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Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report
AIM: Atypical diabetes is commonly reported in Africa. The objective of this case report is to highlight an unusual case of thin, severely hyperglycemic and ketone resistant teenager with history and signs of chronic under-nutrition to raise the awareness of clinicians on the existence of atypical p...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457811/ https://www.ncbi.nlm.nih.gov/pubmed/32922057 http://dx.doi.org/10.2147/DMSO.S263229 |
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author | Haftu, Hansa Gebrearegay, Hailemariam Berhane, Alemseged |
author_facet | Haftu, Hansa Gebrearegay, Hailemariam Berhane, Alemseged |
author_sort | Haftu, Hansa |
collection | PubMed |
description | AIM: Atypical diabetes is commonly reported in Africa. The objective of this case report is to highlight an unusual case of thin, severely hyperglycemic and ketone resistant teenager with history and signs of chronic under-nutrition to raise the awareness of clinicians on the existence of atypical phenotype of diabetes not fitting the current classification of diabetes. CASE PRESENTATION: A 17-year-old male patient, known diabetic, was diagnosed in the health center as type1 diabetes for 8 months. He was on insulin for 3 months and discontinued for 5 months. He presented with polydipsia, polyuria, and weight loss since he discontinued the drug. On examination, he was severely wasted and underweight with unexplained bilateral parotid enlargement. On investigations;, he had hyperglycemic, glucosuria but no ketonuria. The patient was admitted with the diagnosis of type 1 diabetes and severe acute malnutrition. He started insulin (1IU/Kg/day) subcutaneously and nutritional management. On follow-up, RBS and FBS remained high and insulin was escalated to 3.32 IU/kg/day. Subsequently, serial RBS and FBS, the measurements were in the acceptable range and the patient was gaining weight. As the weight increases, his demand for insulin was decreased and the dose of insulin was de-escalated to 1.2 IU/Kg/day over 3 months. Finally, the patient was discharged with 1.2 IU/Kg/day with a weight of 44 kg over 4 months of hospital course with the diagnosis of malnutrition-modulated diabetes. Now, the patient is in diabetic clinic follow-up with good glycemic control. CONCLUSION: Though there are unclear and uncertainties in malnutrition-modulated diabetes mellitus, clinicians need a high index of suspicion to reach the diagnosis especially in those countries where malnutrition is common. Early diagnosis and appropriate management of the patients demand are important in patient care and outcome. |
format | Online Article Text |
id | pubmed-7457811 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-74578112020-09-11 Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report Haftu, Hansa Gebrearegay, Hailemariam Berhane, Alemseged Diabetes Metab Syndr Obes Case Report AIM: Atypical diabetes is commonly reported in Africa. The objective of this case report is to highlight an unusual case of thin, severely hyperglycemic and ketone resistant teenager with history and signs of chronic under-nutrition to raise the awareness of clinicians on the existence of atypical phenotype of diabetes not fitting the current classification of diabetes. CASE PRESENTATION: A 17-year-old male patient, known diabetic, was diagnosed in the health center as type1 diabetes for 8 months. He was on insulin for 3 months and discontinued for 5 months. He presented with polydipsia, polyuria, and weight loss since he discontinued the drug. On examination, he was severely wasted and underweight with unexplained bilateral parotid enlargement. On investigations;, he had hyperglycemic, glucosuria but no ketonuria. The patient was admitted with the diagnosis of type 1 diabetes and severe acute malnutrition. He started insulin (1IU/Kg/day) subcutaneously and nutritional management. On follow-up, RBS and FBS remained high and insulin was escalated to 3.32 IU/kg/day. Subsequently, serial RBS and FBS, the measurements were in the acceptable range and the patient was gaining weight. As the weight increases, his demand for insulin was decreased and the dose of insulin was de-escalated to 1.2 IU/Kg/day over 3 months. Finally, the patient was discharged with 1.2 IU/Kg/day with a weight of 44 kg over 4 months of hospital course with the diagnosis of malnutrition-modulated diabetes. Now, the patient is in diabetic clinic follow-up with good glycemic control. CONCLUSION: Though there are unclear and uncertainties in malnutrition-modulated diabetes mellitus, clinicians need a high index of suspicion to reach the diagnosis especially in those countries where malnutrition is common. Early diagnosis and appropriate management of the patients demand are important in patient care and outcome. Dove 2020-08-25 /pmc/articles/PMC7457811/ /pubmed/32922057 http://dx.doi.org/10.2147/DMSO.S263229 Text en © 2020 Haftu et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Case Report Haftu, Hansa Gebrearegay, Hailemariam Berhane, Alemseged Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report |
title | Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report |
title_full | Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report |
title_fullStr | Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report |
title_full_unstemmed | Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report |
title_short | Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report |
title_sort | malnutrition-modulated diabetes mellitus in children, rare disease with atypical presentation: case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457811/ https://www.ncbi.nlm.nih.gov/pubmed/32922057 http://dx.doi.org/10.2147/DMSO.S263229 |
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