Objectives: To assess the prevalence of metabolic syndrome and evaluate proinflammatory status in patients with type 1 diabetes, and to analyse the relationship between inflammation, metabolic control and insulin resistance in these patients. Methods: Patients with type 1 diabetes were stratified according to the presence or absence of metabolic syndrome. Serum adiponectin, leptin, tumour necrosis factor (TNF)-a, interleukin (IL)-6 and high-sensitivity C-reactive protein (hsCRP) were quantified. Results: The prevalence of metabolic syndrome was 28.6% (22/77). Patients with metabolic syndrome had lower adiponectin concentrations and higher leptin, TNF-a, IL-6 and hsCRP concentrations compared with patients without metabolic syndrome. In addition, metabolic syndrome was associated with higher glycosylated haemoglobin and insulin dose, and increased insulin resistance. Conclusions: The proinflammatory state associated with metabolic syndrome in patients with type 1 diabetes leads to deterioration of glycaemic control and an increase in the required daily dose of insulin. Early and proactive diagnosis of metabolic syndrome in these patients will allow medication and lifestyle optimization, in order to prevent the occurrence of diabetes complications and improve health-related quality-of-life.
We report the case of an obese 58 years old patient evaluated for hypoglycemia. The response to a prolonged fasting test was normal, but symptomatic hypoglycemia ensued after mixed meals and with oral glucose loading. A magnetic resonance scan of the abdomen revealed a pancreatic tail tumor, histologically diagnosed as benign insulinoma after successful laparotomy. "Glucose-responsive" insulinomas, although rare, have been previously described in the literature. Therefore, the diagnosis of insulinoma should also be considered in patients that exhibit postprandial rather than fasting hypoglycemia. key words: insulinoma, hyperinsulinemic hypoglycemia, postprandial hypoglycemia. Case presentationA 58 years-old male patient was admitted to "N. C. Paulescu" Institute in March 2009 for medical evaluation of hypoglicemic episodes. Two weeks prior to admission the patient experienced an episode of lipothymialike symptoms (lightheadedness, palpitations, sweating) followed by transient loss of conscience. The symptoms appeared during postprandial state (2-3 hours after a meal), when the patient was supine, wich implies a moderate physical activity. The ambulance team found the patient partially recovered, conscious, complaining of dizziness, and tested the glycemia upon arrival, with a glucometer, revealing a value of 47 mg/dl. With intravenous glucose administration the patient's state improved slowly over the next hour. Further history taking from the patient revealed similar rare episodes troughout the last year consisting of dizziness, sweating, and lipothymia (without loss of consciousness) which did not prompt the patient to seek medical attention.Clinical examination after admision was near-normal. It revealed: patient in no apparent distress, height 168 cm, weight 102 kg, BMI 36 kg/mp, abdominal circumference 115 cm, normal respiratory system, normal cardiovasculary system, BP=120/80 mmHg, HR=72 bpm, no palpable masses in the
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