In this case it is very important to know whether it is LADA. Latent autoimmune diabetes in adults (LADA), is a condition that shares characteristics of both type 1 and type 2 Those who have LADA essentially needs treatment with insulin Fasting C peptide level and Autoantibodies - islet cell antibodies ( antibodies against cytoplasmic proteins in the beta cell), Antibodies to glutamic acid decarboxylase (GAD-65), Insulin autoantibodies Are important investigation to diagnose LADA
For Diagnosis of MODY - Should have history of diabetes of three successive generations required in absence of monogenetic abnormalitiy of MODY gene like HNF1 alpha or Glucokinase gene . Do C -Peptide estimation after sugar control . Because glucotoxicoty leads to low c peptide level . In absence of positive family history of three successive generations , rule out LADA. But probability of DM2 is still high , because no diabetic ketoacidosis in presence of high blood sugar level. Mixed hyperlipidemia also
? MODY .. NEED'S.. SULFONYLUREAS.. LIFE STYLE CHANGES.. DIET.. REGULAR EXERCISE..
Try: 1.Vasantkusumakar rasa tabs 1 bd. 2.Arogyawardhini tabs 1 bd. 3.Chandraprabha tabs 1 bd. 4.Yogabasti with Madhutailika basti minimum 3 courses. 5.Proper aahar vihar instructions. May be sufficient.
Uncontrolled diabetic I feel should be shifted on basal bolus insulin Dapagliflozin Vildagliptin Metformin
I am agree with@Dr. Kute Ankush Sir.
What about family history of the patient,as pt cannot be labelled as MODY with out appropriate family history. And see for signs of insulin resistance which point more towards T2 DM
Cases that would interest you
- Login to View the image
*Chief complaint* A 26 year old male complains of polyuria, polydipsia, blur vision, and dry mouth for 10 days. He also has abdominal pain *History* The patient is obese and complains of 10 kg weight gain over 2 years. *Vitals* BP 168/115 mmHg, RR normal *Investigations* Glucose of 795 mg/dL [69-99 mg/dL], Potassium of 2.5 Mmol/L [3.6-5.2 Mmol/L], Hemoglobin A1c of 14.2%, Triglycerides of 486 mg/dL [<150 mg/dL] Metabolic alkalosis *Diagnosis* What are your comments?Dr. Arun Bali2 Likes11 Answers
- Login to View the image
26y/M patient complaining fatigue since 2 days. k/c DM 2 on insulin. investigation report suggestive high level of acetone. management?Dr. Nikunj Soni2 Likes10 Answers
- Login to View the image
Friends today I am discussing about Hyperglycemia, Diabetes. TYPE 2 DIABETES SYMPTOMS According to the American Diabetes Association, in patients with type 2 diabetes, hyperglycemia (high blood glucose) typically develops gradually and, at earlier stages, is often not severe enough for you to notice any classic symptoms. This may be why many people are undiagnosed for many years, but being able to recognize the symptoms of high blood sugar can help you to diagnose diabetes, manage it better, and prevent an emergency. For those people already diagnosed with diabetes, having a blood sugar that is sporadically higher than usual doesn't necessarily put you in immediate danger. However, chronically elevated blood sugar may be problematic. Over time, blood sugar levels that are too high can affect the small and big vessels of the body, leading to complications of the eyes, heart, kidneys, and feet. hyperglycemia symptoms Frequent Symptoms Experiencing common hyperglycemia symptoms may be a diabetes warning sign for those who have not yet been diagnosed. If you know you have diabetes, noting these symptoms may be an indication that a tweak in your treatment plan is needed. Excessive Thirst (Polydipsia) In an effort to restore blood sugar balance, your body tries to get rid of excess sugar through urine. As a result, the kidneys are forced to work overtime absorbing excess sugar. But, because they are unable to keep up with the glucose load, they pull fluids from your tissues along with the excess sugar. The more fluid you lose, the stronger your urge is to drink. If you find that you can continuously drink and not feel as though your thirst is quenched, or that you have a severely dry mouth, this may be a sign of hyperglycemia. Increased Hunger (Polyphagia) Excess sugar in your bloodstream means that your body is unable to utilize it for fuel. Hence, your cells become starved for energy and you feel extra hungry and, in extreme cases, unsatiable. But the more carbohydrates you consume, the higher the blood sugars rise. Increased Urination (Polyuria) More frequent trips to the bathroom, especially at night, can be a sign of high blood sugar. This is a result of the kidneys drawing extra water out of your tissues to dilute the extra sugar in your blood and get rid of it through the urine. Blurry Vision High sugar levels force the body to pull fluid from your tissues, including the lenses of your eyes, which can affect your ability to focus and result in blurry vision. Fatigue When sugar remains in the blood as opposed to being taken to the cells for energy, your cells become starved of food, leaving you to feel sluggish or fatigued. This can commonly happen after you've eaten a meal, particularly one that is rich in carbohydrates. Severe Symptoms These particular symptoms tend to occur when someone has had hyperglycemia for a long time, or when the blood sugar is extremely elevated. They usually indicate an emergency. Stomach Pain Chronic hyperglycemia can result in nerve damage to the stomach (gastroparesis). Stomach pain can also be a sign of diabetic ketoacidosis, a medical emergency that needs to be treated right away. Weight Loss Unintentional weight loss is an important sign, particularly in kids who are drinking and urinating often, that the blood sugars are elevated. Many children who are diagnosed with type 1 diabetes lose weight prior to diagnosis. This usually occurs because the body is not able to use the sugar in the bloodstream for fuel. Mouth and Breathing Changes Nausea, vomiting, fruity breath, deep and rapid breathing, and loss of consciousness are indications that you need to seek emergency help. These symptoms can be warning signs of other diabetes-related conditions that can result in death if not treated immediately. Rare Symptoms Some more rare symptoms can occur in people with hyperglycemia, too. Numbness Nerve damage in the extremities (known as peripheral neuropathy) occurs over time and can present as numbness, tingling, or pain in the hands, feet, or legs. Skin Conditions Dry/itchy skin, wounds or cuts that are slow to heal, and acanthosis nigricans (thick, velvety patches found in the folds or creases of areas like the neck, indicative of insulin resistance) can be an indication of hyperglycemia. Frequent Yeast Infections and Erectile Dysfunction These are manifestations that affect women and men, respectively. Hyperglycemic Hyperosmolar Nonketotic Syndrome Hyperglycemic hyperosmolar nonketotic coma (HHNKC) is an extremely serious complication which can happen in those with type 1 or type 2 diabetes, but most often occurs in those who are non-insulin dependent (type 2 diabetes). HHNKC is characterized by a dangerously high blood sugar that is over 600 mg/dL and is typically brought on either by an infection such as pneumonia, a urinary tract infection, or inability to effectively manage your blood sugar. If left untreated, it can result in coma and even death. Signs and symptoms include: extreme thirst confusion fever (usually over 101 degrees Fahrenheit) weakness or paralysis on one side of the body The best way to prevent HHNKC is to take your medications as directed and to keep in contact with your healthcare team when your blood sugar is consistently over 300 mg/dL. Diabetic Ketoacidosis Hyperglycemia can lead to another very dangerous condition referred to as diabetic ketoacidosis (DKA), which occurs most commonly in people who have type 1 diabetes and is often the condition that leads to the diagnosis of type 1 diabetes. DKA is caused when the body has little or no insulin to use and, as a result, blood sugars rise to dangerous levels and the blood becomes acidic. Cell damage can occur and if it continues to progress, it can cause coma or death. DKA needs immediate medical intervention—patients with DKA will need to be monitored by a medical professional and given intravenous fluids, electrolytes, and insulin. Complications Frequent and long-standing hyperglycemia can lead to a host of complications known as micro (small) and macro (large) vascular issues. They include damage to the: eye (retinopathy) kidney (nephropathy) peripheral and autonomic neuropathy (nerve loss in the feet and other areas of the body such as the intestine) Additionally, chronically elevated blood sugars can cause or exacerbate heart disease and peripheral arterial disease. During Pregnancy Hyperglycemia in pregnancy can be particularly damaging to the fetus and the mother. According to the American Diabetes Association, uncontrolled diabetes in pregnancy can pose risks such as spontaneous abortion, fetal anomalies, preeclampsia (uncontrolled blood pressure in mother), fetal demise, macrosomia (large baby), hypoglycemia in babies at birth, and neonatal hyperbilirubinemia, among others. In addition, diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life. In Children Hyperglycemia in children, especially when undiagnosed, can lead to the development of type 2 diabetes or ketoacidosis in those children who have type 1 diabetes. Those children with diabetes who have chronically elevated glucose levels are at increased risk for developing diabetes complications. When to See a Doctor If you don't feel like your usual self and think your blood sugar is elevated, test it to confirm. If your blood sugar happens to be elevated and it's an isolated event, odds are that you can probably get it back to normal on your own. Go for a walk or do some light exercise, drink extra water, and take your medicine as prescribed. On the other hand, if you are experiencing elevated blood sugars for several consecutive days, give your medical team a call, as you may need to tweak your treatment plan. If you don't have diabetes and notice any of these signs or symptoms, and are overweight or obese or have a family history of diabetes, you should schedule an appointment with your doctor to be screened. Microvascular complications of diabetes can occur prior to diagnosis, so the sooner you receive treatment, the better. For Parents of Children Without Diabetes If you've noticed that your child is drinking, eating, and urinating more often than usual, a trip to the doctor is a good idea, especially if you've seen a quick change in weight. If the symptoms appear to be more severe and resemble those of DKA (refer above), go to the emergency room right away. For Parents of Children With Diabetes If your child is presenting with hyperglycemia symptoms and their blood sugar is greater than 240 mg/dL, you should test them for ketones. Upon a positive test, call your medical team for guidance on what to do next or refer to your sick day plan. Depending on the severity of the ketones, you may be advised to go to the emergency room. Homeopathic remedies marketed to treat the symptoms of diabetes or prevent complications include: Syzygium jambolanum or S. cumini (black plum) is said to help treat thirst, weakness, skin ulcers, and excessive urination. Uranium nitricum is marketed to treat excessive urination, nausea, swelling, and burning with urination. Conium (hemlock) is purported to treat numbness in the feet and hands as well as diabetic neuropathy (nerve damage). Plumbum (lead) is said to help with numbness in the hands and feet, nerve pain, and tinnitus. Calendula (marigold) is said to treat infected ulcers. Phosphoric acid is promoted to treat impaired memory, confusion or heavy head, frequent urination at night, hair loss, and difficulty maintaining an erection. Candida (yeast) is said to treat yeast infections.Dr. Rajesh Gupta8 Likes10 Answers
- Login to View the image
45 year female having black skin lesion on face .plz diagnosis and say Rx.Dr. Hitesh Gangani3 Likes21 Answers
- Login to View the image
60 yr old man c/o darkening of skin at groin and axilla. O/E:warty, velvety brown skin Biopsy : hyperplastic epidermis with peaks and valleys. What could be the etiological factor.?Which malignancy is commonly associated with this condition? 1--Diabetes 2--Immunosupression 3--Infectiin 4--Skin MalignancyDr. Ashok Laddha3 Likes16 Answers