Newly diagnosed type 1 diabetes in a 93 year old

2022 ◽  
Vol 15 (1) ◽  
pp. e246799
Author(s):  
Waqar Ahmad ◽  
Catherine Bates ◽  
Laura Dale ◽  
Naveen Siddaramaiah
Keyword(s):  
Type 1 Diabetes ◽  
Venous Blood ◽  
Primary Hypothyroidism ◽  
Intravenous Insulin ◽  
Parietal Cell Antibodies ◽  
High Clinical Suspicion ◽  
History Of ◽  
Laboratory Investigations ◽  
Venous Blood Gas

Type 1 diabetes is typically a disease of young but can present at any age. We present a case of a 93-year-old woman who presented with 10 days history of feeling lethargic, polydipsia and decreased appetite. Her capillary blood glucose was raised at 25 mmol/L with significant ketonaemia and venous blood gas showing metabolic acidosis. She had a background of primary hypothyroidism and vitamin B12 deficiency with weakly positive parietal cell antibodies. Laboratory investigations confirmed diabetes with HbA1c of 117 mmol/mol (12.9%). In view of high clinical suspicion of type 1 diabetes, her diabetes autoantibodies were checked which showed strongly positive anti-GAD antibody with titre of >2000 IU/mL (range<10) confirming our diagnosis. She was treated with diabetic ketoacidosis protocol with intravenous fluids and intravenous insulin. On recovery, she was discharged home on once daily insulin with aim to self-manage diabetes with support from district nurses and to avoid hypoglycaemia.

Severe hypertriglyceridemia at new onset type 1 diabetes mellitus

2017 ◽  
Vol 30 (8) ◽  
Author(s):  
Tyler Fick ◽  
Julie Jack ◽  
Amy L. Pyle-Eilola ◽  
Rohan K. Henry
Keyword(s):  
Type 1 Diabetes ◽  
Pediatric Population ◽  
Rare Complication ◽  
Venous Blood ◽  
Laboratory Data ◽  
Clinical Criteria ◽  
Severe Hypertriglyceridemia ◽  
Venous Blood Gas ◽  
New Onset

AbstractBackground:Severe hypertriglyceridemia (HTG) as well as diabetic ketoacidosis (DKA) are complications of type 1 diabetes (T1DM). HTG is an exceedingly rare complication in the pediatric population and herein we report a case of HTG at new-onset T1DM in DKA and discuss management and potential complications.Case presentation:An 11-year-old previously well patient with a history of fatigue and weight loss presented with: glucose >600 mg/dL, venous blood gas: pH 7.26, pCOConclusions:Lipemia secondary to severe HTG, though exceedingly rare, may exist in new onset T1DM with DKA. Complicating the diagnosis is the possibility of an analytical error from lipemia causing incongruence in diagnostic criteria. Clinicians should rely on clinical criteria for management and should consider HTG if laboratory data is inconsistent with the clinical picture.

scholarly journals Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002099
Author(s):  
Yuji Komorita ◽  
Masae Minami ◽  
Yasutaka Maeda ◽  
Rie Yoshioka ◽  
Toshiaki Ohkuma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Bone Fracture ◽  
Severe Hypoglycemia ◽  
Japanese Patients ◽  
Anatomic Site ◽  
Cross Sectional ◽  
History Of

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

scholarly journals Accelerated Bilateral Cataract Formation as a First Manifestation of Diabetes Mellitus

2013 ◽  
Vol 114 (4) ◽  
pp. 258-262 ◽  
Author(s):  
M. R. Manaviat ◽  
Nasim Oveisi ◽  
A. Zare-Bidoki
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Emergency Room ◽  
Type 1 Diabetes Mellitus ◽  
Cataract Formation ◽  
Bilateral Cataract ◽  
Duration Of Diabetes ◽  
History Of ◽  
New Onset

There is a proved relationship between diabetes mellitus and the cataract formation. The incidence of this is usually related to the duration of diabetes. In this manuscript we report a 15 years old female presented to the emergency room with a 4 hour history of rapid bilateral diminished vision, initially diagnosed with idiopathic cataracts, but after more laboratory evaluations revealed new-onset type 1 diabetes mellitus without ketosis.

scholarly journals Pregnancy and delivery in a patient with a 40-year history of type 1 diabetes mellitus and antiphospholipid syndrome

2018 ◽  
Vol 67 (6) ◽  
pp. 93-99
Author(s):  
Roman V. Kapustin ◽  
Natalia V. Borovik ◽  
Ekaterina V. Musina ◽  
Olga N. Arzhanova ◽  
Maria I. Yarmolinskaya ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Antiphospholipid Syndrome ◽  
Perinatal Outcomes ◽  
Increased Risk ◽  
Pregnancy And Delivery ◽  
Perinatal Center ◽  
History Of

Type 1 diabetes mellitus is a condition associated with an increased risk of adverse perinatal outcomes such as spontaneous abortions, preterm birth, placental insufficiency, congenital malformations, and perinatal mortality. Diabetes mellitus combined with cardiovascular diseases in women during pregnancy often leads to hypertensive disorders and pre-eclampsia. The severity of the microvascular diabetic complications and frequency of hypoglycemic episodes, particularly in early pregnancy, are related to the risk of pre-eclampsia. We report the case of pregnancy and delivery of a live newborn in a 42-year-old woman with type 1 diabetes mellitus, pre-existing hypertension, heritable thrombophilia, and antiphospholipid syndrome. She had a 40-year history of type 1 diabetes mellitus with well-controlled diabetic nephropathy and retinopathy. The woman had been receiving continuous subcutaneous insulin therapy for the last five years, which allowed maintaining an appropriate glycemic control during pregnancy. Multidisciplinary supervision of course of pregnancy was carried out from the pre-gravidity stage until delivery and postpartum. In spite of the severe pre-eclampsia and preterm delivery by cesarean section at 36 weeks, she and newborn could avoid the intensive unit care and discharge from perinatal center without any complications.

scholarly journals SAT-509 Sudden Onset of Malabsorption

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Gabriela Mroueh ◽  
James K Burks
Keyword(s):  
Medication Adherence ◽  
The Elderly ◽  
Sudden Onset ◽  
Primary Hypothyroidism ◽  
Caucasian Woman ◽  
Thyroid Function Tests ◽  
Autoimmune Hypothyroidism ◽  
High Clinical Suspicion ◽  
Immune Mediated ◽  
History Of

Abstract Celiac disease (CD) is an immune-mediated enteropathy caused by a reaction to gliadin which responds to a restriction to dietary gluten. It has been traditionally recognized in children and young adults, although, recently, detection in the elderly population has increased. CD occurs in 2–5% of patients with autoimmune hypothyroidism, and is more prevalent in this group than in the general population An 82-year-old Caucasian woman with primary hypothyroidism and a BMI of 16 is referred to our endocrinology clinic for help with the management of hypothyroidism. She had a history of well controlled hypothyroidism on weight-dosed levothyroxine for many years until several months prior when she developed sudden onset of diarrhea and weight loss. Since then, her thyroid function tests showed an elevated TSH despite medication adherence. Her levothyroxine dose was steadily increased to 300 mcg daily and yet, her TSH still remained elevated. Laboratory work up was done which revealed elevated transglutaminase antibodies, suggesting the diagnosis of CD. The patient refused an endoscopy for a tissue diagnosis. Even though the patient has been diagnosed with CD, she has trouble following a gluten free diet and still has intermittent diarrhea and high levothyroxine requirements. Although lack of medication adherence is common, it is important to exclude gastric or intestinal causes of malabsorption in patients with high thyroid replacement requirements. Elderly patients often have paucity of symptoms, so high clinical suspicion is necessary to diagnose these patients.

scholarly journals HHEX-IDE Polymorphism Is Associated with Low Birth Weight in Offspring with a Family History of Type 1 Diabetes

2009 ◽  
Vol 94 (10) ◽  
pp. 4113-4115 ◽  
Author(s):  
Christiane Winkler ◽  
Thomas Illig ◽  
Kerstin Koczwara ◽  
Ezio Bonifacio ◽  
Anette-Gabriele Ziegler
Keyword(s):  
Type 1 Diabetes ◽  
Birth Weight ◽  
Family History ◽  
Low Birth Weight ◽  
History Of

Impaired Function and Altered Morphology in the Skeletal Muscles of Adult Men and Women with Type 1 Diabetes

2021 ◽  
Author(s):  
Athan G Dial ◽  
Cynthia M F Monaco ◽  
Grace K Grafham ◽  
Tirth P Patel ◽  
Mark A Tarnopolsky ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Type 1 Diabetes ◽  
Muscle Function ◽  
Morphological Changes ◽  
Venous Blood ◽  
Accelerated Aging ◽  
Myosin Heavy Chain Isoforms ◽  
Hybrid Fibers ◽  
Skeletal Muscle Function

Abstract Context Previous investigations on skeletal muscle health in type 1 diabetes (T1D) has generally focused on later stages of disease progression where comorbidities are present and are posited as a primary mechanism of muscle dysfunction. Objective To investigate skeletal muscle function and morphology across the adult lifespan in those with and without T1D. Design Participants underwent maximal contraction (MVC) testing, resting muscle biopsy and venous blood sampling. Setting Procedures in this study were undertaken at the McMaster University Medical Centre. Participants Sixty-five healthy adult (18-78 years old) men/males and women/females [T1D=34; control=31] matched for age/biological sex/body mass index (BMI)/self-reported physical activity levels were included. Main Outcome Measures Our primary measure in this study was MVC, with supporting histological/immunofluorescent measures. Results After 35 years of age (‘older adults’), MVC declined quicker in T1D subjects compared to controls. Loss of strength in T1D was accompanied by morphological changes associated with accelerated aging. Type 1 myofiber grouping was higher in T1D, and the groups were larger and more numerous than in controls. Older T1D females exhibited more myofibers expressing multiple myosin heavy chain isoforms (hybrid fibers) than controls, another feature of accelerated aging. Conversely, T1D males exhibited a shift towards type 2 fibers, with less evidence of myofiber grouping or hybrid fibers. Conclusions These data suggest impairments to skeletal muscle function and morphology exist in T1D. The decline in strength with T1D is accelerated after 35 years of age and may be responsible for the earlier onset of frailty which characterizes those with diabetes.

Autoimmune hepatitis

2010 ◽  
pp. 2460-2464
Author(s):  
H.J.F. Hodgson
Keyword(s):  
T Cells ◽  
Type 1 Diabetes ◽  
Autoimmune Diseases ◽  
Autoimmune Hepatitis ◽  
Chronic Inflammation ◽  
Case History ◽  
Plasma Cells ◽  
Portal Tract ◽  
History Of

Case History—A 24 yr old woman presenting with a short history of jaundice. Autoimmune hepatitis describes chronic inflammation in the liver attributed to immune responses against self-antigens in the liver, typically in the form of a marked portal tract infiltrate containing both plasma cells and T cells. It usually affects women (female:male, 8:1), is often familial, and 60% of patients have other autoimmune diseases (e.g. thyroiditis, type 1 diabetes) in addition....

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