Dear Madam. I am more in touch with Dear Dr.Mohanji...So I was lacking vary valuable posts of yours. Well, i have read about your case handeling of Mauriac Syndrome...The rarest to diagnosed.... Before I proceed let me clear that I am bit Orthodox academician..Ask more to Mohanji.. In Commonwealth and European countries..... to label "Majuriac Syndrome ".. Following are necessarily to be ticked... * Hepatomegaly..Due to intra hepatic glucogen deposits. * Growth/Puberty delay. * Elevated Transminas &S.Lipids. * Cushingoid features. * Nephropathy & Microvascular complications like Retinopathy.. * Puberty delay... I had a line to approach .. * Endocrinology../Pediatrics / Nutritions / Psychology & Psychiatric.. You both have performed wonderful task.. But where am I confused is... ABSENCE OF RATINOPATHY..!!??? I like Dr.Prasad approach.he seems to be more similar to my nature.. Convey my regards to my dear Mohanji.. I wish all the success in your professional Carrier.. Pranam.
Really a good catch.!.congrats- Madam and Sir. U could have released some more data that could have made the diagnosis still impressive. 1) an u/s report cofirming ' extreme hepatomegaly. 2) Ht/ wt percentiles to substantiate ' grouth retardation' 3) age to substantiate delayed puberty. 4) Duration of inadequately treated hyperglycemia - as the syndrome occurs after prolonged poor control of hyperglycemia. 5 BMI- TO SUPORT OBESITY. 6) FULL PIC TO SUGGEST CUSHINGOID FEATURES. 7) BLOOD SUGAR LEVELS AT THE START OF TREATMENT. 8) FAMILY HISTORY. FOR PUBLICATION PURPOSE- 9 )LIVER BIOPSY. 10) GENE DEFECT ANALYSIS. WITHOUT 9 AND 10 THE DATA FORTIFIED WITH POINTS 1 TO 8 STILL MAKES A GOOD CASE REPORT. IF DONE IT WOULD BE A FEATHER IN CAP OF " SEPURIS ". CONGRACTS AND WISHING WIDER APPRECIATION BY WAY OF PUBLICATION ...I remain ( that should have been done b 4 !, better late than never !) Regards...
Fundus shows diabetic retinopathy with papilledema, signifying raised ICT what about left eye. What is the vision
We both are very happy to diagnose a very rare case in our Sepuri Diabetes center.
Thanks for the informative post....@Dr. Sepuri Tirumala Devi
I have similar case of 18 yes old male with uncontrolled dm1
Congratulations for your achievement Convey Madam also
Congratulations ma'am and dear sir,,, very useful
Good explanation. Happy to see such cases.
CONGRATULATIONS TO BOTH OF YOU
Cases that would interest you
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Diabetes Supplements: Vitamins, Minerals, And Antioxidants 1mg TeamSeptember 11, 2018 Diabetes,Eat Well, Health A-Z, Supplements ￼ There is no doubt that diet plays a key role in the management and treatment of diabetes. In addition to taking medications, it is important to follow a nutritious diet to keep your blood glucose level in control. If your diet lacks adequate nutrition, adding dietary supplements might be recommended. Here is a quick guide on the use of vitamin, mineral and antioxidantsupplements for diabetes. Vitamin supplements for diabetes Vitamins play a key role in glucose metabolism and the lack of these nutrients could make supplementation necessary to manage and prevent diabetes-related complications. Due to abnormal glucose metabolism in diabetics, there is an excess production of free radicals. This, in turn, reduces the antioxidants in the blood, which causes a deficiency of vitamins such as A, C, and E, which are potent antioxidants. This may require you to load up on the vitamins to meet your body’s requirements. Certain medicines used to treat diabetes can lower the absorption of Vitamin B9 (folic acid) and Vitamin B12. So, if you are taking diabetes medication for a long time, you may also need to take supplements. -Vitamin A: The active form of Vitamin A is retinol, which is a potent antioxidant that not only helps deal with stress but also improves the functioning of the pancreatic cells. This is important as pancreatic cells produce insulin. -Vitamin C: According to a 2007 study in the Indian Journal of Medical Research, consumption of 1000 mg of Vitamin C supplements on a daily basis was found to lower levels of glucose and lipids in people with type 2 diabetes. Supplements can also help prevent Vitamin C deficiency and thereby reduce the risk of complications associated with diabetes. -Vitamin E: The use of Vitamin E supplements in people with diabetes mellitus for around 24 months was found to prevent the development of diabetic complications. This includes complications like diabetic retinopathy, foot ulcers, and cardiovascular problems. Moreover, vitamin E supplementation slows down the progression of complications in people with uncontrolled diabetes. -Vitamin B1: Many people with Type 1 and type 2 diabetes suffer from Vitamin B1 or thiamine deficiency. Studies have reported that the use of thiamine supplements for at least a month decreases blood glucose level in diabetics, also lowering the risk of diabetic nephropathy. -Vitamin B9: Studies have shown that folate supplementation can help improve glycemic control by reducing HbA1c levels. Additionally, it improves serum insulin and insulin resistance in type 2 diabetes patients. When used in combination with other vitamins like Vitamin B6 and Vitamin B12, it can also improve symptoms of diabetic retinopathy. -Vitamin B12: Supplementation of vitamin B12, along with folate (Vitamin B9) and pyridoxine (Vitamin B6), improves symptoms of diabetic retinopathy such as retinal edema (fluid accumulation in the eyes) and increased sensitivity to light. When supplemented along with lipoic acid, vitamin B12 also improves nerve function, protecting against diabetic neuropathy. Overall, numerous research studies have reported that vitamin supplementation not only improves glycemic control in diabetics but also prevents diabetes-related complications. Mineral supplements for diabetes Minerals play an equally important role in the management and treatment of diabetes. This is because lack of minerals can impair glucose metabolism, raising the risk of health complications. In fact, diabetes patients often suffer from low levels of magnesium and zinc. -Magnesium: Magnesium is needed for the breakdown of glucose by various enzymes. Moreover, low levels of this mineral can impair the secretion of insulin by the pancreas. For this reason, the use of magnesium supplements can improve glycemic control, helping in the management of diabetes. -Zinc: Zinc plays a significant role in the synthesis, storage, and secretion of insulin. Low levels of zinc not only increase the risk of diabetes and associated complications, but it also affects other cellular functions. Hence, to regulate glucose levels and prevent diabetic complications, zinc supplementation may be recommended. -Chromium: Research studies have shed light on the need for chromium, which is a trace mineral. This mineral is required for the metabolism of carbohydrates. Although low doses of this mineral are regarded as safe, there is not enough evidence on the appropriate dosage. Do talk to your doctor before you take any mineral supplements for diabetes. Antioxidants for diabetes Hyperglycemia or high blood glucose levels can lead to auto-oxidation of glucose to form free radicals. An excess of free radicals in the body can lead to vascular damage and dysfunction of the blood vessels and neurons, thus increasing the risk of diabetic neuropathy. Antioxidants help to scavenge free radicals, thereby lowering the risk of complications. Intake of antioxidants such as Vitamin C and alpha lipoic acid (ALA), either through natural food sources or through supplements, can help to prevent the risk of diabetic pathologies. This makes them helpful in the management of diabetes. ALA is a potent antioxidant that lowers fasting blood glucose levels, reduces oxidative stress, and decreases insulin resistance. However, this supplement should be used with caution as it can cause a drastic drop in your blood glucose levels. Before you start using any supplements, keep in mind that certain supplements might interfere with your diabetes medications. This is why it is important to first consult your doctor for the appropriate dosage and usage information, depending on your specific requirements. (The article is reviewed by Dr. Lalit Kanodia, General Physician)Saquib Nomani Microbiologist4 Likes4 Answers
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80yrs old Male ,Diabetic bite by fox DEVELOP Gangrene. Treatment pleaseDr. Ramesh Kumar Singh3 Likes17 Answers
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DIABETIC NEUROPATHIES. Diabetic neuropathies are a family of nerve disorders caused by diabetes. WHAT CAUSES DIABETIC NEUROPATHY. Nerve damage is likely due to a combination of factors. 1.METABOLIC FACTORS. : hyperglycemia, long duration of diabetes, abnormal blood fat levels and low levels of insulin. 2.NEUROVASCULAR FACTORS : Neurovascular factors leading to damage of blood vessels that carry oxygen and nutrients to nerves. 3.AUTOIMMUNE FACTORS : Causes inflammation of nerves. 4.MECHANICAL FACTORS : Injury to nerves as in carpel tunnel syndrome. 5.INHERITED TRAITS : That increase susceptibility to nerve disease. 6.LIFESTYLE FACTORS : Smoking, alcohol. SYMPTOMS. Symptoms depends on the type of neuropathy and which nerves are affected.Symptoms involve sensory,motor and autonomic nervous system. 1.Tingling, numbness or pain in the toes,feet,legs,hands,arms and fingers. 2.Wasting of muscles of hand or feet. 3.Indigestion, nausea, vomiting, diarrhea,c constipation. 4. Dizziness or fainting due to a drop in blood pressure after standing or sitting up. 5.Problems with urination. 6.Erectile dysfunction. 7.Weakness. TYPES OF NEUROPATHY. Diabetic neuropathy can be classified as 1.Peripheral neuropathy. 2.Autonomic neuropathy. 3.Proximal neuropathy. 4.Focal neuropathy. PERIPHERAL NEUROPATHY. Peripheral neuropathy,also called distal symmetric neuropathy or sensorimotor neuropathy ,is nerve damage in arms and legs.Symptoms are *Numbness or insensitivity to pain or temperature. *A tingling,burning or prickling sensation. *Sharp pains or cramps. *Extreme Sensitivity to touch. *Loss of balance and coordination. Peripheral neuropathy also causes muscle weakness and loss of refle guyxes.Blisters and sites may appear on the numb areas of the foot because pressure or injury goes unnoticed.I f an infection occurs and is not treated promptly,the infection may spread to the bone and the foot may need amputation.Many amputations can be prevented if minor problems are treated in time. AUTONOMIC NEUROPATHY. Autonomic neuropathy affects the nerves that control the heart,blood pressure and blood glucose levels.Autonomic neuropathy also affects internal organs causing problems with digestion,respiration. urination,sexual response and vision. 1.HYPOGLYCEMIA UNAWARENESS. Normally,symptoms such as shakiness,sweating and palpitations occurs when the blood glucose levels drop below <<70 mg/dl.In people with autonomic neuropathy,symptoms may not occur making hypoglycemia to be recognized. 2.HEART & BLOOD VESSELS. Damage to the nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate. Due to this,blood pressuremay drop sharply after standing or sitting,causing a person to feel light headed or faint. Damage to nerves that control heart rate makes the heart rate to stay high , instead of rising and falling in response to normal body functions and physical activity. 3.DIGESTIVE SYSTEM. Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty slowly,a condition called GASTROPARESIS. Gastroparesis can lead to persistent nausea and vomiting,bloating and loss of appetite. Gastroparesis also makes blood glucose levels to fluctuate widely ,due to abnormal food digestion. Nerve damage to the OESOPHAGUS MAKES SWALLOWING DIFFICULT. Nerve damage to bowels can cause constipation alternating with uncontrolled diarrhea, 3.URINARY TRACT & SEX ORGANS. Autonomic neuropathy often affects the organs that control urination and sexual functions. Nerve damage can prevent the bladder from emptying completely , allowing the bacteria to grow in bladder and kidneys causing urinary tract infections. When the nerves of the bladder are damaged,urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine. Autonomic neuropathy also leads to decreased sexual response in men and women. A man may have erectile dysfunction or may reach sexual climax without ejaculating normally. A woman may have difficulty in arousal,lubrication or orgasm. 5.SWEAT GLANDS. Nerve damage may cause improper working of sweat glands.It can also result in profuse sweating at night or while eating. 6.EYES. Due to autonomic neuropathy,pupils become less responsive to changes in light.A s a result,a person may not be able to see well when light is turned on In a dark room or have trouble driving at night. PROXIMAL NEUROPATHY. Proximal neuropathy//lumbosacral plexus neuropathy //femoral neuropathy //diabetic amyotrophy causes pain in the thighs,buttocks,hips or legs,usually on one side of the body. FOCAL NEUROPATHY. Focal neuropathy appears suddenly and affects specific nerves,most often in the head,torso or leg. Focal neuropathy is painful and unpredictable.and occurs most often in older adults with diabetes. However,it tends to improve itself over weeks or months and does not cause long term damage. Focal neuropathy can cause *Inability to focus the eye. *Diplopia. *Aching behind the eye. *Bell's palsy. *Severe pain in the lower back and pelvis. *Pain in the front of the thigh. *Pain in the chest and stomach. *Pain on the outside of the shin or inside of the foot. *Chest pain and abdominal pain is mistaken for heart attack or appendicitis. CAN DIABETIC NEUROPATHIES BE PREVENTED. THE BEST WAY TO PREVENT NEUROPATHY IS TO KEEP BLOOD GLUCOSE LEVELS AS CLOSE TO THE NORMAL RANGE AS POSSIBLE.MAINTAINING SAFE BLOOD GLUCOSE LEVELS PROTECTS NERVES THROUGH OUT THE BODY.Dr. Suvarchala Pratap11 Likes21 Answers
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A case of diabetic male aged 43 years has not much problem except slight whitish discharge in 1st morning sample. Diabetic of 9 years duration, presently taking glyree 2mg BF,glycinorm GP2 in lunch and glycinorm GP1 in dinner. Also taking Telma 40 and Tonact 10.Diabeic diet control is good and daily 30 minutes walks /jogging. Reports show F 140 HBA1C 9.3.,PP >220. RE urine normal except 3+ sugar. Hb 12.6gm% All other test are normal including RFT, serum calcium total proteins. PSA is normal. He had recurrent attack of haemoptysis 5 years back for which underwent thrice bronkoscopic procedures in a reputed hospital in Mumbai, though xray was normal had been diagnosed as bronchiectasis. Also received full course of ATD.AT present no problem from that side but ESR is 32.What should be the line of treatment now to control diabetes.Dr. Deepak Ambastha2 Likes29 Answers
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11.09.201 A case of repeated hypoglycaemic episodes in a case of liver damage. Hypoglycaemia is the cause or effect of liver damage? This case is about T2DM of about one year duration in 82 years old man. He is normotensive. His sugar was moderately high. Initially he was on 1000 mg of Metformin. Considering his high sugar it was increased to 1500 mg and 2 mg of Glimiperide was added. About a week ago he developed jaundice. Liver enzymes and other biochemical values were very high. Serological test for HBsAG was positive. Lab report is enclosed herewith. He was brought to me for second opinion about 5 days back. In view of his age and liver damage Metformin was withdrawn and Glimeperide was reduced to 0.5 mg a day (1/4th of the previous dose). In addition he was put on B-complex, dietary advice was also given. He was advised to come for follow up after a week. Today morning his son calls me on phone at about 7.30 to inform me that his father has become suddenly semi-conscious and they don't know what to do. Patient was sweating a lot too. Hypoglycaemia was suspected, therefore the son was asked to forcefully give his father about 3-4 spoonful of sugar and report the developments after about 15 minutes. Accordingly he called me to say that his father has started blinking and recovering. I too was happy. But this didn't last long, he had one more such episode after about an hour, one more round of sugar, made him recover. He was advised to visit me for a thorough checkup. He looked like any other normal person waiting for his turn in the clinic. He had his breakfast about an hour ago, his capillary blood sugar was astonishingly as low as 32 mg/dl. Doubting about a possible defect in my Glucometer itself I checked my own blood sugar for verification. It was as it should be, meaning thereby that the device was normal. He was given sumptuous sugar and a repeat test was done after 20 minutes. He was advised to stop Glimmiperide till further instructions. The value was a mere 80 mg/dl. At night after his dinner his sugar was again checked, it was again a mere 74 mg/dl. In view of repeated episodes he was hospitalised. Points to ponder: Evidently it was a case of hypoglycaemia on all the four occasions. But why should he go into hypoglycaemia inspite of Metformin withdrawal and reducing Glimiperide to 0.5 from 2.0 mg OD. The case will be further discussed after 2-3 days. If you have anything to add or ask, kindly do so, I will try to answer. There will be someone who can highlight on this case, if I fail to comply.Dr. Shreeram Herlekar7 Likes19 Answers