A more intense application of insulin may sometimes paradoxically lead to a deterioration of the existing diabetic retinopathy. This phenomenon was recorded back in the 80s of the last century and is now termed a phenomenon of syndrome of normoglycaemic re-entry. This syndrome is above all described in the case of patients suffering from type 1 diabetes. In this paper, however, we present a less frequent case of a patient suffering from type 2 diabetes undergoing oral anti-diabetic treatment, in whose case the application of more intense doses of insulin caused an acceleration of a medium advanced non-proliferated form of diabetic retinopathy. We analysed the cause of this deterioration and the existing preventive options available from the point of view of ophthalmology, diabetics and the patient himself.

Key words: type 2 diabetes mellitus, glycol haemoglobin, premature normo-glycaemic deterioration, diabetic retinopathy, laser treatment

We present a case report of 16-year-old boy treated from 6 years of age for type 1 diabetes mellitus with persistent non-compliance with high level of glycosylated haemoglobin hospitalised for emergent hepatomegaly. After exclusion of infectious, vascular, other metabolic or proliferative causes and because of normalized liver enzymes and hepatomegaly after strict diabetes control, our conclusion was secondary glycogenosis related to diabetes. In the follow-up, the patient was in-and-out compliant, fluctuation of glycosylated haemoglobin was in close relation to the changes of liver enzymes and hepatomegaly.

Key words: hepatomegaly, glycogenosis, type 1 diabetes mellitus, non-compliance

This is a case of a patient with a highly unstable LADA type of diabetes mellitus with repeated serious incidents of life-threatening night hypoglycaemia and a very speedy development of organ complications only two years after the sickness was diagnosed.
Mostly the hypoglycaemia occurred at night, gradually the frequencies increased as well as the intensity which required the assistance of another person and subsequently often a few days in hospital. In this case we noted a combined set of causes for the hypoglycaemia – irregular meals, an increase in physical strain and inadequate doses of insulin. The patient was repeatedly instructed and advised on the correct way of dealing with hypoglycaemia.
Considering the high frequency, the intensity of night hypoglycaemia we chose to apply compensation by introducing a continual subcutaneous application of insulin with an insulin pump. Unfortunately the patient was incapable of handling the pump properly and the faulty use led to life-threatening conditions. So that this led to a reversion to the application of insulin injections and the selection of insulin analogues combined with glargine in morning doses and lispro with the main meal. The effect of this treatment was satisfactory; the long-term metabolic compensation is comparable.

Key words: LADA, hypoglycaemia, continual subcutaneous application of insulin, insulin analogue

It is a case report of a 45-year-old patient with diabetes mellitus type 1. About eight years he suffered from gradual deterioration of erection. He changed some medicaments for an improvement of the erection. Now he uses sildenafil and tadalafil with a good effect.

Key words: diabetes mellitus type 1, erectile dysfunction, sildenafil, tadalafil

The paper attempts to evaluate the treatment of newly diagnosed type 1 diabetes mellitus in an outpatient clinic. Rapid compensation in a young woman with type 1 diabetes mellitus led to postinitial partial remission in the third month after diagnosis. The early onset of remission can be associated with the prompt diagnosis and rapid compensation of the disease. The remission despite its short duration can be considered as a favourable prognostic factor for the further sequel of the disease.
The advantages of outpatient management in newly diagnosed type 1 diabetes mellitus are unquestionable. It allows the patient to return back into a worthfull and productive life without delay.

Key words: type 1 diabetes mellitus, metabolic compensation, post-initial partial remission

A woman, born in 1953, suffering from type 1 diabetes mellitus which was diagnosed when she was 17, was treated from the initial stage with daily doses of insulin, later with two. Now the routine has been intensified and insulin is applied four times a day. We have observed the patient on a regular basis since 1992 for the syndrome of a diabetic leg, mostly based on diabetic polyneuropathy. The patient has undergone amputation of the toes on both feet, has experienced repeated skin grafts on both soles of her feet, repeated treatment with PGE1 and ATB infusions. From the initial stages of treatment she rejected various aids to alleviate her handicaps (therapeutic shoes, crutches, later a wheel chair); until the end of the therapy she wore lighter plaster-of-Paris immobilizers. Now she has undergone amputation of her left leg at the shin due to a chronic defect and osteomyelitis with positive resistant staphylococcus which could no longer be treated by a conservative method due to an allergy to vankomycin.
The patient experienced a serious stressful state of mind before the drastic amputation which almost led her to commit suicide, but she is currently SWW in an optimistic frame of mind. Four months after the amputation she is now capable of walking on her own with an artificial limb. She does not use crutches, feels “healthy”. However, there is a threat that the other leg will have to be amputated if she overtaxes it. Some serious situations, which cannot be solved by a slight amputation, in spite of the best of intentions, and non-cooperation of the patient to spare straining the leg, may be solved by planning a shin operation, which the patient can tolerate. The shin, however, must be closely observed to prevent ulcers and the amputation of the other leg.

Key words: diabetic leg, polyneuropathy, amputation

The paper describes the experience of a several-year-long finally successful treatment of type 1 diabetes mellitus of a formerly long-term undisciplined and practically permanently sub-compensated artist. This was due to his wife’s single-minded systematic cooperation in playing a key role is achieving reasonable compliance and an improvement in the patient’s condition.

Key words: type 1 diabetes mellitus, stroke, diabetic neuropathy, insulin therapy, self-monitoring, glycosed haemoglobin, compensation, compliance

We present a paper dealing with a 29-year-old patient suffering from type 1 diabetes mellitus diagnosed when she was 13-years-old. Ever since she was diagnosed she was treated with intense doses of insulin. Following permanent unsatisfactory compensation (glycosed haemoglobin between 15 – 17 %) treatment with an insulin pump was applied. The glycosed haemoglobin decreased to 9 – 10 % in 2000 following the application of the insulin pump. However, in spite of repeated attempts to enlighten the patient we have not succeeded in an improvement in compensating her diabetes and eliminating acute decompensation. We are considering the option of interrupting the insulin pump treatment and reintroducing an intensive application of insulin.

Key words: diabetes mellitus, insulin pump, ketoacidosis

The paper reports on a clinical experience whereby a unilateral ptosis of the eyelids may be a symptom of a serious metabolic illness, or a complication of this complaint. An impaired nerve may be the first sign of diabetes mellitus.

Key words: type 2 diabetes mellitus, diabetic polyneuropathy, oral glucose toleration test (oGTT)

Diabetes patients suffer from a high rate of undetected ischaemia, an inadequate coronary blood flow is frequently serious and complex. Percutaneous and surgical methods of treatment lead to a greater morbidity and mortality rate. The paper describes the case of a 74-year-old patient whose minimal and atypical symptoms disappeared following treatment with aspirins and statin which led to postponing invasive examinations. Following a sudden occurrence of unstable angina pectoris the patient immediately underwent examinations on a coronagraph which indicated the need for instant surgical myocardial revascularization. Subsequently, the patient underwent a pre-obliteration of a mammary bypass on the ramus interventricularis anterior and was treated percutaneously with an implantation of a stent. Later a restenosis occurred in the stent, this time it developed into an acute infarct. Following repeated unblocking of the graft the patient has not suffered any serious complaints for several months. 
Our paper therefore proves that in spite of the afore-mentioned complications success can be achieved in the apparently hopeless case of a diabetic patient by applying a combination of drastic procedures and intensified medication.

Key words: type 2 diabetes mellitus, heart ischaemia, surgical myocardial revascularization

The paper demonstrates how cooperation between a general practitioner and home care nurse is important for quality of life of their patients. The paper also recommends forms of nursing the consequences of diabetes. It mentions the significance of damp therapy in the case of chronic wounds which play a significant role in reducing the healing time and so enables an earlier return to work. This then not only saves health insurance companies money, but also cuts the expenditure of social security benefits. 

Key words: diabetes mellitus, damp therapy of chronic wounds, home care

This report describes a case of a 52-year-old obese woman with type 2 diabetes mellitus presenting with acute respiratory failure and very significant insulin resistance necessitating the infusion of high doses of a short acting insulin analogue. Due to the seriousness of her condition, mechanical ventilation, massive parenteral fluid replacement with potassium and albumin supplements and antibiotic therapy were instituted as well. This resulted in correction of metabolic derangements, regaining of normal consciousness and successful weaning from mechanical ventilation. Later on, diabetes mellitus was satisfactorily controlled by an intensive insulin regimen.

Key words: acute respiratory failure, type 2 diabetes mellitus, insulin resistance

A deterioration of the function of the thyroid gland is a characteristic feature influencing fertility. It is less likely to be taken into consideration in the case of dermatological hyperandrogenous symptoms. This paper deals with a patient in whom this hypofunction was manifested by such problems. Following the treatment of hypotyreosis the problems diminished.

Key words: hirsutism, acne, hypotyreosis

The paper describes the case of a 70-year-old patient who was by chance diagnosed as suffering from hypercalcemia and diagnosed for primary hypoparatyreosis in a clinically apparently non-symptomic period. A more detailed examination ascertained only secondary osteoporosis without pathological fractures. Considering the failure to precisely localize the adenoma in the pituitary gland a thorough examination of the neck was undertaken two years later. The surgeon found the adenoma attached to the pituitary gland on the right hand side under the lower end of the thyroid gland. Four years after the operation the patient’s condition improved almost ad integrum.

Key words: primary hypoparatyreosis, adenoma attached to the pituitary gland, hypercalcemia

In the case of a 37-year-old woman with an anamnesis of oligoamenorea and acne and borderline hypertension, it was ascertained that she was suffering from hypercalcemia in the course of primary hyperparatyreosis. This did not recede entirely following adenomarectomy of the pituitary gland (and the normalizing of PTH). The development of more complaints led doctors to diagnose active acromegaly (retrograde anamnesis pre-dates the existence at least three years ago of the complaint) bordering on macroadenoma of the hypophysis following partial hypophysealectomy (while preserving the other trophic functions). The activity of the acromegaly (confirmed by the residue) in treating with a dopamine agonizer persists, the residual pituitary glands are eufunctional.

Key words: hyperparatyreosis, acromegaly, hypercalcemia, acne

Authors describe the case of a patient in a state of relapse marked by fainting and attacks of cramp which were treated on a long-term basis as secondary epilepsy following an operation of an adenoma of the pituitary gland. The attacks of unconsciousness, however, were connected with hypoglycaemia. The cause of the hypoglycaemia was found to be the result of the organic hyperinsulinism, which combined with the presence of hyperparatyreosis and prolactinom creates an image of type 1 multiferous endocrinal neoplasm – Wermer syndrome. The paper demonstrates the multiferous clinical image when several endocrinal organs are impaired, especially when it is the case of previously modified therapy.

Key words: hypoglycaemia, Wermer syndrome