V. Baskar

Diabetic ketoacidosis in pregnancy

The occurrence of diabetic ketoacidosis in pregnancy compromises both the fetus and the mother. It usually occurs in the later stages of pregnancy and is also seen in newly presenting type 1 diabetes patients. Despite improvement in its incidence rates and outcomes over the years, it still remains a major clinical problem since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis. This article illustrates a typical case of diabetic ketoacidosis in pregnancy and reviews the literature to provide an insight into its pathophysiology and management.

Exenatide therapy in insulin-treated type 2 diabetes and obesity.

BACKGROUND Exenatide, a GLP-1 analogue, is used in combination with oral anti-diabetic agents in type 2 diabetes and obesity, and promotes weight loss. Exenatide use in combination with insulin in insulin-treated type 2 diabetes and obesity is unlicensed in the UK and outcomes are unclear. AIMS To assess the effectiveness of exenatide in insulin-treated type 2 diabetes with obesity. DESIGN AND METHODS This prospective study included 174 consecutive patients with insulin-treated type 2 diabetes and obesity initiated on exenatide in our out-patient, between October 2007 and November 2008. Weight, BMI, HbA1c, serum fructosamine, total cholesterol, HDL-cholesterol and insulin doses were recorded at baseline, 3, 6 and 12 months. Side effect profiles were recorded. RESULTS Fourteen patients discontinued exenatide before 3 months of initiation, because of side effects, and were excluded. Data were analysed on remaining 160 people all of whom completed 6 months and 57 completed 12 months treatment. Mean weight loss was 10.7 +/- 5.7 kg and 12.8 +/- 7.5 kg (P < 0.001) at 6 and 12 months. Insulin doses dropped significantly (mean 144 +/- 90 U/day at baseline to 51 +/- 55 U/day and 55 +/- 53 U/day at 6 and 12 months). At 3 months, 25% came off insulin. There was little change in HbA1c. CONCLUSION Exenatide therapy in insulin-treated type 2 diabetes and obesity was associated with very significant reductions in weight and insulin doses. Exenatide should be considered in people with type 2 diabetes on insulin and have obesity, weight gain and poor glycaemic control.

Combination of insulin and thiazolidinedione therapy in massively obese patients with Type 2 diabetes.

Aims To evaluate the influence of addition of rosiglitazone to insulin therapy over a 24‐week period in massively obese patients with poorly controlled Type 2 diabetes taking large doses of insulin.

Diabetic ketoacidosis (DKA) in Birmingham, UK, 2000—2009: an evaluation of risk factors for recurrence and mortality

Diabetic ketoacidosis (DKA) is an acute metabolic complication of type 1 diabetes mellitus. This study aimed to define the DKA mortality rate in a Birmingham population and to identify risk factors...

An assessment of care of paediatric and adolescent patients with diabetes in a large district general hospital.

Aims To assess the process of clinical care and outcomes of young patients with diabetes attending clinics at a large district general hospital.

Clinical utility of estimated glomerular filtration rates in predicting renal risk in a district diabetes population

Aims  To determine the utility of estimated glomerular filtration rates (eGFR) in predicting renal risk over and above currently available strategies that incorporate serum creatinine and microalbuminuria in a diabetes population.

Uncertain clinical utility of contemporary strategies for microalbuminuria testing.

Aims:  To determine whether conventional dipstick tests for proteinuria accurately identified patients with diabetic nephropathy and whether repeat testing for elevated albumin excretion and screening for urinary tract infection was required as part of the screening process for microalbuminuria.

Spontaneous regression of hypercalcemia in a patient with primary hyperparathyroidism and prolactinoma

We describe a unique case of spontaneous resolution of hyperparathyroidism in a lady with combined parathyroid adenoma and prolactinoma, raising the possibility of underlying multiple endocrine neoplasia (MEN) 1 syndrome. We also discuss the mechanism and natural history of such spontaneous remission.

Severe and disabling diabetic autonomic neuropathy: A case report

We report a case of a woman with several and severe disabling manifestations of autonomic neuropathy in whom reasonable quality of life was established by combining continuous insulin infusion, jejunal feeding, colostomy and bladder self-catheterisation. We discuss the prevalence rates, pathophysiology, management and prognosis of this disabling condition.

Algorithm combining HbA1c and fasting plasma glucose for screening subjects for OGTT: Authors' response

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