The paper presents the causality of three children of various ages – a baby, a toddler and eight-year-old girl suffering from type 1 diabetes mellitus who were not diagnosed in time and the symptoms of diabetic ketoacidosis were erroneously interpreted as indications of other complaints. In the first case of the baby with an anamnesis of repeated respiratory infections the alternation of this condition as a whole with marked tachypnoe was considered to be an acute bronchial infection. In the second case Kussmaul breathing led to a diagnosis of bronchopneumonia, acidotic colouring of the mucous membrane, yeast exanthema in the mouth cavity and difficulty in swallowing when dehydrated were diagnosed as tonsillitis. The eight-year-old girl suffering from dehydration, stomach ache and repeated bouts of nausea was sent to hospital suspected of some sudden stomach trouble which, following an examination by a surgeon, was diagnosed as acute gastroenteritis. A prompt glycaemia examination could have prevented in these children a marked failure of their internal organs.

In the presented causality a diabetes type 2 patient, also suffering from obesity and hypertension, accedes to expert treatment and radically alters his approach to his illness by launching out on a process of a new daily stereotype for a diabetic. This attitude toward his complaint is highly effective for observing the patient, for in the course of the study an essential reduction in medication therapy was achieved. This system of treatment albeit demanding timewise is relatively safe provided the patient adheres to the fundamental instructions.

Immobile type 2 diabetic patient with morbid obesity, polyneuropathy, polyarthrosis and ischemic heart disease with effort angina reduced 40kg of weight during orlistat treatment. All his complaints disappeared. After stopping the medication weight gain and hyperglycaemia reappeared. New therapy with orlistat was followed by weight loss and normalisation of blood glucose level again.

To persuade an adult man with Type 2 diabetes mellitus about the necessity of weight loss and change of usual way of life is sometimes a very difficult and time-consuming task. The realisation depends mainly on himself. It is the first step in the treatment strategy but the physician is often faced with misunderstanding and reluctance to cooperate. During continuous education the individual responsiveness of the patient should be taken in consideration together with his ambitions, expectations and ideas about his personal quality of life. It is very important to go in search of proper motivation that can wake up his aspirations.

Home care as an integral component of primary health care constitutes the future for identifying patients at risk of chronic DM 2 type complications, especially among senior citizens. As yet the task of nurses in performing home care has not been fully appreciated and moreover not every general practitioner makes use of this service nor has sufficient confidence in it. Causality has proven the enormous significance of team collaboration and conscientious edification of senior citizens suffering from diabetes which leads to patients managing to change their habits. A doctor's thorough diagnosis and a regular check up by a home-care nurse contribute to the quality of life of the diabetes patient thus preventing chronic complications.

Physical exercise plays an important role in the treatment of obesity and in the compensation of type 2 diabetes mellitus. In this causality we demonstrated the optimal effect of complex treatment in the case of an obese diabetic with a very low degree of physical fitness (cca 66 % average of the population), by combining therapy with regular physical exercise which was recommended on the basis of a spiroergometric examination. In the course of a three-month programme there was an improvement in the glyconated haemoglobulin by 0,8 % and after another two months by another 0,7 %. There was a weight loss of 5 kg, that is to say 7 kg (after 5 months) and a reduction in waist girth by 13 cm, respectively 16 cm. The results merely confirm that physical activity is vital for the successful treatment of obesity and diabetic compensation.

The causality demonstrates the case of a 28-year-old patient suffering from type 1 diabetes mellitus who developed central pontin myelinolysis (CPM), which is a rare diabetes complication. CPM in this case is diagnosed as the consequence of hypoglycaemia prior to treatment. Subsequently the patient was admitted to hospital once more with rare lesions of the cerebellum.

The paper describes the case of a type 1 diabetes mellitus patient who was treated for symptoms of diabetes as at the age of 10 by the application of short-acting insulin 3 - 4 times a day until the time when purified insulin was available. She recovered three times from ketoacidotic coma every time there was an attempt to treat the patient with depot insulin. Thanks to the excellent co-operation of the patient with diabetologist, her firm desire to live, daily self-monitoring of glycosuria and subsequently glycaemia, the patient today, after 57 years of suffering from diabetes, is enjoying good health except for slight micro-angiopatic complications.

The paper describes the case of a diabetes type 2 patient with progressive diabetic maculopathy bordering on a cystoid macular oedema, which was the cause of a significant decline in central sharpness of vision in both eyes. The macular oedema progressed after a laser coagulation of the retina and cataract operation followed by the implantation of lenses into both eyes. The primary performed pars plana vitrectomy did not lead to a functional improvement because the adherent posterior vitreous area which caused the vitreretinal traction and supported a cystoid macular oedema was not removed. After a second operation with the aid of pars plana vitrectomy entailing a careful removal of the adhering posterior vitreous area which we explained a "membrane blue" we noted an improvement of the central sharpness of vision in the case of the re-operated eye from 3/24 to a correction of -3,0 to 6/24 - 18 with correction -1,5 D. After re-operation the patient can read with the left eye the Jäger table nos. 5 - 4 with a hyper-correction of +4,0 D.

The paper describes the case of a 51-year-old man who suffered severe and extensive burns (78 % of his body surface) as consequence of being involved in an explosion. Immediate blood glucose values in the course of the first days following his admission were 10 and 15 mmol/l. Prior to this injury the patient had undergone treatment for high blood pressure and chronic kidney failure. His anamnesis gave no indication of diabetes mellitus. In the course of burn trauma treatment the patient underwent resuscitation following cardiac arrest. Subsequently a progression of kidney failure necessitated dialysis treatment. The blood glucose values remained high even after successful shock treatment, and the diagnosis of diabetes mellitus was confirmed on the basis of glycaemic profile values. Treatment with short-term action of insulin partially normalized the glucose metabolism disorder. The patient died on 39th day after the burn trauma despite intensive treatment of burns and of the end stage of kidney failure.

Causality is demonstrated in the case of a seventy-five-year old patient admitted to the clinic for treatment of temporal arthritis whereby while in hospital he developed decompensation diabetes. At first sight this appeared to be the consequence of high doses of glucocorticoids, but soon it became apparent that the patient was suffering from a serious oncological disease, which, however, was n-o-t manifested clinically. The only symptom indicating that the patient was suffering from a serious disease was an inadequate symptom of diabetes, or rather a non-standard glucose metabolism. Unlike in cases of type 2 diabetes patients where this condition is usually compensated by administering oral anti-diabetics, it was now necessary to gradually apply increasing doses of insulin. For several days this failed to stabilize the metabolism, on the contrary it became necessary to relatively increase the doses of insulin. An examination programme had to be designed, which included both biochemical and instrumental procedures, to help reveal the pathological or organic mutations and thus explain the recorded laboratory deviations. Within a short period of time it was shown that the value of one of the onco-markers – CEA – exceeded limits. And even though the anamnesis and clinical data showed absolutely no response, it was indicated by colonscopy. It therefore came as no great surprise that at a distance of cca 10-12 cm from the rectum a pathological formation, exulcerized, non-bleeding tumour of about a quarter of the circumference was found. Subsequently a histological examination unequivocally diagnosed a medium differentiated tubular adenocarcinom of the mucous membrane of the colon with sporadic necrosis. Again it must be stressed that this tumour was entirely without symptoms, that is to say clinically absolutely inert.

The author describes the case of a 76-year old patient, biologically fit considering his age, suffering from type 2 diabetes, who visited the clinic following augmented symptoms of left-side heart failure diagnosed on an echocardiographic image as diffusion of the left chamber. The patient underwent coronarographic examinations which previously were not indicated even though the patient doubtlessly experienced an acute myocardial infarction in 1983. The coronary angiography showed the patient to be suffering from a diffuse coronary effusion. The result of an isotope examination to determine the viability of the myocardium played a fundamental role in determining further procedure; doctors, including a coronary surgeon and a cardiologist, recommended conservative treatment. The first months indicated that the decision was correct, the patient's condition improved by one degree according to NYHA classification. In our opinion the chief role in the improvement was played by the addition of an inhibitor of a converting enzyme; we cannot underestimate the favourable influence of trimetazidin. The role of an increased concentration of lipoprotein (a) is not clear. We decided in spite of the "optimal" values of cholesterol and triglycerides to supplement the treatment with statin.

Symmetric distal polyneuropathy frequently leads to subsequent diabetic complications among undisciplined patients suffering from diabetes type 1 and 2.