<p class="MsoNormal"> <b><span lang="EN-US">Background: </span></b><span lang="EN-US">A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to pa</span><span lang="EN-US">tients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated</span><span lang="EN-US">. </span><b><span lang="EN-US">Objective:</span></b><span lang="EN-US"> To better understand fasting-evoked en route hypoglycemia in diabetes (FEEHD), a recently recognized overlooked safety problem in diabetes management. <b>Methods and Patients: </b>A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. We undertook this retrospec</span><span lang="EN-US">tive case series study, which enrolled 4 consecutive cases of fasting hypoglycemia in patients with diabetes who were on diverse antidiabetic medications. The study duration was June 1, 2010 to June 1, 2012.</span><b><span lang="EN-US"> Results: </span></b><span lang="EN-US">The 4 cases (3 women, 1 man), with either type 1 or type 2 diabetes, revealed multiple defects in either the patients’ knowledge and education regarding preparation for lab tests requiring fasting. The degree of hypoglycemia ranged from mild (65 mg/dl) to severe (31 mg/dl), and the events were either mildly symptomatic or asymptomatic. The possible causes of, and con</span><span lang="EN-US">tributing factors to hypoglycemia are discussed, and recommendations for preventive measures are provided.</span><b><span lang="EN-US"> Conclu</span></b><b><span lang="EN-US">sion: </span></b><span lang="EN-US">Some patients with diabetes who fast for lab tests are at risk of hypoglycemia, and there seems to be an overall lack of proper education of patients with diabetes about this form of hypoglycemia. This overlooked problem can be prevent</span><span lang="EN-US">ed</span><span lang="EN-US"> by proper education and preparation.</span><span lang="EN-US"><o:p></o:p></span> </p>

Dengue is an arthropod borne viral disease which has a huge impact on human health as well as the global and national economies. It is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature, relative humidity, and unplanned rapid urbanization [1]. A total of 390 million dengue virus infections occur per year of which 96 million manifests clinically with varying severity [2]. A study on the prevalence of dengue estimates that 3.9 billion people are at risk of infection with dengue viruses. Despite a risk of infection existing in 129 countries [3], 70% of the actual burden is in Asia [2]. In 2020, dengue continues to affect several countries, with reports of increase in the numbers of cases in number of countries including India. Bhatt et al. showed a discrepancy between reported and modeled dengue incidence, which was particularly high for India. According to their estimates, India contributed 34 of 96 million apparent global dengue infections, a number which stands in stark contrast to the 12,484 reported cases from India to the World Health Organization (WHO) in the same year. Such a mismatch was also reported for India in another study, in which the actual numbers of dengue cases were 282 times the number reported by the national vector-borne disease control program [4].Dengue is a systemic and dynamic disease. After the incubation period, the illness begins abruptly and is followed by the three phases; febrile, critical, and recovery phase [5]. The WHO classifies dengue into two major categories: Dengue (with/ without warning signs) and severe dengue. This subclassification

We describe a 6-year-old boy who presented to the emergency department with the complaint of nausea and vomiting with diarrhea. Workup revealed a glucose level of 1904 mg/dL, and hyperglycemic hyperosmolar syndrome was diagnosed. Hyperglycemic hyperosmolar syndrome is very rare in the pediatric population, but recent published reports suggest that the incidence of this disorder may be increasing.