The case presents an inadequately compliant female patient with type 2 diabetes mellitus, which manifested at her age of 16. Multiple organ complications including a significant and severe atherosclerosis of peripheral vessels with gangrene of toes resulting from a long lasting inadequate metabolic compensation developed at the age of 31. The patient comes from a family with a cumulative incidence of type 2 diabetes mellitus and other components of the metabolic syndrome.

Key words: type 2 diabetes mellitus, diabetic foot syndrome, nephropathy, insufficient metabolic compensation

A female patient with type 2 diabetes mellitus, in whom an intensified insulin regimen based on human insulins did not bring a successful compensation for a long time, significantly improved following a switch to a premixed insulin analogue in a 50:50 ratio, including a reduction of a total daily dose of insulin and a reduction of her weight. 

Key words: type 2 diabetes mellitus, intensified insulin regimen, body weight, premixed insulin analogue, treatment adherence

Lactic acidosis is a known adverse risk of metformin treatment. We report case in whom lactic acidosis developed during treatment. There were no contraindications to metformin treatment. Cause of lactic acidosis was acute renal failure leading to metformin accumulation. Acute renal failure was caused by combination of dehydration due to low intake of fluids when disabeled because of ankle fracture, concominant diuretic treatment of arterial hypertension and angiotensin-converting enzyme inhibitor treatment). Patient was successfully treated by combination of haemodialysis and infusion therapy. Patient was than treated by basal-bolus insulin therapy with advantage of insulin Levemir. 

Key words: type 2 diabetes mellitus, renal failure, lactic acidosis, metformin, basal-bolus insulin therapy, detemir

A fully valuable and active life, which length and quality almost approaches the life of patients without diabetes, should be the aim of the treatment of diabetic patients. As most of type 2 diabetic patients die from cardiovascular diseases or they are prematurely handicapped by their consequences, the diabetologists are focused on the cardiovascular risk and its possible modification in type 2 diabetic patients. The RECORD study showed a cardiovascular neutrality of rosiglitazon compared to metformine and sulphonylurea derivates. There was no difference between the number of hospitalizations and deaths caused by cardiovascular complications in patients treated with rosiglitazon and those treated with metformine and sulphonylurea derivates. The RECORD study also showed the significant improvement of a heart failure during the treatment with rosiglitazon compared to metformine and sulphonylurea derivates treatment. 

Key words:  cardiovascular risk, hospitalization caused by cardiovascular complications, death caused by cardiovascular complications, heart failure, incidence of fractures, incidence of malignancies

Our cases describe the progress of treatment in two patients with type 2 diabetes mellitus who following several years of being untreated demanded insulin therapy because of a failure of insulin secretion. The use of the intensified treatment with new basal insulins supported by a quality self-monitoring of glycemia enabled to stabilize a very good compensation with a regression of a painful form of a diabetic polyneuropathy in one patient while in other patient, who was unwilling to change his life style, the same strategy did not improve the compensation and he did not change his attitude even following a development of a painful form of an ischemic heart disease. 

Key words: intensified insulin treatment, humane insulins, insulin analogues, microvascular complications of diabetes, macrovascular complications of diabetes

Problems in a complex treatment of type 2 diabetes mellitus are described in a patient with extreme obesity and fully developed metabolic syndrome. The surgery led to a dramatic improvement of all metabolic parameters and simultaneously to a tapering off or even a withdrawal of multiple medications. 

Key words: obesity, type 2 diabetes mellitus, metabolic syndrome, bariatric surgery, metabolic surgery

A 26 years old patient with type 1 diabetes mellitus (active, formerly top-level athlete – a kick­boxer) is presented as an example of a potential benefit of a switch between basal analogues (detemir was replaced by glargin) on a control of diabetes mellitus and a reduction of hypoglycemic episodes. 

Key words: diabetes mellitus, hypoglycaemia, sport, insulin analogues, detemir, glargin