TYPE I DIABETES MELLITUS – DIAGNOSIS BASED ON COMPLICATIONS

Lorena Elena Melit,Oana Marginean,Maria Oana Marginean,Cristina Campean

doi:10.37897/rjp.2015.2.13

Abstract

We present you an atypical case of type 1 diabetes mellitus at onset, with multiple abscesses, diagnosis confirmed afterwards by laboratory tests. This report is of a 14 year-old girl, who presented with abscesses of thighs, hypogastric and inguinal area. The regular investigations performed pointed out hyperglycemia with glucose in the urine, accompanied by weight loss, polyuria and polydipsia. The abscesses were incised and drained. The pathological signs of the clinical examination were: influenced general status, decreased skin turgor, dry lips, multiple fistulized abscesses of the thighs and hypogastric area, hyperemic pharynx and tonsils. The blood tests revealed hyperglycemia (272 mg/dl), leukocytosis with granulocytosis, thrombocytosis, and increased values of hemoglobin. The clinical and paraclinical data were suggestive for type I diabetes mellitus, complicated with abscesses. The treatment consisted in substitutive treatment with insulin associated with antibiotics, antimycotics, analgesics, antipyretics, endo-venous perfusions for rehydration. The evolution of the case was favorable under treatment with insulin, the condition of the cutaneous abscesses improved very much after surgical treatment and administration of antibiotics, but they healed only after the equilibration of diabetes mellitus. In conclusion, even though in the specialty literature it is reported that there appear multiple cutaneous infections in patients with diabetes mellitus wrong treated, these are rarely diagnosed at the onset of this disorder in children, this fact being probably explained by the acute onset of the disease at this age.

Highlights

Type 1 diabetes mellitus is an autoimmune disease, that consists in an autoimmune specific process, in which the antibodies directed against the β pancreatic cells, lead to selective destruction of these ones
The most important genetic factor is represented by the major antigens of histocompatibility (HLA), leading in many cases to the association of type I diabetes with other autoimmune pathologies, such as autoimmune tiroiditis, pernicious anemia and Addison’s disease, the most frequent of which being the autoimmune tiroiditis [2]
The treatment of type 1 diabetes mellitus consists in lifetime supplement with insulin, associated with strict monitoring of glycaemic values, appropriate education for the patient and care-givers for being capable of recognizing the symptoms of hypoglycaemia and hyperglycaemia and to know the management of this kind of situations, and last but not least the education of the patient’s compliance for preventing situations at risk and late complications of this pathology

Summary

INTRODUCTION

Type 1 diabetes mellitus is an autoimmune disease, that consists in an autoimmune specific process, in which the antibodies directed against the β pancreatic cells, lead to selective destruction of these ones. The clinical picture of type 1 diabetes mellitus is mainly represented by polyuria, polydipsia and polyphagia, but it can appear tiredness, muscle weakness, nausea, impairment of the visual function, abdominal pain, bowel movements disorders, impairment of the peripheral nerves, with numbness in the extremities The onset of this pathology is usually sudden, even associated with diabetic ketoacidosis. The treatment of type 1 diabetes mellitus consists in lifetime supplement with insulin, associated with strict monitoring of glycaemic values, appropriate education for the patient and care-givers for being capable of recognizing the symptoms of hypoglycaemia and hyperglycaemia and to know the management of this kind of situations, and last but not least the education of the patient’s compliance for preventing situations at risk and late complications of this pathology. We chose to present this case because we want to underline an atypical onset of type 1 diabetes, the complications being the ones that led to establishing the diagnosis

CASE PRESENTATION

Findings

CONCLUSIONS