Relato de caso: diabetes Flatbush - da cetoacidose ao tratamento não-farmacológico

Rodacki, Melanie; Zajdenverg, Lenita; Lima, G. A. B. de; Nunes, Rodolfo de Alkmim Moreira; Milech, Adolpho; Oliveira, José Egídio Paulo de

doi:10.1590/s0004-27302007000100021

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…Quando a síntese de acetil-Coa é maior que a utilização hepática, a substância é convertida em corpos cetônicos (CC). A retenção de CC no plasma provoca acidose metabólica (ACM), característica da CAD 13,14,18,19 .…”

Section: Autor Principais Achadosunclassified

Diabetes melito: hiperglicemia crônica e suas complicações

Ferreira

Saviolli

Valenti

et al. 2011

Arq. Bras. Ciên. Saúde

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ResumoIntrodução: O termo diabetes melito descreve uma desordem metabólica de múltipla etiologia, caracterizado por hiperglicemia crônica decorrente de defeitos na secreção e/ou ação da insulina. O diabetes melito é classificado em tipo 1 e 2, diabetes gestacional e outros tipos. A hiperglicemia crônica é o fator primário desencadeador das complicações do diabetes melito. Objetivo: Descrever os mecanismos fisiopatológicos das complicações crônicas e dos distúrbios metabólicos decorrentes da hiperglicemia. Métodos: Foram consultadas as bases de dados do SciELO, Lilacs e Medline. As consultas incluíram artigos registrados entre 1999 e 2010, nas línguas portuguesa e inglesa. Resultados: A hiperglicemia promove a formação dos produtos de glicação avançada (AGEs), responsáveis por complicações macrovasculares. A insulinopenia estimula a secreção de hormônios contrainsulínicos como glucagon, cortisol, catecolaminas e hormônio do crescimento. Iniciam-se processos catabólicos (lipólise e proteólise). Ácidos graxos são captados pelas células hepáticas. Ocorre síntese de acetil-Coa que é convertida em corpos cetônicos. A retenção de corpos cetônicos no plasma provoca acidose metabólica. Alterações na fisiologia ocular são derivadas da opacificação do cristalino e de modificações vasculares retinianas. Nefropatia diabética é a complicação crônica microvascular que compromete a função renal por aumento da membrana basal glomerular. A neuropatia diabética envolve a ativação da via do poliol, a síntese de AGEs e a redução do fluxo sanguíneo neural. Conclusão: A patogênese das alterações fisiológicas e metabólicas decorrentes da hiperglicemia compreende mecanismos fisiológicos, biológicos e bioquímicos que afetam a qualidade de vida do organismo.Palavras-chave: diabetes mellitus; hiperglicemia; complicações do diabetes; cetoacidose diabética. AbstractIntroduction: The term diabetes mellitus describes a metabolic disorder of multiple etiology, which is characterized by chronic hyperglycemia resulting from

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Section: Autor Principais Achadosunclassified

Diabetes melito: hiperglicemia crônica e suas complicações

Ferreira

Saviolli

Valenti

et al. 2011

Arq. Bras. Ciên. Saúde

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“…A review of the theme demonstrates the prevalence according to ethnicity, with a high risk of occurrence in the African American and Hispanic populations and low risk in Caucasian and Asian populations (10), but data are insufficient to define the exact prevalence. In Brazil, a recent study showed that the Brazilian population has a predominance of European and African ancestry (11), but only one case report (12) of KPD in more than a decade, so this type of diabetes may be underdiagnosed in Brazil.…”

Section: Discussionmentioning

confidence: 99%

The first series of cases of ketosis-prone type 2 diabetes (flatbush diabetes) in Brazilian adults

Ramaldes¹,

Santos²,

Sá³

et al. 2021

Archives of Endocrinology and Metabolism

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Ketosis-prone type 2 diabetes (KPD) is an emerging form of diabetes mellitus characterized by unprovoked ketoacidosis, absence of autoimmunity and beta-cell dysfunction. The KPD may improve after initial glycemic compensation and evolve to exogenous insulin independence, most cases were observed in populations with African or Hispanic backgrounds. We reviewed the literature on KPD and, to date, only one case of KPD has been described in Brazil's multi-ethnic population. A group of adult Brazilian KPD patients without autoimmunity and insulinopenia was identified for this study. We report a retrospective study of four KPD cases (3 males) evaluated in southeast Brazil, the patients were overweight or obese, age between the third and fifth decades of life, had a family history of type 2 diabetes, hyperglycemia (809.5 ± 344.2 mg/dL), acidosis (pH 7.21 ± 0.07; normal range (nr): 7.35-7.45 and bicarbonate 9.1 ± 6.2; nr: 22-26 mEq/mL), ketonuria (142.5 ± 114.4 mg/dL; nr: absence), absence of glutamic acid decarboxylase antibodies (GAD-65), and beta-cell function reserve (C-peptide 1.19 ± 0.53 ng/mL-nr: 1.1-4.4 ng/mL) on diagnosis. After glycemic compensation, there was increase of C-peptide (2.21 ± 0.41) indicating the recovery of beta-cell function and the time to insulin independence was 7.7 ± 3.5 months. They evolved after the period of glucotoxicity with insulin withdrawal and could be treated with oral antidiabetic therapy. This is the first case series of KPD described in Brazil being characterized by ketoacidosis at diagnosis, absence of autoimmunity, recovery of beta-cell function and insulin independence.

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“…Increased α-tocopherol serum concentration may be related to metabolic changes that occur in the maternal body due to GDM. At the end of pregnancy, there should be a reduction in insulin secretion, leading to a hormonal response that make tissues dependent on insulin to metabolize lipids instead of carbohydrates, initiating a process of lipolysis ( 24 - 26 ) , which culminates in increased release of free fatty acids in the circulation ( 27 ) . Once the primary means of storage of α-tocopherol in the body is the adipose tissue ( 28 ) , this vitamin can be influenced by increased lipolysis, leading diabetic women to present high concentration of serum tocopherol.…”

Section: Discussionmentioning

confidence: 99%

“…A concentração sérica aumentada de α-tocoferol pode estar relacionada às alterações metabólicas que ocorrem no organismo materno devido ao DMG. No final da gestação, pressupõe-se redução na secreção de insulina, levando a uma resposta hormonal que faz os tecidos dependentes de insulina metabolizarem os lipídeos em vez dos carboidratos, iniciando um processo de lipólise ( 24 - 26 ) , que culmina em maior liberação de ácidos graxos livres na circulação ( 27 ) . Uma vez que o principal meio de estocagem de α-tocoferol no organismo é o tecido adiposo ( 28 ) , essa vitamina pode sofrer influência do aumento da lipólise, fazendo com que gestantes diabéticas apresentem concentrações elevadas de tocoferol sérico.…”

Section: Discussionunclassified

Alpha-tocopherol concentration in serum and colostrum of mothers with gestational diabetes mellitus

Resende

Clemente

Bezerra

et al. 2014

Rev. paul. pediatr.

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OBJECTIVE: To evaluate and compare the levels of α-tocopherol in colostrum and in the serum of healthy and diabetic mothers.METHODS: This cross-sectional study enrolled 51 volunteer mothers, 20 with the diagnosis of gestational diabetes mellitus and 31 without associated diseases. Serum and colostrum samples were collected in fasting in the immediate postpartum period and α-tocopherol was analyzed by high performance liquid chromatography (HPLC). In order to define the nutritional status of vitamin E, the cutoff point for the serum (697.7µg/dL) was adopted. Student's t-test for independent variables compared the average concentrations of α-tocopherol in the serum and in the colostrum between control and gestational diabetes mellitus groups. Pearson's correlation was used to assess the relationship between the concentration of α-tocopherol in serum and colostrum for both groups. Differences were considered significant when p<0.05.RESULTS: The α-tocopherol concentration in colostrum was 1,483.1±533.8µg/dL for Control Group and 1,368.8±681.8µg/dL for diabetic women, without differences between groups (p=0.50). However, α-tocopherol concentration in the serum was 1,059.5±372.7µg/dL in the Control Group and 1,391.4±531.5µg/dL in the diabetic one (p<0.01). No correlation was found between the concentration of α-tocopherol in the serum and in the colostrum for control and diabetic groups. CONCLUSIONS: The groups had adequate nutritional status of vitamin E. Gestational diabetes was not associated with changes in α-tocopherol concentration in colostrum.

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Relato de caso: diabetes Flatbush - da cetoacidose ao tratamento não-farmacológico

Cited by 5 publications

References 14 publications

Diabetes melito: hiperglicemia crônica e suas complicações

Diabetes melito: hiperglicemia crônica e suas complicações

The first series of cases of ketosis-prone type 2 diabetes (flatbush diabetes) in Brazilian adults

Alpha-tocopherol concentration in serum and colostrum of mothers with gestational diabetes mellitus

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