The authors present a case of a 22 years old female patient after subtotal distal pancreatic resection for recurrent hypoglycemias and suspicion of pancreatic tail insulinoma. The suspecting insulinoma was diagnosed in another hospital based on some imaging methods and selective hormonal samplings. The diagnosis of insulinoma was not confirmed by pathology of the resected pancreatic tissue. Following the surgery the patient was treated for labile secondary diabetes mellitus and recurrent hypoglycemias demanding multiple hospitalizations in a local hospital but also in several specialized centers in Slovakia. The authors describe the problem of diagnosis and treatment of a patient with artificially caused sever hypoglycemias.

Key words: hypoglycemia factitia, diabetes mellitus

We present a case of a 30 years old patient with type 1 diabetes mellitus who was implanted a continual sensor to monitor glucose during a long term physical exercise (Marathon of mountain bikes Author – “King of Šumava”). Continuous monitoring of interstitial glucose level was performed by invasive sensor CGMS of Minimed Company and it lasted for 76 hours. The results explained that hyperglycemia prevailed during the whole period of monitoring (61 %), followed by normal glycemia (32 %) and hypoglycemia (7 %). Hypoglycemia during the race (2,7–3,9 mmol/l) was probably caused by both the incorrect insulin therapy and the diet. Physical exercise can have a positive effect on blood glucose level only provided that a corresponding diet and perfectly adjusted insulin therapy are kept. Monitoring confirmed the changes of glucose level corresponding to glycemic index of food.

Key words: type 1 diabetes mellitus, physical exercise, CGMS sensor, glycemia

Cardiac surgery is a method of choice in the treatment of symptomatic aortal stenosis. The indication in polymorbid elderly patients who suffer from aortal stenosis most commonly is to be considered carefully. Our case confirms that the replacement of aortal valve can be (at least medium-term) successful even in a patient with a history of previous cardiac surgery for ICVD, coincident hematological malignancy in a good partial remission and diabetes mellitus treated with insulin. 

Key words: aortal stenosis, valve replacement, spleen lymphoma, diabetes mellitus

Type 2 diabetes mellitus is a chronic metabolic disease caused by defective insulin secretion and action. Treatment standards to achieve criteria of compensation recommend sequential steps of the treatment beginning from a diet and counseling of lifestyle changes followed by oral antidiabetics and ending with insulin therapy. In our paper we analyze the problem of compensation of a 32 years old female patient with type 2 diabetes with BMI 36 kg/m², HbA_1c 7,6 % (IFCC) and primarily boundary value of lactate 2,31 mmol/l limiting the therapy with biguanides. The treatment with pioglitazone in a dose of 30 mg/day resulted in correction of laboratory profiles during 4 weeks and subsequently the level of HbA_1c decreased to 6,2 %. Following treatment was targeted to a weight reduction.

Key words: type 2 diabetes mellitus, pioglitazone, insulin resistance, dyslipidemia

Secondary failure of the effect of oral antidiabetics is caused by exhaustion of insulin secretion. Time point of the failure is different but usually it happens after more than 5–7 years. In our presentation we want to alert that in obese patient even after short manifestation of type 2 diabetes mellitus chronic decompensation can be caused not only by diet noncompliance but also by inadequate secretion of insulin. Our 152 kg weighting patient required high doses of insulin because of insulin resistance. The treatment with insulin glargine in doses exceeding 0,5 IU/kg did not caused night hypoglycemia in contrast to significantly lower doses of insulin NPH. Insulin glargine is a safe and effective way to achieve compensation in obese patients with type 2 diabetes mellitus.

Key words: type 2 diabetes mellitus, secondary failure of the effect of OAA, insulin glargine

We do not see very often complication of gestational diabetes mellitus (GDM) in young primiparas. For my presentation I chose a 22 years old female patient who developed GDM at week 24 of her first pregnancy and who was diagnosed with papilloedema of optic nerve with dramatic clinical symptoms at week 20. Uncontrolled hypertension was not present, proteinuria did not exceed 100 mg/24 hours, while both edema of lower extremities and a big weight gain were presented. The treatment was targeted to strict control of blood pressure and GDM. Confinement to bed and dietary measures helped to stabilize patient’s health condition. Papilloedema post partum subsided.

Key words: gestational diabetes mellitus, papilloedema of optic nerve, hypertension

In a female diabetic patient hardly controlled with intensified insulin regime the treatment of 2 doses of premixed insulin analogue appeared to be the most effective to achieve optimal control of diabetes mellitus.

Key words: type 2 diabetes mellitus, intensified insulin regime, premixed insulin analogues, compensation of diabetes mellitus

Diabetic foot syndrome represents a severe complication of diabetes mellitus; the term is used to describe destructive affection of foot tissues resulting often in serious consequences. The most important risk factors resulting in the defect are diabetic neuropathy and ischemia of leg. Patients with ischemic disease of lower extremities that is accompanied by infection fall into the most severe group. Case presents the patient with diabetic foot syndrome of ischemic etiology whose functioning leg was preserved thanks to early, aggressive and complex treatment (including revascularization, antibiotics, local treatment of defect, other methods supporting peripheral circulation and treatment of diabetes mellitus, dyslipidemia and hypertension).

Key words: diabetic foot syndrome, critical ischemia of leg

This is a case of a patient whose compensation was significantly influenced by the presence of unrecognized rheumatic disease.

Key words: type 2 diabetes mellitus, ankylosing spondylarthritis (AS), morbus Bechterev, patient compliance, clinical examinations, atherosclerotic complications of diabetes mellitus

The paper demonstrates how the wrong classification of diabetes mellitus leading to long term incorrect treatment and fixation on wrong lifestyle habits. The disease of a 15 years old boy was incorrectly diagnosed as a type 1 diabetes mellitus and treated with insulin from the beginning. More than 20 years later, based on examinations of C-peptide, autoantibodies and other markers, the disease was reclassified to diabetes mellitus type 2 with dominating insulin resistance and the treatment was adequately changed.

Key words: type 2 diabetes mellitus, wrong classification of diabetes mellitus

The case describes the syndrome of inadequate antidiuretic hormone secretion (SIADH). It is not a very common diagnosis nevertheless it can be encountered. As it has many causes, it is essential – after the diagnosis of SIADH – to perform a complex examination of the patient. Confirmed by the given case history this examination must be targeted to exclude a cryptogenic tumor which can manifest by paraneoplastic overproduction of antidiuretic hormone.

Key words: SIADH, paraneoplastic secretion, lithium