Case report of 14-year old girl, presented with hyperosmotic diabetic coma as first manifestation of type 1 diabetes mellitus. Because of her serious condition we started with treatment with massive parenteral rehydration, antiedematous therapy and low dosed insulin. These procedures allowed correction of internal environment and consciousness without arteficial ventilation, central venous catheter insertion or bicarbonate administration.

Key words: hyperosmotic coma, ketoacidosis, type 1 diabetes mellitus manifestation

A description of a patient suffering from long-term type 2 diabetes and hypotyreosis whose weakening of his lower limbs was initially erroneously attributed to diabetic polyneuropathy. Only a more thorough examination proved that the ependymom of the spinal cord was the cause of a gradually developing weak paraparesis of the lower limbs. The author stresses the signficance of circumspect differentiation when diagnosing diabetics suffering from a polyneuropathic syndrome.

Key words: polyneuropathy, weak paraparesis, ependymom

The patient is an obese man, a diabetic aged 61, who has been suffering from type 2 diabetes mellitus for 28 years, which recently has been satisfactorily compensated by keeping to a diet and gliclazid. The patient has an almost ten year anamnesis of symptomatic mutli-stage vascular complications and has undergone repeated percutaneous treatment. The dominant ischaemic diseased lower limbs with a maximum of peripheral as well as obtrusive insoluble changes are considered to be the key causes for the defect on the right heel failing to respond to treatment. This defect underwent repeated surgical treatment at critical intervals.
Six weeks following surgical treatment of this defect the patient displayed signs of acute hepatocellular damage - slight hyper-bilirubinemia, elevation of ALT, AST and GMT. Following initial examinations the serial markers of viral hepatitis A, B and C were absolutely negative. In the course of time ALT and AST exhibited absolutely normal values and there was a significant reduction of all the other "liver enzymes". After another two months, however, a similar laboratory image appeared once more and following repeated examination of virological markers there was proof of reactive anit-HCV antibodies. This therefore led us to suspect an acute infection of a hepatitis C virus. This diagnosis was soon substantiated by a positive proof of HCV RNA. serums. After a two month interval from the time of establishing the diagnosis we launched anti-virus therapy based on a two-phase treatment plan with the use of conventional interferon alfa. The first phase is still under way, during which a virological response has been achieved. Nevertheless we can naturally not express any certainty regarding a definite effect.

Key words: diabetes mellitus, hepatitis C, inductive scheme of monotherapy

The patient has suffered from type 1 diabetes for 19 years is now undergoing treatment following unsatisfactory compensation and initial late complications with the insulin pump. During the last two years the compensation of diabetes deteriorated and therefore the patient was repeatedly requested to attend reconditioning sessions to reeducate her in operating the insulin pump. In spite of this the patient caused herself serious hypoglycemia by faulty manipulation with the insulin pump. It is vital to repeat patient's education in the use of an insulin pump.

Key words: insulin pump, acute complications, diabetes patients' educatio

54-years old man with diabetes and a history of right-sided nephrolithiasis was admitted to the hospital because of pain and swelling of the right thigh. CT of the lower abdomen and thigh showed perinephric abscess with bubbly gas (i.e. emphysematous pyelonephritis), with continuous spread to the pelvis and right thigh. Surgery was performed in his serious state, and foul smelling pus was drained from the retroperitoneal and subfascial space. Acinetobacter Baumanii was identified as the responsible pathogen. He was further treated with antibiotics and right-sided nephrectomy was performed later on an elective basis. 
Emphysematous pyelonephritis (EP) is an uncommon, life threatening infection of the upper urinary tract and it is characterized by bacterial acid fermentation of glucose leading to gas production. 90 % of the patients have diabetes. Gram-negative bacteria (E. coli, K. pneumoniae and Acinetobacter sp.) are the most common pathogens. The radiological picture is characterized by fluid collections and bubbly gas. If gas is found only in the renal collecting system, the disease is termed emphysematous pyelitis, for cases in which the gas is seen in the renal parenchyma or in the perinephric space we use the term emphysematous pyelonephritis.

Key words: emphysematous pyelonephritis, diabetes mellitus, abscess, infection

The prevention of chronic complication od diabetes mellitus is only possible by long-term maintenance of glycemia close to normal values. This aim can be achieved by an individual approach in proposing the regime the patient should abide by.The possibilities of treatment employing various types of insulin have been extended in recent years by the practical introduction of insulin analogues. On the basis of two causalities we demonstrate the advantages of treating diabetes mellitus with a briefly effective insulin analogue.
The causalities were presented in a seminar by Novo Nordisk when a representative of the firm introduced novelties in the treatment of diabetes mellitus in Kosice (Slovakia) on 19. 09. 2003.

Key words: insulin analogue, hypoglycemia, postprandial glycemia

A case of a malignant course of type 2 diabetes mellitus in a 74 years old women is presented. Diabetes type 2 appeared in 54 years. Ten years later clinical coronary heart disease (CHD) was ascertained. Since that time the macroangiopathy rapidly proceeded and advanced microangiopathy appeared as well. High risk of diabetic complications was accounted for family history of premature CHD, probably due to familiar combined dyslipidemia. We wondered whether under contemporary recommendation for therapy and prevention of diabetes type 2 and CHD in clinical practice the malignant course would be prevented.

The concern is the causality of a 52-year old patient who had been suffering from type 1 diabetes for some 25 years and was sent to a diabetic centre to be transferred to insulin pump treatment to facilitate decompensation of diabetes. Following intensive schooling there was a marked improve- ment in the patient's metabolic compensation even when the insulin pump was eliminated.

Key words: type 1 diabetes mellitus, education of the diabetic patient, self-monitoring, hypoglycemia

Transient neonatal diabetes mellitus is a rare self-limited cause of hyperglycaemia that usually occurs in small-for-gestational-age newborns. Hyperglycaemia may cause glykosuria with osmotic diuresis and dehydratation. Severe hyperglycaemia with marked serum hyperosmolarity may cause neurologic damage. Permanent diabetes mellitus does not usually develop.
The pathogenesis of transiet neonatal diabetes mellitus is multifactorial and genetic
influences may regulate several of theses processes. Possible candidate genes contributing to development of transiet neonatal diabetes mellitus are genes on chromosome 6, especially area 6q24.

Transient refractive changes are well recognised features of diabetes and not only ophtalmologists but especially paediatricians should always check for diabetes mellitus
in any case of rapidly changing refraction.

Key words: diabetes mellitus type 1, transient refractive changes

The cause study of a 35-year old patient suffering from the inception of ketoacidosis and low values of C-peptide, and now an eight-year remission. 

Key words: type 1 diabetes mellitus, honeymoon period

The cause study submitted demonstrates the case of an obese diabetic, hypertonic and cardiac patient. in whom there were gradual symptoms which may be described as a whole as paraneoplastic manifestations. The author describes in detail the development of this complaint, more specifically the symptoms leading to a singular clinical conclusion. Furthermore there is a description of examinations unequivocally confirming the clinical diagnosis and the subsequent comprehensive treatment.

Key words: diabetes mellitus type 2, obesity, hypertension, ischemia of the heart, paraneoplastic manifestations, clinical conclusion, nephrectomy, Grawitz kidney tumour, fever, renin-angiotensin system, juxtaglomerular apparatus of the kidney, aerob glycolyza

A description of two elderly patients suffering from diabetic complications of the lower limbs who on the recommendation of their general practitioners became home-care patients. The first of the above-mentioned causalities draws attention to the need for greater attention, regular observation and checkups of senior citizens suffering from polymorbidity and poses the question of the quality of life and the fate of the sick at such an advanced age after amputations. The second points in particular to the importance of the patient's full confidence in the doctor and the nurse responsible for the home care which forms the basis of his active cooperation and the will to take responsibility in part for his own state of health without which all medical efforts are in vain.

Key words: diabetese mellitus, diabetic foot, amputation, home care

According to a classification introduced in 1997 diabetes mellitus is divided into 4 groups - DM type 1, DM type 2, other specific types of diabetes and gestational DM. The paper reports on the course of secondary diabetes mellitus in the case of a patient suffering from an over production of cortisol in the progression of metastasis of the adenocarcinom of the right suprarenal gland. Hyperglycemia was one of the manifestations. Treatment with cytostatic mitotan, which unfortunately failed to curtail the growth of the tumour, did have the effect of inhibiting steroid genesis and so enabled the reduction and gradual elimination of insulin in the diabetes treatment. It therefore follows that patients showing symptoms of diabetes must undergo vital basic clinical and anamnestic examinations supplemented by basic laboratory tests. This should prevent the oversight of other diseases and thus a faulty evaluation of secondary diabetes mellitus.

Key words: secondary diabetes mellitus, endogenous hypercorticism