A Case of Adolescent Type 2 Diabetes
•
1 like•552 views
This was a presentation delivered at Gandhinagar on 18th August 2017. This is a talk on a Case of Adolescent Type 2 Diabetes successfully managed with Basal Insulin with Metformin
Recommended
More Related Content
What's hot
What's hot (20)
Similar to A Case of Adolescent Type 2 Diabetes
Similar to A Case of Adolescent Type 2 Diabetes (20)
More from Dr. Om J Lakhani
More from Dr. Om J Lakhani (11)
Recently uploaded
Recently uploaded (20)
A Case of Adolescent Type 2 Diabetes
- 1. VISIT http://www.dromlakhani.com A CASE OF ADOLESCENT TYPE 2 DIABETES
- 4. VISIT http://www.dromlakhani.com Case scenario ‘THE FENCE-SITTER’
- 5. VISIT http://www.dromlakhani.com Take home Message from the case 1. Type 2 Diabetes is Not uncommon in Adolescents these days 2. C peptide is not enough to differentiate type 1 and Type 2 Diabetes 3. Only Metformin and Insulin are approved for use in Type 2 Diabetics Children <18 years 4. Basal- Plus insulin is ideal in such patients
- 6. VISIT http://www.dromlakhani.com INITIALLY SEEN BY PHYSICIAN
- 7. VISIT http://www.dromlakhani.com • 16 year old boy • School going • c/o of polydipsia and polyphagia
- 8. VISIT http://www.dromlakhani.com • Acanthosis Nigricans + • Obese by Indian standards- BMI – 28 kg/m2 • Normal stature • Strong family history of diabetes (Father, uncles, grandparents) • Father had Diabetic retinopathy • BP- 130/80 mm Hg
- 9. VISIT http://www.dromlakhani.com Investigations • FBS – 305 mg/dl • PP2BS- 403 mg/dl • HBA1c- 11.3 % • Urine ketone – negative
- 10. VISIT http://www.dromlakhani.com DD • Type 1 Diabetes • Type 2 Diabetes • MODY • Others
- 11. VISIT http://www.dromlakhani.com • Q. What would be next step in this patient ?
- 12. VISIT http://www.dromlakhani.com a) Initiate Insulin therapy b) Initiate oral antidiabetics c) Evaluate this patient further before starting treatment d) Initiate Insulin + evaluate e) Initiate OAD + evaluate
- 13. VISIT http://www.dromlakhani.com • Patient and parents – refused to take Insulin • Physician started him on Metformin • Asked for C peptide
- 14. VISIT http://www.dromlakhani.com • C peptide was 2 ng/ml (Normal range 0.8- 3.1 ng/mL)
- 15. VISIT http://www.dromlakhani.com • Q. What is your interpretation of the C Peptide report ?
- 16. VISIT http://www.dromlakhani.com • Short acting insulin / intermediate acting insulin – 10 hours • Metformin, TZD- 10 hours • SU , Long acting insulin – 24 hours • Ideally done when patient is Euglycemic
- 17. VISIT http://www.dromlakhani.com Glucagon stimulated C peptide • Glucagon is injected IV and C peptide measured after 5 min and 10 min
- 18. VISIT http://www.dromlakhani.com Beta negative • Fasting C peptide - <1 ng/ml AND • Glucagon stimulated C peptide - <1.5 ng/ml
- 19. VISIT http://www.dromlakhani.com Preserved Beta cell function is defined as • Fasting C peptide- >1 ng/ml • Glucagon stimulated C peptide- > 1.5 ng/ml
- 20. VISIT http://www.dromlakhani.com • Continued the patient on Metformin • However glycemic control remained poor for the next 2-3 weeks • Referred to Endocrinologist
- 22. VISIT http://www.dromlakhani.com At time of assessment • Obese child • Acanthosis nigricans + • Fasting – 240 mg/dl • PP2BS- 380 mg/dl • Serum Beta Hydroxybutyrate - negative
- 23. VISIT http://www.dromlakhani.com • Started him on Basal bolus insulin and insisted upon it refused Labelled him as FENCE- SITTER • Asked for Antibodies
- 24. VISIT http://www.dromlakhani.com ‘Fence’ sitter Diabetic • Young patient (Adolescent / Young male) • Refusing to accept the Basal-bolus insulin • Start them on Basal insulin or Basal-Plus insulin like Ryzodeg • Mainly to prevent serious complications and buy time to investigate further to convinence the patient.
- 25. VISIT http://www.dromlakhani.com Antibodies • GAD-65, • IA-2 • IAA • ICA All negative
- 26. VISIT http://www.dromlakhani.com DD • Type 1 Diabetes • Type 2 Diabetes • MODY • Others
- 27. VISIT http://www.dromlakhani.com DD • Type 1 Diabetes • Type 2 Diabetes • MODY • Others
- 28. VISIT http://www.dromlakhani.com A beta Classification of Diabetes • A + B – > Antibody positive, beta cell negative - aka Type 1 Diabetes • A + B + > Antibody positive, beta cell function preserved - LADA • A – B+ > Antibody negative, beta cell function present - Early Type 2 Diabetes • A – B - > Antibody negative, absent beta cell function - Late Type 2 Diabetes
- 29. VISIT http://www.dromlakhani.com • This patient should be called A – B+ (Antibody negative, beta cell function present) Diabetes and not labelled as Type 1 or Type 2
- 30. VISIT http://www.dromlakhani.com • Q. So why Insulin at all and Not Metformin plus other OAD ?
- 31. VISIT http://www.dromlakhani.com • Only 2 drugs are approved for use in t2d in children 1. Metformin 2. Insulin
- 33. VISIT http://www.dromlakhani.com Treatment • Metformin – SR- 1 gram • Basal insulin - x units before Dinner • Diet • Exercise • Patient would inform me the BG daily
- 35. VISIT http://www.dromlakhani.com Take home Message from the case 1. Type 2 Diabetes is Not uncommon in Adolescents these days 2. C peptide is not enough to differentiate type 1 and Type 2 Diabetes 3. Only Metformin and Insulin are approved for use in Type 2 Diabetics Children <18 years 4. Basal- Plus insulin is ideal in such patients