[Insulin edema about 3 cases]

Insulin edema is known since a long time as a rare complication of insulin therapy. However, even today its pathogenesis remains unclear. Possible mechanisms involved are increased sodium retention by the kidney [2, 3] and increased loss of albumin from the circulation because of an insulin-induced increase in vascular permeability. We report three cases of adult patients, which presented with edema under insulin treatment. The first observation is a 52-year-old woman with diagnosed diabetes for 1 year, who developed edema a few days after initiation of insulin treatment [0, 9 Ul/kg/d]. The second observation is a 54-year-old woman who developed, ten years after initiation of insulin, generalized edema and two episods of cardiac failure, The third observation is a 42-year-old woman with type 1 diabetes since she was 20 years old. She presented an edema 20 years after the beginning of insulin treatment. In the two first cases, the stopping of insulin treatment resulted in resolution of edema. In the third one, any another cause of edema had been found. Insulin edema is a rare complication that always must be kept in mind, even after a long period of insulin treatment. In almost all the cases, it is not clinically evident. However, it sometimes leads to severe complications like cerebral edema or cardiac failure. A precocious diuretic treatment may prevent those complications

Metabolic control and alimentary contribution of type 2 diabetic during Ramadan under repaglinide

We studied 14 diabetic patients with type 2 diabetes [9 men and 5 women] in the aim to evaluate their metabolic control when treated with repaglinide while fasting during the month of Ramadan; their mean age was 50.6 +/- 2.2 year and their mean diabetes duration was 6.2 +/- 1. 3 years. We followed closely incidences of diurnal hypoglycemia and post prandial hyperglycemia. Mean glycosylated hemoglobin before Ramadan was 7.3 +/- 0.3% and none of our subjects had micro or macroangiopathy. During Ramadan, patients received repaglinide [l.l +/- 0.1mg at Iftar and 0.8 +/- 0.1mg at Shour] and metformine was continued in the 13 patients who were taking it prior to our study. Mean capillary glycemia at the end of the daily fasting was 1.32 +/- 1.06 g/l compared to 1.19 +/- 0.06 g/l for a mean fasting blood glucose before the month of Ramadan. Their mean postprandial 2H blood glucose after Iftar was 2. 15 +/- 0.17 g/l compared to 1.86 +/- 0.19 g/l for postprandial blood glucose after dinner. The mean blood glucose 2H after Shour was 1.76 +/- 0.20 g/l compared to 1.71 +/- 0.18 g/l for postprandial blood glucose after breakfast. The patients' weight remained stable; Fructosamine increased by 20.2 +/- 25.6 micro mol/l and glycosylated hemoglobin by 0.3 +/- 0.1%. Total food caloric intake and food composition remained unchanged. Only one event of clinical hypoglycemia occurred. Use of repaglinide during Ramadan decreases postprandial hyperglycemia without increasing the risk of diurnal hypoglycemia

[Giganto-acromegaly: a report of a case]

The occurrence of acromegaly before the end of the growth period is very rare. We report a case of a patient who presented an acromegalo-gigantism. His height reached 2.45 m and his weight 145 kg. He had a typical facial dysmorphy and an insulin requiring diabetes mellitus. There was no sign of cardio-respiratory failure or of endocrine deficiencies. The echocardiography showed that the left ventricule was moderately dilated and hypertrophied but the systolic function was preserved. Hormonal investigation revealed high growth hormone [GH] levels without suppression after oral glucose load. Other pituitary secretions were normal. Initial tomodensitometry revealed an invasive macroadenoa. The patient had two trans-sphenoidal resections of the tumor completed by radiotherapy [45 Gy]. Afterwards, because of still unsuppressed GH levels, the patient was treated with Octreotide. This first published case of acromegalo-gigantism in Tunisia is particular not only by its rarity but also by its moderated effects on vital functions in spite of along spontaneous evolution

[Hyperlipemia and lymphoma]

While the concept of developing hypocholesterolemia during myeloma or lymphoma is not unusual, the existence of developing hyperlipemia is rare. The authors report the case of a sixty-one year old diabetic patient treated by oral medication. This patient does not have a family history of hyperlipemia. He was hospitalized for degradation of his general condition, and a pain of the right shoulder and bilateral pleural effusion. A major hyperlipidemia [total cholesterol = 13.5 mmol/l, triglycerides = 16.8 mmol/l] was noted during his hospitalization and persisted in spite of a fibrate treatment and a controlled diabetes. The radiography of the upper right limb showed lytic images of the extremity of the humerus. The thoracic CT scan showed bilateral pleural effusion and a hyperdense paravertebral image of ganglion metastasis. The myelograme and the pleural biopsies showed a malignant non hodgkin lymphoma. An immunosuppressor treatment was prescribed resulting in a spectacular improvement of the hyperlipidemia since the first chemotherapy. This is probably an autoimmune hyperlipidemia associated with a lymphoma. Further investigations like the study of the lipoprotein lipase activity, the search of antibodies related to the apo E or the apo B would be useful in order to confirm this assumption