Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report

Hansa Haftu,1 Hailemariam Gebrearegay,2 Alemseged Berhane2 1Mekelle University, College of Health Science, Department of Pediatrics and Child Health, Mekelle, Ethiopia; 2Mekelle University, College of Health Science, Department of Pediatrics and Child Health, Tigray, EthiopiaCorrespondence: Hansa Ha...

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Autores principales:	Haftu H, Gebrearegay H, Berhane A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	malnutrition diabetes mellitus children insulin. Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/499833cfba054a0a9c3b681979e7e2ce
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spelling	oai:doaj.org-article:499833cfba054a0a9c3b681979e7e2ce2021-12-02T10:52:49ZMalnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report1178-7007https://doaj.org/article/499833cfba054a0a9c3b681979e7e2ce2020-08-01T00:00:00Zhttps://www.dovepress.com/malnutrition-modulated-diabetes-mellitus-in-children-rare-disease-with-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Hansa Haftu,1 Hailemariam Gebrearegay,2 Alemseged Berhane2 1Mekelle University, College of Health Science, Department of Pediatrics and Child Health, Mekelle, Ethiopia; 2Mekelle University, College of Health Science, Department of Pediatrics and Child Health, Tigray, EthiopiaCorrespondence: Hansa HaftuMekelle University, College of Health Science, Department of Pediatrics and Child Health, Mekelle, EthiopiaTel +251948487877Email hansahaftu21@gmail.comAim:: 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.Keywords: malnutrition, diabetes mellitus, children, insulinHaftu HGebrearegay HBerhane ADove Medical Pressarticlemalnutritiondiabetes mellituschildreninsulin.Specialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 13, Pp 3069-3074 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	malnutrition diabetes mellitus children insulin. Specialties of internal medicine RC581-951
spellingShingle	malnutrition diabetes mellitus children insulin. Specialties of internal medicine RC581-951 Haftu H Gebrearegay H Berhane A Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report
description	Hansa Haftu,1 Hailemariam Gebrearegay,2 Alemseged Berhane2 1Mekelle University, College of Health Science, Department of Pediatrics and Child Health, Mekelle, Ethiopia; 2Mekelle University, College of Health Science, Department of Pediatrics and Child Health, Tigray, EthiopiaCorrespondence: Hansa HaftuMekelle University, College of Health Science, Department of Pediatrics and Child Health, Mekelle, EthiopiaTel +251948487877Email hansahaftu21@gmail.comAim:: 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.Keywords: malnutrition, diabetes mellitus, children, insulin
format	article
author	Haftu H Gebrearegay H Berhane A
author_facet	Haftu H Gebrearegay H Berhane A
author_sort	Haftu H
title	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_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_sort	malnutrition-modulated diabetes mellitus in children, rare disease with atypical presentation: case report
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/499833cfba054a0a9c3b681979e7e2ce
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Malnutrition-Modulated Diabetes Mellitus in Children, Rare Disease with Atypical Presentation: Case Report

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