Glucose ◽  
Treatment Options ◽  
Prader Willi Syndrome ◽  
Feeding Difficulties ◽  
Glucose Levels ◽  
Insulin Requirements ◽  
Bolus Insulin ◽  
Basal Bolus

AbstractObjectivesPrader-Willi Syndrome (PWS) is characterised by hyperphagia often leading to obesity; a known risk factor for insulin resistance and type 2 (T2) diabetes. We present a prepubertal girl with PWS who developed diabetes.Case presentationOur case was diagnosed with PWS in infancy following investigation for profound central hypotonia and feeding difficulties. She commenced growth hormone (GH) aged 8 years for short stature and treatment improved linear growth. At age 12 years, she presented with polydipsia, polyuria and vulvovaginitis. She was overweight (BMI SDS +1.43). Diabetes was diagnosed (Blood glucose = 24.2 mmol/L, HbA1c = 121 mmol/mol or 13.2%). She was not acidotic and had negative blood ketones. Autoantibodies typical of type 1 diabetes were negative. She was initially treated with basal bolus insulin regime. GH was discontinued 3 months later due to concerns regarding GH-induced insulin resistance. Off GH, insulin requirements reduced to zero, allowing Metformin monotherapy. However off GH, she reported significant lethargy with static growth and increased weight. Combinations of Metformin with differing insulin regimes did not improve glucose levels. Liraglutide (GLP-1 agonist) and Metformin did not improve glucose levels nor her weight. Liraglutide and Empaglifozin (SGLT-2 inhibitor) therapy used in combination were well tolerated and demonstrated rapid normalisation of blood glucose and improvement in her HbA1c to within target (48 mmol/mol) which was sustained after 6 months of treatment.ConclusionsNewer treatments for type 2 diabetes (e. g. GLP-1 agonists or SGLT-2 inhibitors) offer potential treatment options for those with diabetes and PWS when conventional treatments are ineffective.

Comparative analysis of different drug delivery methods of injectable hydrogel nanomaterials of insulin biomaterials via multiple daily injections and continuous subcutaneous insulin infusion in the treatment of type 1 diabetes mellitus in children

2021 ◽  
Vol 11 (7) ◽  
pp. 1154-1160
Author(s):  
Yan Sun ◽  
Haoshu Niu ◽  
Zhixia Wang ◽  
Ying Wang ◽  
Xuechun Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Drug Delivery ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Type 1 Diabetes Mellitus ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Insulin Dosage ◽  
Subcutaneous Insulin

The aim of this study was to investigate the difference between multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) in blood glucose control during the treatment of type 1 diabetes mellitus (T1DM) in children. under the nano-hydrogel delivery carrier. In order to improve the efficiency and therapeutic effect of the experiment, this paper adopts injectable nanomaterial-polymer composite hydrogel as drug delivery system to cooperate with insulin injection to improve the effective utilization of drugs. Eighty children diagnosed with T1DM by the department of Endocrinology, Genetics, and Metabolism of INNER MONGOLIA BAOGANG Hospital from October 2018 to December 2019 were selected as research subjects for this study. The children were randomly divided into MDI group (treated with MDI) and CSII group (treated with CSII), with 40 children in each group. The basic data of the children were compared, and changes in hemoglobin A1c (HbA1c) at admission and 1, 2, and 3 months after treatment were detected. During the detection, the blood glucose level, therapeutic time of blood glucose normalization, and daily insulin dosage were recorded. The HbA1c and fasting blood glucose (FBG) were followed up three months after discharge, and incidences of hypoglycemia in the two groups were observed. The results showed that the mean value of HbA1c in the MDI group was higher than that in the CSII group (P < 0.05). Each patient was assessed for the number of times their blood sugar was allowed to dip below normal levels; patients with less hypoglycemia had a higher rate of blood sugar control. The control rates of blood glucose in the MDI and CSII groups were 19.21% and 23.50%, respectively. The CSII group showed significantly higher blood glucose rates than the MDI group (P < 0.05). The therapeutic time of blood glucose normalization in the MDI group was significantly longer than that in the CSII group (P < 0.05). There was no significant difference in the average daily insulin dosage between the MDI and CSII groups (P > 0.05), which indicated that CSII therapy had significant advantages in reducing blood glucose in children with T1DM.

Abstract 015: Increased 20-HETE Levels Contribute to Impaired Glucose Metabolism and Type 2 Diabetes in Cyp4a14 Knockout Mice Fed on High Fat Diet.

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Varunkumar G Pandey ◽  
Lars Bellner ◽  
Victor Garcia ◽  
Joseph Schragenheim ◽  
Andrew Cohen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Weight Gain ◽  
Blood Glucose ◽  
High Fat Diet ◽  
Plasma Insulin ◽  
High Fat ◽  
Plasma Insulin Levels

20-HETE (20-Hydroxyeicosatetraenoic acid) is a cytochrome P450 ω-hydroxylase metabolite of arachidonic acid that promotes endothelial dysfunction, microvascular remodeling and hypertension. Previous studies have shown that urinary 20-HETE levels correlate with BMI and plasma insulin levels. However, there is no direct evidence for the role of 20-HETE in the regulation of glucose metabolism, obesity and type 2 diabetes mellitus. In this study we examined the effect of 20-SOLA (2,5,8,11,14,17-hexaoxanonadecan-19-yl-20-hydroxyeicosa-6(Z),15(Z)-dienoate), a water-soluble 20-HETE antagonist, on blood pressure, weight gain and blood glucose in Cyp4a14 knockout (Cyp4a14-/-) mice fed high-fat diet (HFD). The Cyp4a14-/- male mice exhibit high vascular 20-HETE levels and display 20-HETE-dependent hypertension. There was no difference in weight gain and fasting blood glucose between Cyp4a14-/- and wild type (WT) on regular chow. When subjected to HFD for 15 weeks, a significant increase in weight was observed in Cyp4a14-/- as compared to WT mice (56.5±3.45 vs. 30.2±0.7g, p<0.05). Administration of 20-SOLA (10mg/kg/day in drinking water) significantly attenuated the weight gain (28.7±1.47g, p<0.05) and normalized blood pressure in Cyp4a14-/- mice on HFD (116±0.3 vs. 172.7±4.6mmHg, p<0.05). HFD fed Cyp4a14-/- mice exhibited hyperglycemia as opposed to normal glucose levels in WT on a HFD (154±1.9 vs. 96.3±3.0 mg/dL, p<0.05). 20-SOLA prevented the HFD-induced hyperglycemia in Cyp4a14-/- mice (91±8mg/dL, p<0.05). Plasma insulin levels were markedly high in Cyp4a14-/- mice vs. WT on HFD (2.66±0.7 vs. 0.58±0.18ng/mL, p<0.05); corrected by the treatment with 20-SOLA (0.69±0.09 ng/mL, p<0.05). Importantly, glucose and insulin tolerance tests showed impaired glucose homeostasis and insulin resistance in Cyp4a14-/- mice on HFD; ameliorated by treatment with 20-SOLA. This novel finding that blockade of 20-HETE actions by 20-SOLA prevents HFD-induced obesity and restores glucose homeostasis in Cyp4a14-/- mice suggests that 20-HETE contributes to obesity, hyperglycemia and insulin resistance in HFD induced metabolic disorder. The molecular mechanisms underlying 20-HETE mediated metabolic dysfunction are being currently explored.

scholarly journals Comparison of Changes in Blood Glucose, Insulin Resistance Indices, and Adipokine Levels in Diabetic and Nondiabetic Subjects With Morbid Obesity After Laparoscopic Adjustable Gastric Banding

Medicina ◽  
2013 ◽  
Vol 49 (1) ◽  
pp. 2
Author(s):  
Vaidotas Urbanavičius ◽  
Tomas Abalikšta ◽  
Gintautas Brimas ◽  
Agnė Abraitienė ◽  
Laima Gogelienė ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Gastric Banding ◽  
Laparoscopic Adjustable Gastric Banding ◽  
Adjustable Gastric Banding ◽  
Morbidly Obese

Objective. The aim of the study was to evaluate blood glucose, insulin resistance indices, and adipokine (leptin and adiponectin) levels in morbidly obese individuals with and without type 2 diabetes mellitus and to compare the changes in these parameters 1 year after laparoscopic adjustable gastric banding surgery. Material and Methods. In total, 103 patients (37 subjects with and 66 subjects without type 2 diabetes mellitus) were studied preoperatively and again 1 year after laparoscopic adjustable gastric banding. Results. One year after laparoscopic adjustable gastric banding, the leptin concentrations decreased significantly in both treatment groups, while the adiponectin levels increased significantly in the nondiabetic patients (11.19 μg/mL [SD 7.20] vs. 15.58 μg/mL [SD 7.8], P=0.003) and tended to increase in the group of the patients with type 2 diabetes mellitus (8.98 μg/mL [SD 6.80] vs. 13.01 μg/mL [SD 12.14], P>0.05). A considerable decrease in the insulin resistance indices was noted in the patients with type 2 diabetes mellitus 1 year after the intervention, and it was followed by a partial or complete remission of type 2 diabetes mellitus in 23 (85.19%) of the 27 investigated diabetic patients. The postoperative insulin resistance indices in the patients with type 2 diabetes mellitus became similar to the values in the nondiabetic subjects. Conclusions. Weight loss after laparoscopic adjustable gastric banding is associated with a significant increase in adiponectin secretion in nondiabetic morbidly obese patients and with improvement in adiponectin secretion in type 2 diabetes individuals. In subjects with type 2 diabetes, this surgical intervention results in a significant reduction in blood glucose and insulin resistance.

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