alexa Cessation of Multiple Daily Insulin Injections in a Per
ISSN: 2572-5629

Diabetes Case Reports
Open Access

OMICS International organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations

700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)

Case Report

Cessation of Multiple Daily Insulin Injections in a Person with Twenty-Nine Years of “Type 1 Diabetes”

Joel LIM Guanyi1, Su Fen ANG1, Clara Tan SH1, and Jessie Fong CW1, Su Chi LIM1,2*

1Clinical Research Unit, Khoo Teck Puat Hospital, Singapore

2Diabetes Centre, Khoo Teck Puat Hospital, Singapore

*Corresponding Author:
Su Chi LIM
Clinical Research Unit
Khoo Teck Puat Hospital, Singapore
Tel: +65-66022353
E-mail: lim.su.chi@alexandrahealth.com.sg

Received date: March 12, 2017; Accepted date: March 27, 2017; Published date: March 30, 2017

Citation: Su Chi LIM, Joel LIM G, Su Fen ANG, Clara Tan SH, Jessie Fong CW (2017) Cessation of Multiple Daily Insulin Injections in a Person with Twenty-Nine Years of “Type 1 Diabetes”. Diabetes Case Rep 2:122.

Copyright: © 2017 Su Chi LIM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

Diabetes mellitus is a complex and etiologically heterogeneous metabolic disorder. Therefore, accurate classification of patients into diabetes-subtypes remains a challenge in clinical practice. We report a 50-year-old, non-obese (Body Mass Index (BMI) 22.4 kg/m2) Chinese lady who was diagnosed with Type 1 Diabetes Mellitus (T1DM) at age 21. This diagnosis was made owing to abnormal glucose tolerance detected during pregnancy and the young-onset nature of the disease. Subsequently, a multiple daily insulin injection (MDI) regime was initiated and maintained for almost three decades. Given a few clinical features atypical of T1DM (i.e. relatively stable fasting and post-absorptive glucose profile along with being non-ketotic prone despite occasional interruption of MDI, suggesting preserved pancreatic β cell insulin secretory function), the diagnosis was re-visited. She was subjected to deep re-sequencing of a panel of 16 candidate genes implicated in monogenic diabetes (or Maturity Onset Diabetes of the Young [MODY]) using Next Generation Sequencing (NGS) technology. A glucokinase (GCK) coding non-synonymous mutation (S441W), novel among Asians was discovered. The mutation was predicted to be functionally deleterious by multiple bioinformatics algorithms. Additionally, one recent in vitro site-directed mutagenesis study reported reduced enzyme-substrate (i.e. glucose) affinity associated with this variant. This suggested a revised diagnosis of MODY2. Notwithstanding the long-standing duration of diabetes, she was successfully weaned off from all anti-diabetic agents over the next few months with modest impact on her global glycemic profile (HbA1c 6.4% to 6.9%). Averting unnecessary long-term pharmacotherapy often means substantial health-cost savings, avoidance of potential treatment-related adverse-effects and importantly, better quality of life for the person and their family members. This case-report serves as an important reminder to reconsider the diagnosis and consider the option of genetic testing (especially in the era of NGS), among diabetic individuals with features atypical of the classic forms of diabetes.

Keywords

Share This Page

Additional Info

Loading
Loading Please wait..
 
Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

agrifoodaquavet@omicsonline.com

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

clinical_biochem@omicsonline.com

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

business@omicsonline.com

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

chemicaleng_chemistry@omicsonline.com

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

environmentalsci@omicsonline.com

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

engineering@omicsonline.com

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

generalsci_healthcare@omicsonline.com

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

genetics_molbio@omicsonline.com

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

immuno_microbio@omicsonline.com

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

omics@omicsonline.com

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

materialsci@omicsonline.com

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

mathematics_physics@omicsonline.com

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

medical@omicsonline.com

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

neuro_psychology@omicsonline.com

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

pharma@omicsonline.com

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

social_politicalsci@omicsonline.com

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords