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Diabetology

Case Studies

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

Open Access Type 1 Diabetes Case Study

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

Insulinoma Case Study

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

Diabetes Case Study

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

Open Access Type 2 Diabetes Case Study

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.

Bruns–Garland syndrome as the initial manifestation of type 2 diabetes

Open Access Type 2 Diabetes Case Study

Diabetic radiculoplexus neuropathy, or Bruns–Garland syndrome, is a rare form of microvascular complication that more commonly affects the lumbosacral plexus and, very rarely, the cervical plexus.

HNF1A gene mutations and primary ovarian failure

Open Access Primary Ovarian Insufficiency Case Study

HNF1A mutations are responsible for maturity-onset diabetes of the young (MODY). Coexistence of POF and MODY 3 in an adolescent girl raised the idea that these mutations might also have a role in POF.

Late onset of immune checkpoint inhibitor-induced type 1 diabetes

Open Access Type 1 Diabetes Case Study

A patient with small-cell lung cancer developed type 1 diabetes many weeks after receiving serplulimab, highlighting the need for continued monitoring of blood glucose levels and early signs and symptoms of diabetes.

Chronic abdominal pain and constipation diagnosed as glycogen storage disease type IX

Open Access Metabolic Disease and Nutrition Case Study

A diagnosis of glycogen storage disease type IX is easy to overlook, but it should be considered in children presenting with unexplained hepatomegaly and elevated transaminase levels. Genetic analysis is vital for accurate diagnosis.

Type 1 diabetes and chronic kidney disease – monitoring glucose levels during pregnancy

This case indicates that capillary blood glucose monitoring should be used alongside intermittently scanned CGM when pregnancy is complicated by type 1 diabetes and CKD.

Advanced hybrid closed-loop use with diluted insulin in children less than 2 years old

This case series reports the use of advanced hybrid closed-loop technology with diluted insulin in four very young children with a low total daily dose of insulin, including a premature neonate with transient neonatal diabetes.

H syndrome, hyperglycemia, hypogonadism, and growth hormone deficiency

Open Access Hyperglycemia Case Study

H syndrome should be suspected if a patient has short stature, signs of hyperglycemia, and other endocrine and cutaneous abnormalities. Signs include hyperpigmentation, hypogonadism, hyperglycemia, and hallux valgus.

Rapid improvement of severe fatty liver in a patient with fulminant type 1 diabetes

Fatty Liver Case Study

A case of severe fatty liver in a woman diagnosed with fulminant type 1 diabetes who had no history of obesity or dyslipidemia. Within 17 hours of insulin treatment being started the severe fatty liver improved.

Acute-onset blindness due to severe metabolic lactic acidosis

Open Access Metformin Case Study

Metformin-associated lactic acidosis can cause acute blindness, but vision may be recovered by timely treatment of acidosis. Physicians should be aware that even if patients have severe metabolic acidosis they can still have stable vital signs.

Life-threatening coronary vasospasm in patients with type 2 diabetes treated with SGLT2 inhibitors

Ketoacidosis Case Study

Two cases highlighting the potential association between coronary vasospastic angina and SGLT2-inhibitor-induced euglycemic diabetic ketoacidosis. Early detection of ketoacidosis, electrolyte replacement, and acid–base balance normalization are crucial.

Type B insulin resistance during treatment for NMOSD

AQP4-IgG-positive neuromyelitis optica spectrum disorders are often associated with other autoimmune disorders, but this is the first report of type B insulin resistance, which developed 8 months after initiation of eculizumab.

Clopidogrel-induced non-diabetic hypoglycemia

Open Access Hypoglycemia Case Study

Thorough evaluation of all possible causes of hypoglycemia, including medication, is essential, as shown by this case that occurred in a patient without diabetes after clopidogrel was initiated.

Werner syndrome in a patient with hyperglycemia

Hyperglycemia Case Study

Diabetes is one clinical manifestation of Werner syndrome, a rare hereditary autosomal recessive disorder. Poor glucose control was the main complaint for the patient in this case study, who was found to have a novel WRN p.I223fs mutation.