The paper deals with the treatment of type 2 diabetes mellitus in an 80 years old female patient with complications making the standard treatment impossible. The change of treatment and administration of insulin glargin (Lantus) resulted in a significant decrease of blood glucose level from 20.3 mmol/l (at the beginning of the treatment) to relatively low level 6.6 mmol/l (measured on day 144 of the treatment). However the level of glycated hemoglobin which decreased from 12.6 % (IFCC) to 6 % (measured on day 144 of the treatment) is more relevant with respect to the assessment of therapy effectiveness. Selected effective treatment demands the administration of 64 U of insulin per day.

Key words: type 2 diabetes mellitus, obesity, diabetic complications, compliance, compensation, insulin glargin

We present cases of two patients (70 years old female and 49 years old male) with unstable type 1 diabetes mellitus which was difficult to manage with current insulin regimen. After switching to long acting insulin analogue frequent hypoglycemic and consequently hyperglycemic events have been reduced in both patients. Improved control of diabetes mellitus contributed to improved quality of life of both patients.

Key words: insulin analogues, unstable type 1 diabetes mellitus, hypoglycemia

The case history discusses a course of type 2 diabetes mellitus and cardiovascular complications in a male patient in whom thanks to adequate insulin selection and lifestyle changes consultations the long term control of diabetes mellitus has been improved without a need of increasing doses of insulin as well as his weight has been reduced. Patient’s quality of life has generally improved. 

Key words: type 2 diabetes mellitus, ischemic coronary heart disease, insulin therapy, insulin detemir

The paper refers to the benefit of administration of long acting insulin analogue (detemir) in a combination with oral antidiabetics in a female patient with type 2 diabetes mellitus. The dose of detemir is between 20 –24 U with stable dose of oral antidiabetics. Following one year of treatment we achieved a significant improvement of compensation (confirmed by decrease of glycated hemoglobin) without weight gain.

Key words: long acting insulin analogue, type 2 diabetes mellitus and obesity, insulin detemir, metabolic compensation

The paper discusses a female patient with type 2 diabetes mellitus who was born in 1948. It presents replacement of different insulin regimens up to the initiation of the treatment with intensified regimen using a combination of insulin analogues that finally resulted in achieving targeted values of diabetic control.

Key words: diabetes mellitus, insulin detemir, insulin regimens, reeducation, weight reduction

The paper confirms the advantages of administration of basal insulin analogue with extended action in contrast to human medium-term acting insulin in a female patient with type 2 diabetes mellitus who tends to nocturnal hypoglycemias.

Key words: insulin detemir, type 2 diabetes mellitus, nocturnal hypoglycemias

A female patient with type 2 diabetes mellitus was unsuccessfully treated with conventional and intensified insulin regimen. The use of depot and short acting insulin (in regimen basal-bolus) resulted in higher frequency of hypoglycemic episodes, significant diurnal fluctuation of glycemia and subsequently in inadequate long term control of diabetes mellitus. Combination of short acting and long acting insulin analogue completely eliminated hypoglycemic episodes and allowed to achieve very good long term metabolic control together with slight weight loss. The patient subjectively feels significant improvement with this new way of treatment.

Key words: insulin detemir, type 2 diabetes mellitus, metabolic compensation, hypoglycemia, weight, vascular complications

The case history of an obese type 2 diabetic patient presents a course of treatment and a process of its control during 10 years follow-up in a specialized diabetology outpatient department. The long term unfavorable levels of glycated hemoglobin gradually decreased from 10.8 % in 2004 to 6.2 % in 2007 following the administration of long acting insulin analogue detemir (Levemir), although the range of satisfying levels has not been reached yet (4.5–6 % according to IFCC). Detemir treatment significantly contributed to better control of this patient with objectified risk factors for further development of diabetic complications; it reduced frequent hypoglycemias and totally eliminated nocturnal hypoglycemias reported during the treatment with common human insulin. Patient reduced and consequently stabilized his body weight (together with the change of diet and exercise regimen). The patient assesses the current combined therapy with long and short acting insulin analogue as the recovery of normal life without concerns of hypoglycemia.

Key words: glycated hemoglobin, type 2 diabetes mellitus, hypoglycemia, insulin detemir

This case history describes the use of intensified regimen of insulin detemir in a patient with type 2 diabetes mellitus who developed diabetic foot syndrome. Successful healing of extensive infected defect around the insertion of Achilles tendon and heel demanded to achieve and maintain the best possible control of diabetes mellitus. Adding insulin detemir to current treatment resulted in a decrease of glycated hemoglobin from 7.2 to 4.6 % and in maintaining of improved control in subsequent 8 months that contributed to complete healing of the defect.

Key words: type 2 diabetes mellitus, diabetic foot syndrome, intensified insulin regime, insulin detemir

The paper discusses an obese male patient with type 2 diabetes mellitus and nonalcoholic hepatic steatosis. Initiation of treatment with insulin analogues has lead to both improvement of compensation of diabetes and significant decrease of hepatic enzymes levels as well as weight loss.

Key words: type 2 diabetes mellitus, obesity, non-alcoholic hepatic steatosis, insulin 
analogues

We present a case history of a 56 years old female patient with type 2 diabetes mellitus and advanced complications. The use of detemir analogue (Levemir) as a replacement of basal insulin secretion resulted not only in a significant improvement of diabetes mellitus control but mainly in relief of a long lasting pain caused by the diabetic neuropathy.

Key words: type 2 diabetes mellitus, diabetic neuropathy, control of diabetes mellitus, 
insulin detemir

Insulin analogues were proved in the treatment of type 1 diabetes mellitus. Their use in the treatment of type 2 diabetes mellitus pointed to new possibilities of achieving optimal compensation. Our case is an example of the chance to improve compensation of diabetes mellitus without the risk of frequent hypoglycemias and weight gain.

Key words: insulin analogues, therapy of type 2 diabetes mellitus, safety and effectiveness

The case history of a female patient with type 2 diabetes mellitus who following adding detemir to treatment regimen achieved reduction of hypoglycemic events and significant reduction of unstable glycemia.

Key words: type 2 diabetes mellitus, hypoglycemia, insulin detemir

The presented case history discusses a rare finding in a young female patient with parathyroid cyst that was finally pathologically verified. Fine needle aspiration biopsy (FNAB) is a method of choice in diagnosing of nodose formation on a neck. Also, in suspected cystic affections measuring of parathormone level in aspirate is recommended.

Key words: cyst of parathyroid gland, FNAB, intact parathormone in aspirate