Diabetes: Clinical Case Series-I Viswanathan Mohan, Ranjit Unnikrishnan
INDEX
ABCDEFGHIKLMNOPRSTUVW
Page numbers followed by f refer to figure and t refer to table.
A
Acanthosis nigricans syndrome 2
Acromegaly 2
Acute myocardial infarction 8
Adiponectin 4
Allodynia 172
Alström syndrome 2
Amphotericin B
in DM type 2, with mucormycosis 38
Angiotensin converting enzyme (ACE) inhibitors 155
in diabetes with albuminuria 150
side effects 155
Angiotensin-II receptor blockers (ARBs) 155
side effects 155
Anti-GAD antibody 27
Anti-insulin receptor (anti-IR) antibodies 6
ATP-sensitive potassium 50
B
β-cells 50
dysfunction 81
insulin production from 51f
progressive decline in function 94f
Bariatric surgery
in DM, type 2 with morbid obesity 15, 17
Barraquer–Simons syndrome See Lipodystrophy: acquired partial
Berardinelli–Seip syndrome See Lipodystrophy: congenital generalized
C
Calcium channel blockers 155
Cavernous sinus thrombosis 34
Certified Diabetes Educators (CDEs) programs 92
Chronic kidney disease 150
ultrasound 65f
Continuous subcutaneous insulin infusion 127, 130
CSII See continuous subcutaneous insulin infusion
Cushing syndrome 2
D
Dacryocystitis, acute 33
Dawn phenomenon 124
Diabetes mellitus
gestational 44
monogenic 19
neonatal 19
ABCC8 mutation 19
clinical examination 22
due to mutations in genes associated with pancreatic β-cell 22
laboratory evaluation 22
KCNJ11 mutations 19, 21
management 22
outcome 23
parental genetic screening 23
permanent 22
transient 22
Diabetes mellitus, type 1 124
Glucose counter-regulation 148
SMBG importance in 130
Diabetes mellitus, type 2
in young 25
acanthosis nigricans 29
American Academy of Pediatrics treatment guidelines 30
diagnosis 27, 29
differential diagnosis 27
insulin resistance 29
metformin 28
NASH 29
PCOS 29
treatment 28
ketosis-prone 27
pre-Ramadan consultation 56
with morbid obesity 12
bariatric surgery in 15, 17
case presentation 12
HbA1c levels 15
management 15
with ROCM 31
B-scan of eye 36
case presentation 32
differential diagnosis 37
paranasal sinusitis 36f
ptosis 34
retinal detachment 36
treatment 38
Diabetes Self-Management Education (DSME) programs 92
Diabetic foot 135, 140
effective management 140, 141
investigations 136
ankle-brachial index 138, 141
toe pressure 141
transcutaneous oxygen tension 138, 141
pathological changes associated 140
prevention of amputation 141
surgical debridement 137
Diabetic kidney disease 155
factors affecting progression 155t
Diabetic macular edema 105, 106 See also Proliferative diabetic retinopathy
case presentation 105
Chennai Urban Rural Epidemiology Study 112
diagnosis 107
fundus fluorescein angiography 105
intraretinal microvascular abnormalities in 107
intravitreal injection 106, 109
triamcinolone acetate 106
vascular endothelial growth factor (VEGF) inhibitors 106, 112
VEGF trap 106
macula grid laser photocoagulation 105
optical coherence tomography in 105
treatment 107
treatment goal 113
vision loss in 106
Diabetic nephropathy 97, 98, 152
stages of 152t
end-stage renal disease 152t
hyperfiltration 152t
microalbuminuria 152t
normoalbuminuria 152t
overt proteinuria 152t
Diabetic neuropathy 167
painful 167
Aδ fibers 172
case presentation 168
C fibers 172
manifestations 172
symptoms 168
Diabetic retinopathy 97, 105
diabetic macular edema 105
proliferative 116 See also Proliferative diabetic retinopathy
severe nonproliferative 105
vision threatening 105
Diazoxide, oral
in hyoglyvemia in neonates 50
DME See Diabetic macular edema
Donohue syndrome 2, 3, 5
characteristic features 6
diagnosis 3
Duloxetine
mode of action 172
Dysuria 26
E
Epidemiology of Diabetes and Ramadan (EPIDIAR) study 58
Erectile dysfunction 95
Exenatide 86, 89
dose 89
F
FCPD See fibrocalculous pancreatic diabetes
Fenofibrate
in hypertriglyceridemia 74
Fibrocalculous pancreatic diabetes 28, 62
case presentation 63
glycemic control options 63f
insulin therapy in 62, 66
management 65
oral antidiabetic medication role 66
pancreatic enzyme supplementation 62
risk of pancreatic cancer 66
role of diet 66
Fundus fluorescein angiography 107, 108f, 157, 159, 159f, 160, 161
G
Gene mutations
in congenital hyperinsulinemia 52
3-hydroxyacyl-coenzyme A dehydrogenase (3-HADH) gene 52
glucokinase (GCK) gene: 52
glutamate dehydrogenase (GDH) gene 52
hepatocyte nuclear factor 4-α (HNF4A) 52
homeobox A (HFNF1A) 52
solute carrier family 16 member 1 (SLC16A1) 52
uncoupling protein 2 (UCP2) 52
in neonatal diabetes 19
Glibenclamide 82
Glimepiride 82
Glipizide 82, 83
Gliptins 82
Glucagon-like peptide-1 (GLP-1) receptor agonists 86
American Association of Clinical Endocrinologists guidelines 88
American College of Endocrinology (AACE/ACE) guidelines 88
American Diabetes Association recommendations 86
benefits 89
contraindications 88, 90
dipeptidyl peptidase-4 (DPP-4) inhibitor usage 90
end-stage renal disease 90
medullary thyroid cancer history 90
multiple endocrine neoplasia syndrome type 2 (MEN 2) 88, 90
pancreatitis 88
renal impairment 88, 90
thyroid cancer history 88
disposable pens 88
European Association for the Study of Diabetes recommendations 86
for weight loss in diabetes mellitus 88
mechanism of action 86, 88
delayed gastric emptying 88
early satiety 88
side effects 88, 89
hypogylcemia 89
nausea 88
pancreatitis 89
suppression of glucagon secretion 89
usage in diabetes mellitus type 2
case presentation 86
Glucagonoma 2
Glucagon stimulation test 50
Glucose transporter protein (GLUT2) receptor 50
Glucose transporter type 2 gene 70f
Glucosuria 26
Glycemic control 99
as per American Association of Clinical Endocrinologists 99
as per United Kingdom Prospective Diabetes Study 99
Goiter 69
Graves’ disease 68
Graves’ thyrotoxicosis 69
beta-blocker in 70
ketoacidosis in 71
management 70
H
HAIR-AN syndrome 7
Hematopoietic stem cell transplantation 31
Hepatic transcription factor FoxO1 76
Hirata syndrome 6
HTG See Hypertriglyceridemia
Hyperandrogenism 2, 5
Hyperglycemia
in hyperthyroidism 70
pathophysiology 70f
Hyperinsulinism, congenital 47
case presentation 48
classification of 51
diagnosis 50, 53
F-fluoro-L-DOPA positron emission tomography (PET) 53
Gene studies 53
glucagon stimulation test 50
diffuse form 52
focal form 52
histopathological classification 52
management 52
pathophysiology 50
persistent 51
channelopathies in 51
enzyme abnormalities in 51
prognosis 54
therapeutic options 53
calcium channel blockers 53
chlorthiazide 53
diazoxide 53
glucagon 53
octreotide 53
pancreatectomy 54
transient 51
maternal diabetes 51
perinatal asphyxia 51
SGA 51
treatment 50
Hypertriglyceridemia 72
cardiovascular disease (CVD) risk 75
impending severe 76
in diabetes 72
fenofibrate 75
glargine 75
glimepiride 75
metformin 75
moderate 76
pancreatitis risk 75
severe 76
with acute pancreatitis 74
Hypoglycemia
differential diagnosis of 48
hypoketotic 47
in infants and children
differential diagnosis 49t
in neonates
diazoxide 50
differential diagnosis 49t
safety fast test 50
persistent hyperinsulinemic 47
response in nondiabetic 148
symptoms 144
confusion 144
drowsiness 144
palpitation 144
sweating 144
Hypoglycemia unawareness 143, 144
blood glucose awareness training programs 148
case presentation 145
consequences 144
continuous glucose monitoring system 148
continuous subcutaneous insulin infusion 148
long-term neurological manifestations 144
management 147
mechanisms 144
psychological manifestations 144
risk factors 144
I
Immunomodulator therapy
in insulin resistence, severe 8
Insulin 92
Basal 100
detemir 100
glargine 100
neutral protamine hagedorn 100
basal-bolus therapy 66, 130
biphasic 100, 130
common beliefs with usage 100
common fears with usage 99
continuous subcutaneous insulin infusion 127
initial reduction in glycosylated hemoglobin 132f
for clinical use 94f
basal 94f
prandial 94f
premix 94I
in diabetes mellitus, type 2 92
case presentation 95
in diabetes mellitus, type 2 with mucormycosis 38
in diabetic neuropathy, painful 171
in fibrocalculous pancreatic diabetes 62, 65
in neonatal DM 22
physiology of production 51f
role of 93
secretion pattern in normal indviduals 93
Insulin-like growth factor binding protein 1 4
Insulin pumps 124, 128f
follow-up of patients 131
SMBG 131
Insulin receptoropathies 4
clinical spectrum of 4f
Insulin receptoropathy 2
Insulin resistance 1
severe 1
categories of disorders causing 1
management of 8
type A
Type B 6
Type C 7
subcutaneous 2, 8
systemic 8
Insulin secretogogues 82
Iron
role in mucormycosis 41
K
K+ATP See ATP-sensitive potassium
KCNJ11 gene 51
Ketoacidosis 2, 8
KIR6.2 51
L
Laparoscopic Roux-En-Y gastric bypass surgery 15
Laser photocoagulation 116, 157
Latent autoimmune diabetes of youth 27
Lawrence syndrome See Lipodystrophy: acquired generalized
LDL cholesterol
in high risk patients 99
Leprechaunism See Donohue syndrome
Lipodystrophy 2, 7
acquired generalized 7
acquired partial 7
characteristics 7
cirrhosis 7
congenital generalized 7
congenital partial 7
pancreatitis 7
Lipodystrophy Syndromes 7
Liraglutide 86, 89
dose 89
M
Macula grid laser photocoagulation 105, 107
Maturity onset diabetes of young 27
Maxillofrontal sinusitis 34
Metformin 81
in DM type 2 in young 30
in fibrocalculous pancreatic diabetes 65
in insulin resistence, severe 8
mechanism of action 81
side effects 87
toxic effect 66
Microalbuminuria 150, 152
methods of assessment 150
Mucormycosis 31
clinical manifestations 32
cranial nerve involvement 39
differential diagnosis 37
aspergillosis 37
fusoriosis 37
scedosporiosis 37
Tolosa-Hunt syndrome 37
disseminated 32
incidence in USA 31
orbital 39
MRI 40
rhinocerebral See also Rhino-orbital-cerebral mucormycosis
Sinus 39
biopsy in 40
early diagnosis 39
surgical debridement 40
Mycophenolate mofetil
in insulin resistence, severe 9
Myotonic dystrophy 2
N
NDM See Diabetes Mellitus: Neonatal
NDRD See nondiabetic renal disease
Nesidioblastosis 47
Neuropathic pain 172
pathomechanism 172
treatment
duloxetine 172
pregabalin 172
Nonalcoholic steatohepatitis 27
Nondiabetic renal disease 154
O
OAS See orbital apex syndrome
Optical coherence tomography 107, 108f
Orbital apex syndrome 39
P
Pancreatic enzyme supplementation 62
Pancreatitis
alcoholic 76
biliary 76
chronic 62, 63
Pancreatitis, acute 72, 73
management of 76
combined insulin and heparin infusions 76
heparin infusion 76
insulin infusion 76
octreotide 76
plasmapheresis 76
purified apolipoprotein C-II 76
risk factors for 75
Pars plana vitrectomy 117
complication 121
conformal delamination 121
foldback delamination 120, 121
scissor delamination 121f
scissor segmentation 121f
transconjunctival 121
PDR and clinically significant macular edema 157, 161 See also Diabetic macular edema
intravitreal injection 157, 162
laser photocoagulation 157, 162
neodymium-doped yttrium aluminium garnet laser (Nd: YAG) 162
Peripheral neuropathic pain 168
as per International Association for the Study of Pain 168
Peripheral neuropathy 167
Peripheral vascular disease 134, 135
Pheochromocytoma 2
PNDM See Diabetes Mellitus: Neonatal: Permanent
Polycystic ovary syndrome (PCOS) 7, 27
PPV See pars plana vitrectomy
Prediabetes 43
cardiovascular fitness 43
cardiovascular risk 43
case presentation 43
cholesterol control 43
hypertension control 43
lifestyle management 43
lifestyle modification 45
protein supplements in 44
Pregabalin
mode of action 172
Proliferative diabetic retinopathy 157
complications 157
neovascular glaucoma 157
diabetic macular edema 105
preretinal hemorrhage 117
retinal detachment 117, 157
vitreous hemorrhage 119, 157
fundus fluorescein angiography 157, 159, 159f, 160, 161
laser photocoagulation 116, 157
optical coherence tomography 157, 160,164f
vitrectomy 117
Pruritus vagina 25
Pseudoacromegaly 2
Pseudophakia 117
R
Rabson-Mendenhall syndrome 2, 4f, 5, 8
characteristic features 5
Randle cycle 75, 76
Recombinant IGF-I
in insulin resistence, severe 8
Recombinant methionyl human leptin
in insulin resistence, severe 8
Retinal arterial sclerosis 107
Retinal color photography 108f
Retinal topography map 162f
Rhino-orbital-cerebral mucormycosis 31
blurred vision in 41
diabetic ketoacidosis 32
diplopia in 41
DKA in 39
periorbital swelling in 39
Rhizopus oryzae 31
Rituximab
in insulin resistence, severe 9
ROCM See Rhino-orbital-cerebral mucormycosis
S
Secondary diabetes 27
Seizures, generalized tonic clonic 48
Self-monitoring of blood glucose
to prevent hypoglycemia unawareness 143
Sex hormone binding globulin 4
Silent ischemia 98
SIR See insulin resistance: subcutaneous
Sodium pumps 170
Split-thickness skin graft 138
Split-thickness skin graft (STSG) surgery 138
SREBP-1c See sterol regulatory element-binding proteins-1c Stereoscopic retinal color photography 107
Sterol regulatory element-binding proteins-1c 76
Sulphonylurea receptor 1 51
Sulphonyureas 81
comparison of first and second-generation 82
contraindications 81
high cardiovascular risk 84
organ dysfunction 84
in neonatal DM 22
in young diabetics. 84
mechanism of action 82
side effect 23, 81, 84
hypoglycemia 84
weight gain 84
usage in diabetes mellitus type 2
case presentation 82
Systemic lupus erythematosus
associated with insulin resistence, severe 6
T
TCP See Tropical chronic pancreatitis
Thiazides diuretics 155
Thyrotoxicosis 2
Tolosa-Hunt syndrome 37
Tractional retinal detachment 116, 118f
Transient ischemic attack 95
TRD See tractional retinal detachment
Tropical chronic pancreatitis 62
U
Uncontrolled diabetes 68
and hyperthyroidism 68, 70
V
Vascular endothelial growth factor (VEGF) inhibitors 106
bevacizumab 106, 112, 113, 118
BOLT study 113
comparison between bevacizumab and ranibizumab 113
ranibizumab 106, 113
aflibercept 106
Vascular peripheral disease 138
Vascular peripheral disease with limb ischemia 134
case presentation 135
foot examination and investigations 136
synthetic graft bypass in 138
VEGF trap 106
VGCC See voltage-gated calcium (Ca2+) channel
Vitrectomy 116
indications 117
anterior hyaloid proliferation 117
combined tractional-rhegmatogenous retinal detachment 117
neovascular glaucoma 117
nonclearing vitreous hemorrhage 117
refractory diabetic macular edema 117
tractional retinal detachment 117
vitreomacular traction 117
intraoperative photographs of 119
Vitreous hemorrhage and TRD
case presentation 117
management 118
Voltage-gated calcium (Ca2+) channel 50
W
Werner syndrome 2
×
Chapter Notes

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FM1DIABETES Clinical Case Series – IFM2
FM3DIABETES Clinical Case Series – I
Editors Viswanathan Mohan MD FRCP (London, Edinburgh, Glasgow, Ireland) PhD DSc FNASc DSc (Hon. Causa) FASc FNA FACP FACE FTWAS Chairman and Chief Diabetologist Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation Chennai, Tamil Nadu, India Ranjit Unnikrishnan MD Dip. Diab FRCP FACP Vice Chairman and Consultant Diabetologist Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation Chennai, Tamil Nadu, India
FM4
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Diabetes: Clinical Case Series – I
First Edition: Digital Version 2017
9789352500321
FM5Contributors
EDITORS
CONTRIBUTING AUTHORS
FM9Preface
It gives me great pleasure as the Editor-in-Chief, to write the Preface to the first volume of Clinical Case Series in Diabetes, being published by Jaypee Brothers Medical Publishers. The book is extensive and covers a wide range of case studies in diabetology with each case including case history, investigations, differential diagnosis, and references.
Several well-known diabetologists have contributed chapters to this book which covers a wide range of topics related to management of diabetes, type 2 diabetes in the young, pre-diabetes, hyperthyroidism, use of insulin pump in type 2 diabetes, neonatal diabetes, painful diabetic neuropathy, foot study, diabetes with proliferative diabetic retinopathy, initiation of insulin, etc. Diabetes mellitus is growing on an epidemic scale all over the world. There were about 382 million people with diabetes in 2013 across the globe and this number is expected to reach 592 million by 2035. In India itself, there are over 65 million people with diabetes and another 80 million people with pre-diabetes. Earlier considered a disease of the rich and of old people, it now affects the middle class and the poor people and also the youth, including children.
I am sure this book will serve as a useful guide for general physicians as well as post-graduate students and practicing diabetologists and endocrinologists. I am confident that this book would be a valuable addition to any library. We would welcome your valuable feedback so that we can further improve future volumes of the Case Series.
We hope you enjoy reading this book.
Viswanathan Mohan
Ranjit Unnikrishnan