Medical Case Reports

Editor’s Note

Here we present starting information got from a novel diabetes strategy aiming to spread and extend the scope of effective individual administration versus the augmented family and network. Such methodology accepts that urbanic dejection has a significant job in enlistment of diabetes, and instruction with modified changes in network way of life style might support efforts to prevent diabetes development. Diabetes mellitus, the most well-known endocrine issue, is described by a few metabolic variations from the norm and various long haul confusions influencing generally the kidneys, fringe nerves, veins, organ vision, and central nervous system; also, we must not forget that it is the main cause of morbidity and mortality in the Western and developed countries. The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have, it can lead to excess sugar in your blood. Too much sugar in your blood can lead to serious health problems. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes - when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes - and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered. Today in the clinical practice Diabetes Mellitus (DM) has supplanted syphilis and tuberculosis as the enormous disguise. Presently, from the expert view, numerous doctors are associated with hard difficulties, discussions concerning diabetic patients: insulin resistance, the executives of the disease, diabetic pregnant ladies, starch issues, diabetic foot, diabetes and medical procedure, pharmacological viewpoints, mental and sociological issues, new modalities of treatment and numerous others and significant clinical inquiries.

We often diagnose a patient with diabetes, give them a meter and a prescription and send them on their way. Some of us refer for education or even have an educator in our office but our patients fail no matter what we try. We have learned that there is a psychological component associated with diabetes that is even more powerful than the disease itself and often prevents the successes we all strive for. With this in mind our next Clinical Gems will focus on Psychology in Diabetes Care. This week we start with the history of the psychological effects of diabetes and how they have intensified in the last few years.

Our Diabetes Disaster Averted, Medication Adherence, this week looks at the problems of multiple diabetes medications, adherence, and treatment failure, and our Homerun Slides continue to examine the intricate details of DPP-4 inhibitors and GLP-1 analogs.

Gestational diabetes resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. It is recommended that all pregnant women get tested starting around 24–28 weeks gestation. It is most often diagnosed in the second or third trimester because of the increase in insulin-antagonist hormone levels that occurs at this time. However, after pregnancy approximately 5–10% of women with gestational diabetes are found to have another form of diabetes, most commonly type 2. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause infant respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

Diabetes affects a gauge of 366 million individuals around the world, with type 2 diabetes mellitus (T2DM) representing over 90% of the cases. Renal deficiency is a typical comorbidity condition in T2DM patients with incessant kidney disease defined as kidney damage or an expected glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 for > 3 months. The kidney is both the source and survivor of raised pulse. Hypertension is a pathogenic factor that adds to the crumbling of kidney function. Subsequently, the board of hypertension (salt decrease admission satisfactory eating regimen, exercise and antihypertensive medications) has become the most significant intercession control all modalities of chronic kidney disease. The job of hypertension in renal infection is critical. The matured total populace is expanding. The maturing is the most widely recognized risk factor for the advancement of hypertension and diabetes, just as chronic kidney disease.

People with diabetes (usually but not exclusively in type 1 diabetes) may also experience diabetic ketoacidosis (DKA), a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness. DKA requires emergency treatment in hospital. A rarer but more dangerous condition is hyperosmolar hyperglycemic state (HHS), which is more common in type 2 diabetes and is mainly the result of dehydration caused by high blood sugars.

Treatment-related low blood sugar (hypoglycemia) is common in people with type 1 and also type 2 diabetes depending on the medication being used. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and rarely permanent brain damage or death in severe cases. Rapid breathing, sweating, and cold, pale skin are characteristic of low blood sugar but not definitive. Mild to moderate cases are selftreated by eating or drinking something high in rapidly absorbed carbohydrates. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.