Ambulatory glucose profile in managing hypoglycemia in patients with type 2 diabetes mellitus: a case report

Continuous glucose monitoring (CGM) was done in a 41 years-old female patient with type 2 diabetes mellitus (T2DM) to evaluate the glucose fluctuations, to achieve better glycemic control. The patient presented to the clinic with lethargy, on/off episodes of extreme weakness, sweating, and tingling sensation in the feet (B/L), with leg pains for the past 3 months. She did not have any history of hypertension and cardiovascular disease. On examination, her blood pressure was found to be 120/70 mm Hg. The fasting plasma glucose was 96 mg/dL, postprandial glucose was 160 mg/dL, and glycosylated hemoglobin was 6.8%. The patient was on metformin (500mg)- glimepiride (2mg) combination, once daily, before breakfast, and metformin (500mg) after dinner. Since the symptoms were related to glucose fluctuations and hypoglycemia, the patient was consequently recommended professional CGM to analyze the complete glycemic profile. The profile obtained from Ambulatory Glucose Profile (AGP) revealed glucose fluctuations observed as hypoglycaemia and hyperglycemic episodes. Consequently, the patient抯 treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with vildagliptin (50 mg) and metformin combination (1000 mg) bid with meals. This case study indicates that the use of CGM may help in improving our understanding of glycemic patterns and may have a beneficial effect on glycemic control.

Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management.

Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver, muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type 2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries. Based on percentage body fat and morbidity data, limits of normal BMI are narrower and lower in Asian Indians than in white Caucasians. In this consensus statement, we present revised guidelines for diagnosis of obesity, abdominal obesity, the metabolic syndrome, physical activity, and drug therapy and bariatric surgery for obesity in Asian Indians after consultations with experts from various regions of India belonging to the following medical disciplines; internal medicine, metabolic diseases, endocrinology, nutrition, cardiology, exercise physiology, sports medicine and bariatric surgery, and representing reputed medical institutions, hospitals, government funded research institutions, and policy making bodies. It is estimated that by application of these guidelines, additional 10-15% of Indian population would be labeled as overweight/obese and would require appropriate management. Application of these guidelines on countrywide basis is also likely to have a deceleration effect on the escalating problem of T2DM and cardiovascular disease. These guidelines could be revised in future as appropriate, after another large and countrywide consensus process. Till that time, these should be used by clinicians, researchers and policymakers dealing with obesity and related diseases. ©

Kinetics of specific IgM in patients of hepatic amoebiasis.

Entamoeba histolytica (EH) specific IgM was measured in 54 patients with diagnosed amoebic liver abscess (ALA), 13 with non-suppurative hepatic amoebiasis (NSHA) and 50 controls. The mean levels of EH specific IgM, estimated by ELISA were significantly raised in patients of invasive amoebiasis (both ALA and NSHA) compared to controls (P less than 0.05). EH specific IgG was also raised in both groups of patients. Follow up of patients with ALA showed a significant decline (P less than 0.05) in the specific IgM levels three months after treatment while the specific IgG antibodies persisted in high titres (1:160). Only four patients of NSHA could be followed up and all showed a decline in specific IgM levels. Raised specific serum IgM seems to be an indicator of active (invasive) amoebiasis.