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Diabetology

Case Studies

LADA and Graves disease preceded by minimal change nephrotic syndrome in childhood

A young woman diagnosed with minimal change nephrotic syndrome in childhood developed latent autoimmune diabetes in adults and Graves disease. HLA testing was performed to investigate her genetic background.

Extreme euglycemic ketoacidosis managed with hemodialysis

A patient with pancreatogenic diabetes developed life-threatening euglycemic ketoacidosis following re-exposure to an SGLT2 inhibitor and alcohol excess. Early renal replacement therapy was successful.

Use of GLP-1 agonists in patients with a Fontan circulation

A deep dive into eight cases of patients with a Fontan circulation who were prescribed GLP-1 agonists for obesity or diabetes. Find out if the treatments were effective, and what effects they had on patient comorbidities and safety outcomes. 

Mild familial partial lipodystrophy in a patient with a lamin gene mutation

A 38-year-old woman underwent genetic testing for suspected Brugada syndrome, but a missense mutation in the LMNA gene and the presence of suggestive traits led to a diagnosis of familial partial lipodystrophy type 2.

Circulatory collapse due to autoimmune adrenal insufficiency

A rare case of new onset autoimmune adrenal insufficiency in a 7-year-old boy, presenting with severe cardiogenic shock requiring ECMO. Steroid replacement is critical.

Unusual cause of growth arrest, primary amenorrhea, and metabolic syndrome

IGF-1 deficiency was detected in a 16-year-old girl with primary amenorrhea, height and weight at the 3rd percentile, and a waist circumference at the 90th percentile, but what was the underlying cause?

Maternally inherited diabetes and deafness

Genetic testing was needed to diagnose the mitochondrial disorder MIDD in a woman with diabetes, weight loss, and poor glycemic control. Glycated hemoglobin and pancreatic function improved after treatment with a DPP-4 inhibitor.

Stevens-Johnson syndrome/toxic epidermal necrolysis complicated with fulminant type 1 diabetes

A rare case of fulminant type 1 diabetes induced by SJS/TEN, which had developed in a patient taking carbamazepine and phenytoin. Glucose monitoring should be considered for patients with SJS/TEN.

Accidental use of dulaglutide into the third trimester

The GLP-1 receptor agonist dulaglutide was unintentionally used by a woman with type 2 diabetes until the third trimester of an unplanned and unrecognized pregnancy, but what was the outcome?

An unusual course of diabetes

A woman with a history of neonatal hyperglycemia and a relatively uneventful childhood without treatment, experienced significant hyperglycemia and retinopathy in adulthood, but what was the cause of her diabetes?

Necrotizing myopathy in a woman with type 1 diabetes

Identifying the cause of muscle necrosis can be a diagnostic challenge, as shown by this case of diabetic myonecrosis complicated by pyomyositis and abscess caused by Escherichia coli.

Abnormal glycated hemoglobin level in a patient with diabetes

HbA1c levels that don’t match the clinical picture need further investigation. Other factors, such as Hb variants, can interfere with the HbA1c measurement and make glycemic control difficult to achieve.

A challenging case of CAP

A woman presenting with community-acquired pneumonia developed several serious complications, likely due to co-existence of poorly controlled diabetes and a late diagnosis of thyroid cancer.

Overlooked effect of angiotensin receptor–neprilysin inhibitor

Caution is needed when assessing insulin secretion capability and nephropathy in patients with diabetes who are being treated with an angiotensin receptor–neprilysin inhibitor.

DPP4 inhibitors a cause of IgG4-related kidney disease?

A man with type 2 diabetes and IgG4-related kidney disease developed bullous pemphigoid. DPP4 inhibitor treatment, which also correlated with changes in renal function, was discontinued.

Managing exogenous insulin antibody syndrome

EIAS can cause hyperglycemia, hypoglycemia, and ketoacidosis in people with diabetes. This case in an older adult with type 1 diabetes shows how EIAS can be managed in an outpatient setting.

Insulinoma misidentified as schizophrenia

Intermittently scanning CGM detected hypoglycemia in a woman previously diagnosed with schizophrenia and treated with antipsychotic medication. Insulinoma was diagnosed and resected, resolving her neuropsychiatric symptoms.

ICI-induced insulin-dependent diabetes without islet autoantibodies

Rapidly progressive insulin-dependent diabetes in the absence of islet autoantibodies developed 2 years after starting treatment with the immune checkpoint inhibitor nivolumab.

Nonketotic hyperglycemia hemichorea-hemiballismus

HC-HB is a rare movement disorder that can occur in patients with poorly controlled diabetes and hyperglycemia without ketoacidosis. The mainstay of treatment is prompt correction of hyperglycemia.

Type 1 diabetes after COVID-19 vaccination

This case report considers two cases of type 1 diabetes diagnosed after multiple COVID-19 vaccinations. HLA haplotypes associated with susceptibility to type 1 diabetes were present in both cases.