Aim: To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner's toolkit for insulin motivation in the management of diabetes mellitus (DM). Background: Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician-and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of
Systemic Lupus Erythematosus is an autoimmune disease with female preponderance. Anemia is found in 50% of Systemic Lupus Erythematosus patients. This is a cross sectional case control study with 30 female Systemic Lupus Erythematosus patients having inflammation associated anemia (Hemoglobin \ 10.0 gm/dl) and 30 age matched controls with the aim to measure serum hepcidin and ferritin levels, correlate and study their role as homeostatic regulators of iron metabolism and utility as markers. Serum transferrin, ferritin, iron, total iron binding capacity, hsCRP, liver enzymes and renal parameters were analyzed by using automated analyser. Hepcidin levels were estimated by Sandwich-ELISA method. There was significant decrease in Iron (p \ 0.0001), Iron Binding capacity (p \ 0.0001), Transferrin (p \ 0.0001) in patients, and a significant increase in inflammatory markers: hs-CRP (p \ 0.0001), ESR (p \ 0.0001) compared to controls. Significant increase in both Hepcidin (p \ 0.0001) and Ferritin (p \ 0.0001) was observed in patients with significant positive correlation (r = 0.711) with each other. Additionally, ferritin and hepcidin significantly positively correlated with hs-CRP and ESR (r = 0.526, 0.735); (r = 0.427, 0.742) respectively. Negative correlation with hemoglobin, iron, total iron binding capacity and transferrin with hepcidin (r =-0.80,-0.307,-0.553,-0.584) and ferritin (r =-0.722,-0.22,-0.654,-0.728) was observed respectively. On ROC analysis both hepcidin and ferritin has sensitivity of 96.7%, specificity of 100% at cutoff values of 110 and 49 respectively. AUC of hepcidin was 0.993 and ferritin was 0.978. We have established a positive linear correlation between Hepcidin and Ferritin levels in disease activity and the changes correlated with the inflammatory state and anemia in patients, making them important mediators and potential markers of inflammation associated anemia.
Introduction Though insulin has no upper limit in dosage, we do not encounter very high dose requirements too often. The reported case is the first in Bangladesh to require more than 1000 international units (IU) of subcutaneous insulin per day. Case presentation A 44-year old male diabetic patient from Bangladesh presented with unusually uncontrolled diabetes mellitus due to extreme insulin resistance. Despite dramatic increase in insulin step by step up to 1110 IU of concomitant short and intermediate acting insulin per day by subcutaneous route, his blood glucose remained over 12 mmol/L persistently, in all the fasting, pre-prandial, postprandial and random samples. He was also treated with several oral hypoglycemic agents including metformin, vildagliptin, glimepiride, pioglitazone and miglitol along with insulin but blood glucose levels remained almost unchanged. However, intravenous infusion of insulin over 4 hours caused a plummet in the glucose level. His blood test for insulin autoantibody was negative. Conclusion This paper provides a scope to review literatures on extreme subcutaneous insulin resistance and its management. It also reveals the limitations of management due to lack of facilities in an underdeveloped country, which hinders proper exploration to many medical issues.
Results: During the study period, it was observed that most of the women (63%) belonged to age group between 21 and 30 years. More common congenital abnormalities were anencephaly (21%), bilateral hydronephrosis (17%), hydrocephalous (11%) and ventriculomegaly (8%
This case report is of a 50yrs old man who got admitted in BIRDEM Hospital in a state of unconsciousness for 5 hours .He is a known case of hypertension and diabetes mellitus for the last 12 years and was on insulin. Hypoglycemia was detected, treated with intravenous glucose and the patient regained consciousness. On further query he complained of repeated episodes of nausea, palpitation and sweating for the last 12 years. The episodes were initially labeled as hypoglycemia but blood sugar was never found in hypoglycemic range. The patient was on multiple antihypertensive medications but blood pressure was uncontrolled. All the investigations were normal including 24hrs urinary VMA, serum adrenalin and noradrenalin except ultrasonography of whole abdomen which showed a mass measuring 72x 76 mm in left suprarenal region. One night the patient again developed palpitation, chest discomfort, severe headache and profuse sweating. Blood pressure was recorded 240/160 mmHg. Blood sample was drawn for adrenalin, noradrenalin, 24hrs urine collection was done for VMA and was found very high. The patient was diagnosed as having left adrenal pheochromocytoma. After controlling blood pressure and other preoperative preparations left adrenalectomy was done. Histopathology revealed phaeochromocytoma. Per and postoperative periods were quite eventful. Blood pressure was normal without any antihypertensive drug during discharge. The patient was discharged with the advice to come for follow up after 1 month.
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