ABSTRACT
Insulinoma is a rare neuroendocrine tumor originating from pancreatic beta cells, which clinically manifests Whipple′ s triad and recurrent hypoglycemia. Insulinoma in a patient with type 2 diabetes mellitus is even a more rarely encountered case. In clinical practice, hypoglycemia in patients with diabetes is often considered to be associated with oral hypoglycemic agents, but insulinoma, as a possible etiology, is usually neglected. This article reported a case of a patient with type 2 diabetes mellitus, before the diagnosis of which she had experienced recurrent hypoglycemia for about 14 years. Hypoglycemia symptoms with hyperinsulinemia kept existing even after the withdrawal of antidiabetic agents. The pancreatic imaging and postoperative histopathology supported the diagnosis of insulinoma. After surgery, plasma glucose level of the patient increased and diabetes treatments continued. The co-existence of insulinoma and type 2 diabetes mellitus in this case may be attributed to the insulin resistance induced by chronic hyperinsulinemia due to insulinoma.
ABSTRACT
Insulinoma is a rare neuroendocrine tumor originating from pancreatic beta cells, which clinically manifests Whipple' s triad and recurrent hypoglycemia. Insulinoma in a patient with type 2 diabetes mellitus is even a more rarely encountered case. In clinical practice, hypoglycemia in patients with diabetes is often considered to be associated with oral hypoglycemic agents, but insulinoma, as a possible etiology, is usually neglected. This article reported a case of a patient with type 2 diabetes mellitus, before the diagnosis of which she had experienced recurrent hypoglycemia for about 14 years. Hypoglycemia symptoms with hyperinsulinemia kept existing even after the withdrawal of antidiabetic agents. The pancreatic imaging and postoperative histopathology supported the diagnosis of insulinoma. After surgery, plasma glucose level of the patient increased and diabetes treatments continued. The co-existence of insulinoma and type 2 diabetes mellitus in this case may be attributed to the insulin resistance induced by chronic hyperinsulinemia due to insulinoma.
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Objective · To explore the relationship of adipose chemerin and its receptor chemerinR gene expression to obesity and type 2 diabetes mellitus. Methods · Twenty-four patients undergoing elective abdominal surgery were enrolled, and were divided into normal glucose regulation-normal weight group (NGR-NW), normal glucose regulation-overweight/obesity group (NGR-OW/OB), and type 2 diabetic overweight/obesity group (T2DMOW/OB) according to the body mass index (BMI). The levels of chemerin and chemerinR mRNA were detected by reverse transcription PCR (RT-PCR).Results · Compare to the NGR-NW group, the chemerin mRNA levels of abdominal subcutaneous and omental fat were significantly increased in the NGR-OW/OB and T2DM-OW/OB group (P<0.05). Correlation analysis showed that the chemerin mRNA levels of abdominal omental fat were positively correlated with BMI, fasting insulin (FINS), triglyceride and serum chemerin (r=0.577, r=0.561, r=0.472, r=0.623, P<0.05 for all). The chemerin mRNA levels of abdominal subcutaneous fat showed significant positive correlation with BMI, FINS and serum chemerin (r=0.692, r=0.513, r=0.497, P<0.05 for all). Conclusion · The chemerin mRNA levels of abdominal subcutaneous and omental fat were positively correlated with BMI, FINS and serum chemerin, suggesting that the chemerin gene may play a crucial role in the pathophysiological mechanism of obesity and type 2 diabetes.
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Objective To investigate the incidence of cholelithiasis after laparoscopic Roux-en-Y gastric bypass(LRYGB) for treatment of type 2 diabetes mellitus with obesity.Methods The clinical data of 89 obese patients with type 2 diabetes mellitus who underwent LRYGB at the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from March 2011 to March 2013 were retrospectively analyzed.Sixty-six patients without postoperative gallstone and sludge were divided into the nornal group and 23 with postoperative gallstone or sludge into the gallstone group.The waistline,hipline,body weight,body mass index (BMI),excess weight loss (EWL),fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin (HbAlc),homeostasis model assessment-insulin resistance (HOMA-IR),total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-c),low-density lipoprotein cholesterol (LDL-c),serum total bile acid at postoperative month 6,12,24 were analyzed.The patients were followed up by inpatient,outpatient examination and telephone interview till April 2015.Measurement data with normal distribution were presented as x ± s,comparison between groups and repeated measures data were analyzed using the t test and repeated measures ANOVA,respectively.Count data were analyzed by the chi-square test.Results All the 89 patients underwent successful LRYGB and were fol lowed up for 31 months (range,24-48 months).The EWL,HbAlc and serum total bile acid at postoperativemonth 6,12,24 were 113％±43％,117％±64％,119％±84％ and 6.1％±0.8％,6.2％± 1.1％,6.4％± 1.0％ and (4.6 ± 3.8) μmol/L,(4.5 ± 3.6) μmol/L,(4.6 ± 3.8) μmol/L in the normal group and 157 ％ ± 96％,152％±102％,151％±93％ and 5.9％±0.8％,5.8％±0.6％,5.9％±0.8％ and (23.9 ±9.0) μmol/L,(11.8 ± 7.3) μmol/L,(10.5 ± 9.6) μmol/L in the gallstone group,respectively,showing significant differences in changing trend between the 2 groups (F =6.896,5.226,5.351,P ＜ 0.05).There were significant differences in the EWL at postoperative month 6,12,24 between the 2 groups (t =2.814,2.628,2.099,P ＜ 0.05).There were significant differences in the HbAlc at postoperative month 12 and serum total bile acid at postoperative month 6,24 between the 2 groups (t =2.018,-1.378,-1.990,P ＜ 0.05).Conclusion There is incidence risk of cholelithiasis after LRYGB in obese patients with type 2 diabetes mellitus.The rapid decreasing of weight is associated with cholelithiasis in which patients have higher level of serum bile acid.
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Objective To assess the impact of intervention with Insulin therapy management unit program in the poorly controlled type 2 diabetic patients in a community of Shanghai.Methods There were 55 patients with type 2 diabetes with poorly controlled hyperglycemia (HbA1C ≥ 8％) enrolled in this study.They were divided at random into 2 groups:intensive care group and standard care group.The subjects in intensive care group were provided with a glucose meter and required to monitor their blood glucose levels at least 2 or 3 times per day.Community health provider acquired information of blood glucose level,episodes of hypoglycemia,and dosage of insulin every week by cell phone.Standard care patients received diabetes care from the same provider in outpatient clinic every month.Results By the end of 6 months of intervention,the intensive care group showed a significant difference in HbA1C as compared to the standard care group (7.40％ ±0.91％ vs 8.65 ％ ± 1.28％,P＜0.01).The frequency of self-monitoring of blood glucose (SMBG) was 4 times per month in both groups at baseline.After intervention,the frequency of SMBG in intensive care group was greatly increased compared to standard care group (50times per month vs 5 times per month,P＜0.01).The frequency of self-reported hypoglycemia in intensive care group was increased compared to standard care group (3 times per month vs once per month,P＜0.01).The average daily dose of insulin in intensive care group was increased 6 units by the end of the present study(P＞0.05).Conclusion After 6 months of intervention,the glycemic control was obviously improved in type 2 diabetic patients treated with insulin and the daily dose of insulin was not increased significantly.TheInsulin therapy management unit is effective and safe.
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Objective To analyze the risk factors of retinopathy and nephropathy in hospitalized patients with type 2 diabetics. Methods 24 h-urinary albumin was measured in 2 338 patients with type 2 diabetic hospitalized from July, 2002 to Sep, 2008 in our hospital. All the subjects were divided into normalbuminuria group (NA) and diabetic nephropathy group (DN), the latter consisted of microalbuminuria group (MAU) and macroalbuminuria group (CAU). All the patients were divided into normal retina group (NR) and diabetic retinopathy group (DR), the latter consisted of background diabetic retinopathy group (BDR) and proliferative diabetic retinopathy group (PDR) according to fundus photography. Results (1) The percentages of DR and DN of this cohort were 28.8% and 28.7%, respectively.The percentage of DR and DN had no statistical difference between male and female (27.8% vs 30.0%;29.6% vs 27.6%, P>0.05). (2) The percentage of DR was 23.1%, 37.7% and 56.6% in NA, MAU and CAU group, respectively. There was significant difference among different albuminuria group (P<0.01). (3) The percentage of DN was 23.1%, 41.1% and 59.3% in NR, BDR and PDR group, respectively. There was significant difference among different DR group (P<0.01). (4) Combined with DN, diabetes duration, systolic pressure, hemoglobin A1C, triglyceride were independently associated with DR by Logistic regression analysis. Meanwhile, combined with DR, systolic pressure, hemoglobin A1C, and triglyceride were all independently associated with DN. Conclusions The onset and progression of microvascular complications in type 2 diabetic patiens are correlated with hemoglobin A1C and systolic pressure. Diabetic retinopathy is closely correlated with diabetic nephropathy.
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This paper introduces the nursing care of two children with type 1 diabetes during continuous glucose monitoring. In addition to psychological care,diet instruction and insulin therapy,the nurses actively communicated with the children and their parents,introduced the principle and advantages of continuous glucose monitoring system (CGMS) to promote the children and parents to cooperate with the medical staff. Moreover,the insert site of CGMS was changed from inferior abdomen to up-per lateral buttock according to the physiological character of children. As a result,the CGMS was completed successfully in the 2 eases,which provided reliable reference for the regulation of treatment plan.
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Insulin is secreted in a pulsatile fashion, consisting of ultradian oscillation and rapid pulses. Several aspects of these characteristic features, generating mechanism, and clinical significance are reviewed in this article.