Insulin therapy in diabetes type 2: indications modalities and results

After several years of evolution, insulin therapy becomes necessary in type 2 diabetes mellitus. However there is still an ongoing controversy in the studies devoted to this subject. The objective of our retrospective study was to evaluate the indications, the modalities and the results of insulin treatment in 106 patients with type 2 diabetes. Insulin treatment was temporary in 20 patients [18.86%] and definitive in 86 patients [81.14%]. The therapeutic protocol used a combined treatment with oral hypoglycaemic agents in 11 cases [10.38%], a conventional treatment in 48 cases [45.28%] or an intensive therapy in 47 cases [44.34%]. The outcome could be evaluated in 86patients after 6 months and 1 year. At the first follow-up [6 months], 59 patients [68.6%] had a significant reduction in fasting glycemia [7.8 vs 15.5 mmol/l], post prandial glycemia [8.9 vs 25.8 mmol/l] and glycated haemoglobin [6.9% vs 10.2%]. 69 patients [80.24%] had a mean weight gain of 7 +/- 5 kg and 8 [7.5%] had hypoglycaemic episodes. In the total number of 59 patients who improved with the insulin treatment, 46 patients 77.96% were treated with the intensive insulin protocol. Insulin treatment in type 2 diabetic patients seems to have a limited risk of hypoglycaemia but causes an important weight gain

[Hypoglycemic comas from multiple sources in a type 1 diabetic]

Iterative hypoglycaemic comas in type 1 diabetic patients are a serious problem which may be caused by many factors like educational errors, unawareness of hypoglycaemia and also adrenal insufficiency and diabetic nephropathy while factitious hypoglycaemia is the major diagnostic pitfall. We report an unusual case of a 35-year-old man, who presents a type 1 diabetes for the past 23 years, and who had unexplained hypoglycaemic comas for the past four months even after decreasing his insulin doses. The investigation revealed factitious insulin injections but also the presence of adrenal insufficiency Graves' disease and diabetic nephropathy without renal failure. Psychiatric evaluation showed a depressive state induced by diabetic complications and hyperthyroidism. This case report emphasizes the fact that organic and factitious causes of hypoglycaemia may be present in the same patient that is referred for type 1 diabetic hypoglycaemia

[Long-term evolution of human macroprolactinomas treated with dopaminergic]

The aim of this study is to evaluate the long-term results of dopaminergic therapy in macroprolactinoma in the male. We report 5 cases of macroprolactinoma in men [age 27 to 40 years]. Four of the patients had expansive macroprolactinoma while the fifth one had an enclosed one. One patient was treated after failure of radio-surgical therapy, whereas the four other patients did not have prior surgery. Prolactin level was higher than 2500 mU/l in all cases with the presence of hypopituitarism and visual field amputation. All patients were initially treated with bromocriptin and had hormonal and pituitary CT or RMI follow up. Favourable evolution occurred in four patients with prolactin level normalisation within a few months to two years. There was a tumoral shrinkage in three cases within a period of 5 years. Bromocriptin resistance occurred in only one patient. Two years after ineffective pituitary external radiotherapy, quinagolide treatment lead to normalise prolactin levels and to reduce adenomous mass. These results emphasize the efficacy of dopaminergic therapy as first approach in macroprolactinoma in male. Nevertheless, it requires good compliance and the absence of side effects. Therefore, long acting dopaminergic or D2 receptor specific dopaminergic agents are excellent alternatives to surgery