| Part oneClinical Analysis of Acute Onset Type 1 Diabetes MellitusPurposeIn our study,we made a clinical retrospective analysis of 73 cases with adult T1DM patients with acute onset.To summarized the clinical characteristics of adult acute T1DM.To analysis the gender ratio and the gender difference in adult T1DM patients with acute onset.Methods1)Between January 2006 and August 2015 in the department of endocrinology and department of pediatrics,the First Affiliated Hospital of Guangxi Medical University,in China.We filtrated the clinical data of adult and less than 14 years acute T1DM patients from the cases whose first diagnosis was type 1 diabetes.2)To analyzed the clinical characteristics of adult acute T1DM.To compared the gender ratio and the gender difference between adult and less than 14 years acute T1DM patients.Results1)73 cases were adult T1DM patients with acute onset;the gender ratio(female/male):2.17/1.2)In the cases of adult acute T1DM,the value of men increased in the blood glucose(33.89±13.51 mmol/L vs 28.79±17.86,P=0.04),TG[(0.88,1.86)mmol/L vs(0.53,1.31)mmol/L,P=0.04]than women;The value of men decreased in the fasting C peptide[(0.04,0.17)ng/ml vs(0.07,0.26)ng/ml),p=0.04]?HDL(1.07±0.45 mmol/L vs 1.42±0.41 mmol/L,P=0.00)than women.conclusionsIn our area,it may be a male predominance in incidence rate.Gender differences may exist in blood glucose,fasting C peptide,TG,HDL of adult acute type 1 diabetic patients.Part Twothe Clinical Features of Adult Fulminant Type 1 Diabetes MellitusPurposeIn our study,we made a clinical retrospective analysis of 24 cases with fulminant type 1 diabetes mellitus(FT1DM).To summarized the clinical characteristics of FT1DM.To compared the clinical characteristics between FT1DM group and non-FT1DM group.Methods1)Between January 2006 and August 2015 in the department of endocrinology and department of pediatrics,the First Affiliated Hospital of Guangxi Medical University,in China.We filtrated the patients' clinical data of FT1DM group and non-FTIDM group from the cases whose first diagnosis was adult acute onset T1DM.2)To analyzed the clinical characteristics of the patients in FT1DM group.To compared the clinical characteristics between FT1DM group and non-FT1DM group.Results1)We affiliated 24 cases of FT1DM and 156 cases of non-FTl DM.The case of FT1DM accounted for 2.60%(24/923)of all type ldiabetic inpatients;50%of cases of FT1DM were diagnosed in nearly two years and the number of cases was increased significantly.?In the cases of FT1DM,BMI was 20.66±2.50 kg/m2 and diabetes duration was 3.00±1.93 days;The cases of pregnancy-ralated were 4/9(44.40%)cases.11/24(45.83%)cases had not diabetic symptoms.Abdominal pain symptoms had 13/24(54.17%)cases,nausea and vomiting symptoms had 17/24(70.83%)cases,low blood pressure had 8/24(33.33%)cases,respectively.?The onset plasma glucose was 43.39±16.43 mmol/L;HbA1c was 7.20±0.95%;Fasting C peptide was 0.05(0.01,0.07)ng/ml,postpradial C peptide was 0.093±0.065 ng/ml,blood gas analysis PH value was 7.13±0.10,serum potassium was 5.78±1.50 mmol/L.In the 24 cases of FT1DM,12/24(50.00%)cases' myocardial enzymes,10/24(41.67%)cases' liver function,17/24(70.83%)cases'renal function and 10/23(43.48%)cases'serum or urine amylase increased.?Some FT1DM Patients needed special treatment:drop the pancreatic enzyme treatment(29.27%),gastrointestinal decompression treatment(20.83%),reduce potassium treatment(41.67%),hemodialysis(4.17%),Intensive Care Unit monitoring and treatment(12.5%),endotracheal intubation treatment(8.33%).2)To compared the clinical characteristics between FT1DM group and non-FT1DM group.? The ration of FT1DM group significantly increased in the abdominal pain(54.17%vs 10.20%,P=0.00),nausea and vomiting(70.83%vs 22.45%,P=0.00),disturbance of consciousness(45.83%vs 14.29%,P=0.00),low blood pressure(33.30%vs 4.08%,P=0.00),myocardial enzyme(50.00%vs 24.44%,P=0.03),liver function(41.67%vs14.29%,P=0.01)and rena function(70.83%vs 16.33%,P=0.00)than non-FT1DM group;The value of FT1DM group increased in the blood glucose(43.39±16.43vs 27.78±11.15 mmol/L,P=0.00),serum pota-ssium(5.78±1.50 mmol/L vs 4.49±1.01 mmol/L,P=0.00),blood leukocyte(14.74±7.64×109/L vs 8.79±4.89× 109/L,P=0.000)than non-FT1DM group.? The value of FT1DM patients in our area were significantly younger in the diabetes duration[(1.00,4.00)d vs(7.00,60.00)d,P=0.00],blood gas analysis(7.13±0.10vs 7.26±0.17,P=0.00),HbAlc(7.20±0.95%vs 12.99±3.20%,P=0.00),Fasting C peptide[(0.01,0.07)ng/ml vs(0.08,0.25)ng/ml,P=0.00],postpradial C peptide(0.09±0.07 ng/ml vs 0.38±0.24 ng/ml,P=0.00)and insulin doses(0.65±0.17 U/kg/d vs 0.80±0.26 U/kg/d,P=0.01)than non-FT1DM group.2)To compared the clinical characteristics between our study and Japan The value of FT1DM patients in our area were significantly lower in the age(30.9±10.0y vs 39.8±15.7y,P=0.38),duration(3.00±1.93d vs 4.4±3.14,P=0.03),fasting C peptide(0.09±0.07 ng/ml vs 0.38±0.24 ng/ml,P=0.00)than Japan,but HbA1c(7.20±0.95%vs 6.4±0.9%,P=0.00)was higher.conclusions1)In our study,the cases of FTIDM were adult,onset abruptly and more complications.We should train the diagnosis and treatment of FT1DM to the doctors from the municipal hospital and the county basic-level hospital.2)The values of FT1DM patients in our area were significantly lower in the age,duration,fasting C peptide than Japan,but HbA1c was higher.3)The insulin dose of FT1DM group was less than non-FT1DM group.CLINICAL RESEARCH OF LIPOATROPHY INDUCED BY INSULIN INJECTION IN TYPE 1DIABETIC PATIENTS Part threePurposeWe aimed to analyze clinical features,pathologic features and treatment in four diabetic patients with lipoatrophy induced by insulin injection.Methods1)Between January 2014 and January 2015 in the Department of endocrinology,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,in China,4 diabetic patients who had insulin injection induced lipoatrophy were selected to collect their clinical data;2)Histologic examination and immunohistochemistry checking(CD34,CD31,CD68,IgM,IgG and IgA)of dermal and subcutaneous tissue were used in a patient.Results1)4 female type 1 diabetes patients with the age of 26?61 years old,BMI:18.4?27.6 kg/m2.After these patients were injected with insulin,they had the following symptoms,including subcutaneous nodules or urticaria in the injection site,high titers of anti-insulin antibodies and substantial fluctuations in blood glucose;Repeatedly injecting insulin at the same site,3 patients used the insulin needle more than 10 times and 1 patient used it from 6 to 9 times.CT or MRI showed reduced subcutaneous adipose tissue in lipoatrophied areas.CT scanning revealed fibrosis in the subcutaneous tissue.2)Pathological mechanism:Adipocytes in lipoatrophied areas to be fewer and significantly smaller than those in normal areas(996.34±524.60 vs 8559±5240 um2,P<0.001).There were positive immumohistochemical staining of skin basal cells(IgM)in lipoatrophied areas.By making a comparison between lipoatrophied areas and non-lipoatrophied areas,it showed that CD34 immumohistochemical staining microvascular density in lipoatrophied areas was significantly increased than non-lipo-atrophied areas(42.83±2.86vs 6.5±1.9,P<0.01).There were more pro-liferation of small vessels and more immature morphology in the lipoatrophied areas.Conclusions:1)The lipoatrophy induced by insulin injection is still exist.The patients who experienced lipoatrophy had high titers of anti-insulin antibodies and substantial fluctuations in blood glucose.2)Adipocytes in lipoatrophied areas to be fewer and significantly smaller than those in normal areas.There were lots of collagen fibers,immature morphology small vessels in the lipoatrophied areas.3)Changing insulin,injection site and injection needle may resolve the problem in some cases. |
PDF Full Text Request