The Centenary Celebrations-Insulin and Diabetes.

Most people will know the word diabetes. Few people will not know it has something to do with sugar. Diabetes mellitus is the complete name for the condition, mellitus meaning sweet or honey taste found in the urine. Not to be confused with Diabetes insipidus, a condition of the pituitary gland, the kidney or the Psyche where water cannot be retained by the body and very severe thirst and huge polyuria (passing a huge amount of urine occurs). The condition Diabetes mellitus was known in Egyptian times and in recent times has become so much more prevalent. Alas most people will have a relation with the condition and will be aware that complications can occur such as blindness. Even today with all our new medications and all our new knowledge, still diabetes shortens life span by 10 or so years but this figure is rapidly getting less due to earlier diagnosis and better treatment for high blood sugar, cholesterol and high blood pressure. To go back more than 100 years obese patients who developed diabetes could cure the symptoms which include thirst, passing a lot of urine, tiredness and genital itch by weight reduction and exercise. The reason for this improvement is now known in much more detail than it was then. The hormone insulin which is secreted by the islet cells in the pancreas lowers blood sugar. A deficiency of insulin leads to a rising blood sugar and the high blood sugars are the cause of the thirst. The high blood sugar is no longer able to be contained by the kidney and is secreted in the urine. The high concentration of sugar in the urine pulls out sugar by osmosis, drags with it, water, so the higher the glucose in the blood and urine the more water is pulled through the kidneys which are filters. The increased amount of water thus lost, results in frequency of passing water which is now full of glucose. The loss of water is recognised by the thirst mechanism which gets switched on and being very thirsty the patient with diabetes starts to drink and drink to make up for the loss of water in the urine. Sometimes the patient who might have been keen on lemonade or other sweet drinks just drinks more and more not realising that the drinks are heavily laden with sugar. This results in increasing the blood sugar even higher and even more thirst until the whole system collapses. The patient becomes unconscious very dehydrated and will die unless given intravenous fluids and then insulin. One such lady was a patient of mine. The African lady was so complicated that after she recovered we wrote up her case in one of the medical journals to inform others of the problems we faced and the treatments we gave which resulted in her recovery. Hyperosmolar coma is the name of the condition and thankfully rare. I can of course remember other patients who we were not successful in saving but they are too painful to relate.

Hospitalization for Short-Term Diabetes-Related Complications: Focus on Patients Aged over 85 Years

(1) Background: The prevalence of diabetes in elderly people is frequently high. When occurring in the elderly, diabetes is often accompanied by complications and comorbidities, at least one in 60% and four or more in 40% of older people with diabetes. As far as short-term complications among the elderly are concerned, hypoglycemia and hyperglycemic crises prove to be frequent. The aim of this study was to investigate the difference in hospitalization for short-term diabetes complications in patients below and over 85 years of age. (2) Methods: Data were collected from hospital discharge records (HDRs) of all hospital admissions that occurred in Abruzzo Region, Italy, from 2006 to 2015. Only diabetic patients aged over 65 years were included. Outcomes included were diabetic ketoacidosis, hyperosmolar coma, hypoglycemic shock, iatrogenic hypoglycemic coma, and other diabetic comas. (3) Results: During the study period, 144,376 admissions were collected, 116,305 (80.56%) of which referred to patients below 85 years. Those aged over 85 years were significantly associated to all short-term diabetes-related complications with the exception of ketoacidosis. (4) Conclusions: In older diabetic patients, the avoidance of short-term diabetes complications are a greater concern than in younger patients. Diabetes management among very elderly patients should be tailored accordingly to patient characteristics.

Renal Dysplasia and Precocious Diabetes Onset in Microcephalic Osteodysplastic Primordial Dwarfism Type II Syndrome: A Case Report

Microcephalic osteodysplastic primordial dwarfism type II (MOPDII) is a genetic syndrome. Its main characteristics are bony dysplasia, prenatal and postnatal growth deficiencies, microcephaly, and cerebrovascular disease. Several other features have been added recently. We report an individual with MOPDII affected by congenital renal dysplasia and hyperosmolar coma diabetic onset. Renal dysplasia has not been previously described in individuals with MOPDII. By publishing cases of unusual genetic disorders, it will be possible to broaden the spectrum of these rare syndromes, and improve the diagnosis and management of comorbidities.

Diazoxide toxicity in a child with persistent hyperinsulinemic hypoglycemia of infancy: mixed hyperglycemic hyperosmolar coma and ketoacidosis

Background: Persistent hyperinsulinemic hypoglycemia of infancy (PHHI), also known as congenital hyperinsulinism, has been known to go into spontaneous remission, with patients developing diabetes in later life. A temporary phase of hyperglycemia is, however, rarely reported. Case presentation: We describe a 16-month-old child, a known case of diazoxide responsive PHHI, presenting with mixed hyperglycemic hyperosmolar coma and ketoacidosis with rhabdomyolysis while on diazoxide treatment. The patient required temporary cessation of diazoxide and initiation of insulin infusion, followed by a relapse of hypoglycemia again necessitating diazoxide therapy. Conclusions: Hyperosmolar coma with ketoacidosis is a rare side-effect of diazoxide therapy, documented even in patients with persistent hyperinsulinemic hypoglycemia of infancy.

Central Nervous System Manifestations in Diabetes Mellitus - A Review

The impact of diabetes mellitus on the CNS (Central Nervous System) has gained attention only recently. Peripheral neuropathy has been the primary neuroscience focus of diabetes research. Contrary to some early impressions, however, the CNS is not spared by diabetes. Chronically, diabetes mellitus affects the CNS in several ways. Diabetes increases stroke risk and damage, overtreatment with insulin or oral agents can permanently damage the brain, and diabetes may increase the prevalence of seizure disorders. Diabetes changes brain transport, blood flow and metabolism, and may produce a chronic encephalopathy. Acutely, glycemic extremes cause coma, seizures, focal neurolclgical deficits, and impaired consciousness. The pathophysiological basis for these marked CNS abnormalities seen in hypoglycemia, hyperosmolar coma, and ketoacidosis are largely unknown.Methods: This review was based on a search of Pubmed, the NCBI Database of systemic Reviews, and citation lists of relevant publications. Subject heading and key words used central nervous system, diabetes mellitus, stroke, encephalopathy and hypoglycaemia. Only articles in English were included.J MEDICINE July 2017; 18 (2) : 109-112