Diabetes mellitus type 2 accompanied by an extreme obesity demonstrated in a young female patient two years following the left adrenal extirpation for peripheral nodular hyperplasia with clinically manifested Cushing’s syndrome. It resulted in an increasing insulin resistance, which caused a long-term metabolic decompensation with an early manifestation of the late neurological complications. The presence of infectious skin complications further accented the poor diabetes control. Neither the conventional insulin treatment nor the intensified insulin regime significantly improved the metabolic state, only the unconventional insulin regime by the insulin pump resulted in the achievement of a long-term suitable metabolic compensation and following correction of other objective metabolic parameters and only very slow remission of the neuropathy symptoms in the lower extremities.

Key words: diabetes mellitus type 2, Cushing’s syndrome, metabolic compensation, hyperglycemia, intensified insulin regime, insulin pump, diabetic polyneuropathy

The case study shows a relatively dramatic influence of a setting up of a continuous insulin therapy on the development of complications in a patient with type 1 diabetes mellitus.

Key words: type 1 diabetes mellitus, continuous insulin therapy, complications

In the article is presented a case history a female patient with newly detected type II diabetes mellitus, by whom late diabetes complications were present at the time of diagnosis. Patient’s complaints resulting from these complications were interpreted as sing of a chronic degenerative arthropathy, which lead to the overuse of non-steroid analgesics. Only the attack of upper gastrointestinal tract bleeding lead to diagnosing the diabetes and commencing adequate treatment. 

Key words: type II diabetes mellitus, late diabetes complications

In this paper we present a case history of a 17 years old female type I diabetes patient, who has been treated for this disease since 2001. The patient treated by an intensified insulin regimen of basal/bolus type is a student of a sporting grammar school. Due to problems with handling of school activities, she discontinued her profession swimming activities. Within one year, this resulted into weight gain of 10 kg along with decompensation of the diabetes associated with an increase of insulin consumption up to 65 IU/24 hours. She was repeatedly hospitalized at the pediatric department due to both decompensation and diabetic ketoacidosis. The illness was eventually controlled by setting up of an insulin pump with a short-acting insulin analogue. This therapy allowed for return to active sport activities and regular training program.

Key words: type 1 diabetes mellitus, insulin pump, sport

48 years old male type 2 diabetes mellitus patient tested a novel model of prophylactic diabetic shoes for 2 years. He was continuously followed by diabetologist, medical podiatrist and shoes technologist. Despite of a satisfactory diabetic control the patient developed progression of both microvascular and macrovascular diabetic complications (retinopathy, nephropathy, neuropathy and microangiopathy progressed to a more serious stage) after two years, however, the clinical finding on the feet did not get worse. On the contrary some parameters of interest even improved which we consider to be related to the use of the prophylactic diabetic shoes because other foot care remained the same as before the start of clinical testing.

Key words: diabetic foot syndrome, risky foot, health diabetic footwear

Elderly demands specific approach and diagnostic decision in surgery indication both of acute and scheduled procedures. Our case history points out to the unreasoned delay of acute surgical procedures in senior patients until the surgery is performed from “vital indication” which results in the worsened quality of life of patients in the “waiting for procedure” period, the increased risk of permanent mobility impairment and the self-sufficiency decrease and the increased risk of long-term post surgical mortality. In conclusion, we recommend certain necessary examinations to be performed before responsible discretion to surgery indication in elderly patients.

Key words: general criteria to assess surgical risk – ASA, cardiovascular risk assessment, assessment of functional capacity of seniors – mental and physical abilities

Weight loss and slimming is a common complaint of seniors. A slight weight loss in elderly is physiological. Main causes of unclear slimming are organic diseases, mental disorders and psychosocial reasons. Authors present a case of a patient with unclear weight loss that was initially attributed only to the recent diabetes mellitus.

Key words: diabetes mellitus, slimming

We present the benefit of a conservative treatment with orlistat in a type 2 diabetic patient. The patient with a significant obesity (weight 146 kg, BMI 40 kg/m2), insulin resistance, uncontrolled hypertension and poor compliance (treatment withdrawal) was successfully compensated, even with respect to diabetes mellitus, following a compliance improvement and beginning of obesity treatment. Concurrently to the diabetes control improvement and the body weight lowering the patient could gradually down-titrate and withdraw insulin and oral antidiabetics and he remained treated by diet only. The weight reduction provided for a combined antihypertensive treatment reduction, lipid spectrum improvement, big joints pain and fatigue relief, improvement of movement (total left hip joint replacement).

Key words: obesity, diabetes mellitus type 2, orlistat

An extremely obese female patient with weight gains during pregnancy and menopauses, repetitive attempts on weight reduction by a diet lead to further weight gains (yo-yo effect). Successful treatment during the 3rd hospitalization, at the beginning of which the patient was in a critical state in connection with concurrent illnesses. Now, the patient presents weight stability, has reduced her weight by 64 kilograms in total and has been indicated for gastric by-pass as an long-term effective solution of the morbid obesity.

Key words: morbid obesity, yo-yo phenomenon, gastric bypass

Author describes a case of a female patient with recurrent syncope, a cause of which was diagnosed after hospitalization at both the Neurology and Internal Department. The diagnosis was followed by a complicated search for insulinoma itself, which was detected only per-operatively.

Key words: insulinoma, nesidioma, hypoglycemia

Presented case histories document symptoms variability and demonstrate how atypical the results of laboratory assessment in primary hyperparathyroidism can sometimes be, that can subsequently pass unnoticed for a long time to a final problem solving. They point put to the multidisciplinary cooperation in the diagnosis of this disease.

Key words: primary hyperparathyroidism, symptoms variability

PAES II is an autoimmune disorder of two or more endocrinal glands often associated with an autoimmune disorder of non-endocrine organs. The case history presents a female patient with the autoimmune thyreopathy who presented in a connection with an increase of thyroid gland substitution by levothyroxine with so far undiagnosed hypocorticalism caused by the autoimmune adrenallitis. Concurrently, the premature menopauses caused by the autoimmune oophoritis was present, in addition to that, during the screening on organ specific antibodies a presence of ICA antibodies was detected, which may indicate presence of an asymptomatic prediabetic stage.

Key words: Polyglandular autoimmune endocrine syndrome, autoimmune thyreopathy, Addison´s disease, substitution treatment, screening of organ specific antibodies, prediction

Insulin glargine (Lantus) is a modern tool for the treatment of both type 1 and type 2 diabetes mellitus offering 24hours covering of the basal insulin demand, in addition to a more or less stable level. The important part of a correct therapy adjustment is a gradual up titration of the insulin doses aiming to achieve normal glycemia. One of the recommended methods of patient’s self up titration of glargine (Lantus) is a method of 3 day steps with a gradual efforts to achieve targeted morning fasting glycemia of ≤ 5,5 mmol/l. The case history presents an example of such a method in a female patient with type 2 diabetes mellitus treated by the intensified insulin regime, in whom so far used human insulins were replaced by their analogues (lispro, glargine).

Key words: glargine, titration, hypoglycemia, self-monitoring

The case demonstrates that preservation of physiologic proportion of prandial and basal insulin secretion in the “basal-bolus” treatment regime results in better metabolic control of type 1 diabetes mellitus. In the reported case, the adjustment of proportion between the short-term and the long-term analogue was possible without the change of the total daily insulin dose.

Key words: basal and prandial insulin secretion, basal-bolus system, metabolic control of diabetes mellitus

The case of a 61 years old type 2 diabetes mellitus patient with advanced diabetic complications who achieved significant improvement of disease control and simplification of the treatment by higher dose of insulin analogue glargine (Lantus) as a basal secretion replacement despite of irregular regime.

Key words: type 2 diabetes mellitus, insulin regime, insulin glargine (Lantus)

Application of the long-term basal analogue glargine in the treatment of type II diabetes mellitus provides for improvement of patients´ quality of life. This case history depicts development of treatment of a type II diabetic patient, which was significantly influenced by the changes in both professional and personal life of the patient and alike by treatments available in late nineties of the past century. Pursuit of good diabetes compensation is connected with the risk of hypoglycemia. The case history supports the benefits of the long-term analogue glargine for good compensation of the diseases, but also for the safety of the insulin therapy. The case history confirms that it can be achieved by the knowledge of the pharmacokinetic characteristics of the insulin glargine, by the application of self-monitoring and co-operation with an educated patient.

Key words: type 2 diabetes mellitus, diabetic control, insulin regime, glargine

The case of a female type 2 diabetes mellitus patient who achieved good metabolic control, better weight control and subjectively good condition with intensified regime of insulin analogues only after significant adjustment of proportion of long-term and short-term acting analogues favoring insulin glargine.

Key words: type 2 diabetes mellitus, insulin regime, insulin analogue, insulin glargine, Lantus, metabolic control

Long-term acting insulin analogues proved to be effective in the treatment of both type 1 and type 2 diabetes mellitus. In the presence of insulin resistance is the common dose of the long-term acting insulin analogue ineffective. The case demonstrates the course of type 2 diabetes mellitus and the need of gradual up-titration of glargine dosing according to fasting glycemia levels 5,5 mmol/l to higher total daily dose, i.e. the dose leading to optimal diabetes control.

Key words: type 2 diabetes mellitus, insulin analogue, insulin glargine, metabolic control, glycemia profile