engleski

DIABETES AS PART OF THE METABOLIC SYNDROME

A 59-year-old female diabetic patient was referred to the Vuk Vrhovac University Clinic for evaluation of her diabetes complications and treatment. She had suffered from hypertension for twenty years before, and diabetes was quite accidentally detected when she was being prepared for cholecystectomy at the age of 40. For 10 years, she was treated with diet, then she switched to insulin. She had already undergone photocoagulation therapy for retinopathy on several occasions, and cataract operations on both eyes. She was on conventional intensified insulin treatment with 12 U of regular insulin before meals and 14 U of NPH at bedtime. She was also taking nifedipine and furosemide for hypertension. Her body weight was 94 kg, height 166 cm, body mass index (BMI) 34 kg/m2, blood pressure 190/105 mm Hg, fasting blood glucose 11.9 mM/L, glycosylated hemoglobin 9.48%, total cholesterol 7.5 mM/L, HDL cholesterol 0.95 mM/L, and triglycerides 9.15 mM/L. She was re-educated in diet and advised to lower her insulin dosage. She also was scheduled for hospital admission. On hospital admission, her body weight was 85 kg, BMI 31 kg/m2, and blood pressure 140/85 mm Hg. She discontinued NPH insulin and evening regular insulin, and was taking 8 U of regular insulin at breakfast and lunch. Her fasting blood glucose was 3.9 mM/L, glycosylated hemoglobin 6.95%, total cholesterol 5.82 mM/L, HDL cholesterol 1.09 mM/L, LDL cholesterol 3.44 mM/L, and triglycerides 2.83 mM/L. Ophthalmologic examination revealed proliferative retinopathy bilaterally, and maculopathy, whereas neurologic examination indicated sensorimotor polyneuropathy. There were no signs of diabetic nephropathy. Also, euthyroid goiter was detected. During her hospital stay, the patient was successfully switched to glibenclamide. On control visits (twice a year), she was continuously losing weight down to 80 kg (BMI 29 kg/m2), and she was able to maintain a satisfactory glycemic control and lipid levels.

diabetes; metabolic syndrome

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