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Introduction: Self-care and self-management skills are at the forefront of disease management skills in individuals with Type 1 and Type 2 diabetes. An individual with diabetes who defines his/her self-care well will have increased his/her disease management skills as well as self-management skills to the desired level. The aim of this study is to evaluate the self-management skills of individuals with Type 1 and Type 2 diabetes receiving insulin therapy according to their sociodemographic characteristics.Method: The research is a prospective analytical study. Within the scope of the study, 913 individuals with Type 1 and Type 2 diabetes who applied to the diabetes polyclinic of a university hospital in Izmir in a month were included. The researchers collected the data through face-to-face interviews into Diabetes Patient Diagnosis Form and Diabetes Self-Management Skill Form.Results: In study 99.8% of the patients received diabetes education at least once and 60.8% of the individuals had never experienced hypoglycemia. When the diabetes self-management skills and self-insulin making skills of individuals with diabetes are examined; A statistically significant difference was found between the diagnostic variable categories in the sub-dimensions of medical nutrition therapy, exercise and treatment management, awareness of chronic complications, and diabetic outpatient care behaviors. It was determined that there was a significant difference between the education styles of individuals with diabetes, the frequency of blood sugar control and the frequency of hypoglycemia, and the sub-dimensions of diabetes self-management skills and the ability to make insulin on their own (p lt;0.001).Conclusion: Diabetes education given to individuals with diabetes contributes to their development of self-management skills. Multiple factors can affect individuals' self-management skills. As the number of educations, type of education, treatment methods, and education level of individuals with diabetes increase, their self-management skills and self-insulin making skills increase. If type 1 and type 2 diabetes patients can be followed closely and their training needs, diversity and application methods can be corrected, disease management will improve. Complications that may develop due to insulin application errors can be prevented.

Objective: As society ages, managing people with diabetes gains importance and becomes difficult because of accompanying diseases and complications. This study examined the effects of treatment changes in people with diabetes over 65. Methods: The data of patients aged ≥65 who were followed up in the İstanbul University, İstanbul Faculty of Medicine between 2010 and 2017 were retrospectively analyzed. Demographic data, comorbidities, complications, and metabolic effects of treatment changes were evaluated. Results: The study included 250 patients with a mean age of 72.0±6.6 years. Of the patients, 78.8% had hypertension, 58.4% had dyslipidemia, 32% had coronary artery disease, and 10% had chronic renal failure. The frequency of diabetic neuropathy was 26%, nephropathy 22.8%, and retinopathy 20.8%. The incidence of hypoglycemia was 16.4%. While oral antidiabetic drugs (OAD) alone decreased by 19%, 14% of these patients switched to OAD + basal insulin therapy and 4% to basal-bolus therapy during the follow-up period. With the addition of basal insulin to OAD, an additional 0.9% reduction in glycated hemoglobin (HbA1c) was achieved, and a further 1.2% reduction was achieved by switching to basal-bolus insulin. Conclusion: Our study has shown that continuing the use of metformin in older adults with diabetes with preserved renal functions and adding insulin to their existing treatments when needed, despite all the reservations, provides an effective treatment by decreasing the HbA1c level. However, the lower-than-expected hypoglycemia frequency in our study may be due to the progressive age of diabetes and hypoglycemia unawareness due to accompanying autonomic neuropathy. Education of patients gains importance in this regard. [ABSTRACT FROM AUTHOR]

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Copyright of Mersin Üniversitesi sağlık Bilimleri Dergisi is the property of Mersin University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Glycogen storage disease type I (GSD I) is one of rare inborn error of metabolic disorder inherited with autosomal recessively. It has a key role both in glycogenolysis and gluconeogenesis. Infants exhibit hypoglycemic episodes, developmental delay, growth retardation, hepatomegaly accompanying with increased blood concentrations of lactic acid, triglycerides, cholesterol, and uric acid. The major treatment is frequent feeding containing slow release carbohydrate supplementation. In this study we aimed to investigate the effects of adequate fiber supplementation to metabolic controls of patients with GSD I. Materials and Methods: Patients followed up in our clinic with GSD I were enrolled to the study. Fiber amounts to be supplemented for each induvidual were calculated according to 3 day diet dairy and daily recommended amounts. Patients were subjected to 6 day continuous glucose monitorization and their biochemical metabolic parameters were reqruited before and at the end of 6 week fiber supplementation. Results: Mean, lowest and highest glucose values insignificantly decreased, however HbA1c levels significantly increased. Lactate, cholesterol, LDL, AST, and uric acid mean values also decreased, however the differences were not statistically significant. In addition, decreased mean levels of triglyceride, GGT were statistically significant. Conclusion: The results of this study suggest the improvment of glucose homeostasis and biochemical parameters which encourage for the use of adequate fiber supplementation in terms of contributing metabolic control in GSD I patients. However, randomized, double blinded controlled prospective long-term trials with expanded number of patients are required to investigate the effects of fiber supplementation perspectively. [ABSTRACT FROM AUTHOR]

Objective: Blood glucose dysregulation is independently associated with mortality and morbidity in critically ill patients. However, it is difficult to keep glycemic control at targeted levels in diabetic and non-diabetic patients in intensive care units (ICU). A point prevalence study was planned to evaluate glycemic control in patients treated in the tertiary ICU. Ethics committee approval was obtained before starting the study. Methods: The demographic data of the patients, their characteristics at the time of admission, intensive care follow-up and treatment, the nutrition method, and the parameters related to glycemic control were recorded. Results: On the study day, a total of 107 patients, 35 of whom were COVID (C-ICU) and 72 were in the non-Covid ICU (NC-ICU), were included in the study. 47.6% of the patients were male and 29.9% had a diagnosis of diabetes mellitus (DM). The mean blood glucose value of the patients was measured as 158 mg/dL and glycemic dysregulation (4.7% hypoglycemia and 25.2% hyperglycemia) was detected in 29.9% of all patients. Blood glucose levels were unregulated in 28.6% (n=10) of the patients in C-ICU and 30.5% (n=22) patients in NC-ICU. The patients with regulated blood glucose were similar between the two groups (p=0.510). A statistically significant correlation was found between the patients' unregulated blood glucose levels and the presence of DM (p=0.05). Conclusion: The idea that a certain glucose target may not always be optimal for all patients and that individualized glucose control is currently being discussed. We believe that blood glucose algorithms are necessary in ICUs without putting patients into hypoglycemia or hyperglycemia in routine follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Neonatal hypoglycemia (NH) is frequent in neonatology practice. This study aimed to evaluate the regional cerebral tissue oxygenation and cerebral blood flow in neonates who developed NH immediately after birth. Methods: This prospective study included infants who developed NH (n=50) and the control healthy term neonates (n=50). Infants with NH are monitored in terms of continuous regional cerebral tissue oxygenation (rcSO2) via near-infrared spectroscopy (NIRS) during the first 24 hours of life. Middle cerebral artery (MCA) blood flow was evaluated by doppler ultrasound at the first and 24 hours of life. The pulsatility index (PI) was measured to assess cerebral vascular resistance. Results: The mean gestational age, birth weights and hemoglobin levels of infants were similar. The mean rcSO2 was continuously higher and fractional tissue oxygen extraction (FTOE) was lower in infants with NH. The mean MCA PI values at the first and 24th hours of life were significantly higher in NH. Conclusions: This study shows that cerebral perfusion was impaired in infants with NH. They had higher rcSO2, lower FTOE values and increased PI compared to healthy term infants. We suggest that increased PI may reflect increased vascular resistance and higher rcSO2 values associated with increased cerebral perfusion as a compensatory auto-regulatory response mechanism. Significantly lower FTOE values may dedicate decreased cerebral tissue oxygen extraction resulting from impaired cerebral perfusion even in the presence of auto-regulatory mechanisms. Therefore, even if they are asymptomatic, long term neurological outcomes should be followed in infants with NH due to impaired cerebral perfusion. [ABSTRACT FROM AUTHOR]

Copyright of Yeni Üroloji Dergisi is the property of Ali Ihsan Tasci and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The aim of this study is to determine the factors associated with fear of hypoglycemia and perception of self-efficacy and related factors in diabetic patients using insulin. Material and Method This descriptive and correlational study was conducted with a total of 136 patients followed by a diabetes education nurse in a State Hospital between December 2016 and February 2017. "Patient Information Form", "Self-Efficacy Perception Sub-Scale of Multidimensional Diabetes Questionnaire" and "Hypoglycemia Fear Scale (HFS)" were used to collect data. In order to determine whether the data showed a normal distribution, Kolmogorov-Smirnov test, kurtosis and skewness values were calculated and the tests to be used for the analysis of the data were determined. The t test was used to compare the data between two independent groups, and the one-way analysis of variance was used to compare the data between more than two groups. Pearson Correlation analysis was performed to determine the relationship between scale scores. Multiple Linear Regression analysis was performed to determine whether the independent variables significantly predicted the Self-Efficacy Perception Scale and HFS scores. Results The mean age of the individuals participating in the research is 58.12 ± 12.4. In addition, 66.9% of the participants are women and 75% of them are fifty years old and over. The total mean score of the participants on the HFS was 52.5 ± 11.2; Behavior sub-dimension mean score was 28.12 ± 4.76 and Worry sub-dimension mean score was 24.46 ± 8.11. The mean score of the Self-Efficacy Perception Scale of the patients was 364.2 ± 18.46. It was determined that there was a statistically significant difference between the patients' DM duration, DM type, DM drug treatment type, regular follow-up visits, hypoglycemia experience and knowing the symptoms of hypoglycemia, and the scores of HFS and Self-Efficacy Perception Scale (p < 0.05). A negative and moderate correlation was found between the Self-Efficacy Perception Scale score and the total score of HFS, the Behavior sub-dimension score and the Worry sub-dimension score (r=- 0.578, p<0.001; r= - 0.588, p<0.001 ve r= - 0.548, p<0.001 respectively). According to the multiple regression analysis carried out to determine whether the duration of DM, type of DM, DM medication, regular follow-up visits, hypoglycemia, and knowing the symptoms of hypoglycemia significantly predicted the total score of the HFS and Self-Efficacy Scale, the model was found to be significant and the variance explained 42% and 53% of them respectively. (F= 16.71; p<0.001; F= 19.47; p<0.001, respectively). Conclusion Fear of hypoglycemia and self-efficacy perception of diabetic patients using insulin are affected by some characteristics of the disease. In addition, the self-ef- ficacy perception level of the patients is effective on the fear of hypoglycemia. In this context, improving the perception of self-efficacy in individuals with diabetes may be effective in reducing fears of hypoglycemia. [ABSTRACT FROM AUTHOR]

Copyright of Türk Radyoloji Seminerleri is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Karya Journal of Health Science is the property of Karya Journal of Health Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Neonatal convulsions may be an early sign of brain injury and the presence of convulsions in the neonatal period has been associated with long-term sequelaes such as mental retardation, postnatal epilepsy and death. We aimed to determine associations of etiological factors with neurodevelopment and postneonatal epilepsy and evaluate the risk factors in newborns with neonatal convulsions that were not related to hypoxic-ischemic encephalopathy. Material and Methods: This study included full-term infants who were born between January 2010 and December 2014 and had neonatal convulsion history, had no history of hypoxic-ischemic encephalopathy and were followed for at least 1 year at our neurology clinic. Results: Forty-nine patients were included to the study. Among the identified etiologies on first clinical visit, hypoglycemia was the most common cause which was presented in 11 (40.74%; 11/27 patients) patients. During follow-up, 22.4% (n=11) of patients developed postneonatal epilepsy. In 4 of 7 patients with abnormal Bayley II test results, epilepsy developed in the follow-up. The risk for development of postneonatal epilepsy was significantly associated with abnormal neurological findings, such as cerebral palsy or significant delays in developmental stages; being not benefited from acute treatment and follow-up abnormal EEG findings of the patients. Conclusion: Hypoglycemia should be primarily investigated and treated in term neonatal seizures without hypoxia. Abnormal neurological findings, being not benefited from the acute treatment and follow-up EEG findings were associated with developing epilepsy. In the literature, most of the studies were limited due to short follow-up periods. More information about prognostic factors in neonatal convulsions and the occurrence of postneonatal epilepsy is needed. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted in order to determine the frequency and severity of hypoglycemia and factors affecting hypoglycemia in diabetic patients. Materials and Methods: The patients hospitalized in the endocrinology ward or admitted to our outpatient clinics were included. All patients were above 18 years of age and had diabetes who were receiving insulin treatment. A total of 1038 patients were enrolled. Results: According to our findings, the patients in the study group were mostly female and relatively older. Most patients had low education levels and social status, and they were mostly living in the city suburbs. Most female patients in that group were housewives, and the most common accompanying comorbidities were hypertension and hyperlipidemia. The patients had a long duration of diabetes history and had received "diabetes and insulin education" before. Despite education, they didn't make the appropriate lifestyle changes such as diet and exercise. The mean insulin usage time was two years, and premixed insulins were the most common ones that were being used. Although hypoglycemia was frequent, the rate of severe attacks was low. Almost all cases had glucometer at home and were making self blood glucose monitoring. Moreover, almost all patients were injecting insulin to themselves, and the most common needle diameter was 8 mm. In our study, the enrolled patients' mean BMI, FPG, PPG were above the target range. Conclusion: In the analysis made in the research, occupation, diabetes type, insulin type, retinopathy, glucose follow-up, duration of diabetes, the duration of insulin treatment were found to be significant in terms of the presence of hypoglycemia; age and duration of insulin treatment were found to be significant in terms of frequency of hypoglycemia; duration of insulin treatment was significant in terms of severity of hypoglycemia. [ABSTRACT FROM AUTHOR]

Anti-insulin antibody syndrome is a rare autoimmune disorder that is characterized by severe hypoglycemia, elevated blood insulin level, insulin autoantibodies, and the absence of pancreas islet cell pathology or exogenous insulin exposure. Alpha-lipoic acid is a sulfhydryl-containing compound that is used to treat diabetic peripheral neuropathy and was first reported as a cause of anti-insulin antibody syndrome in Japan in 2003. In the literature, 17 cases with anti-insulin antibody syndrome following alpha-lipoic acid use have been reported from Japan, along with one case from Turkey, two from Korea, and seven cases from Italy. In this article, we present three cases with anti-insulin antibody syndrome developed after alpha-lipoic acid use. Case 1: A 72-year-old male patient was observed to have lost consciousness at home. This patient had no history of diabetes mellitus, diabetic medication, or insulin use. The patient complained of tiredness, palpitations, and sweating that began 3-4 h after eating but regressed after eating during the past month. The patient had a history of diagnosis with lumbar disk hernia two months ago and was using alpha-lipoic acid (600 mg). Case 2: A 67-year-old diabetic female patient using alpha-lipoic acid (600 mg) following the diagnosis of diabetic peripheral neuropathy. She complained of shivering and sweating two to three hours after a meal that started after starting alpha-lipoic acid therapy. Case 3: A 46-year-old male patient complained of fatigue, palpitations, and sweating for the last three weeks. Seven weeks ago, he started using alpha-lipoic acid (600 mg) after being diagnosed with carpal tunnel syndrome. The patients were diagnosed with anti-insulin antibody syndrome secondary to alpha-lipoic acid use, following which their alpha-lipoic therapy was discontinued. Alpha-lipoic acid is widely used in the treatment of diabetic peripheral neuropathy, nutritional support, or as an anti-aging agent. However, it should be noted that its use may cause anti-insulin antibody syndrome in genetically predisposed people. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Tepecik Education & Research Hospital / İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Dokuz Eylül Üniversitesi Hemsirelik Fakültesi Elektronik Dergisi is the property of Dokuz Eylul Universitesi Hemsirelik Fakultesi Elektronik Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Amaç: Ramazan ayında oruç tutmak Müslümanlar için dini bir zorunluluktur. Uzamış açlık bu hastaları hipoglisemi ya da hiperglisemi gibi akut komplikasyonlarla karşı karşıya getirmektedir. Bu çalışmada Ramazan ayında oruç tutan bireylerde açlığın glukoz regülasyonu üzerine etkisini araştırmayı amaçladık.Gereç ve Yöntem: Hastalar uzun süreli açlığın olası komplikasyonları hakkında bilgilendirildikten sonra Ramazan ayında oruç tutacağını beyan eden bireylerle Ramazan ayı bitiminden 1 ay sonra telefon görüşmesi yapıldı. Telefon görüşmesiyle gerçekleştirilen bu retrospektif kohort çalışmada, kaç gün oruç tuttukları, günlük glukoz ölçümleri, eğer yaşadılarsa hipoglisemik atak sayısı ve tedavilerini değiştirip değiştirmedikleri soruldu.Bulgular: Çalışmaya 46 diyabetik hasta dahil edildi. Ortalama yaş 54.3±9.5 saptandı. Ortalama oruç tutulan gün sayısı 25.24±2.4 idi. Hastalar risk sınıflamasına göre gruplandırıldı. Hipoglisemik atak sayısında ramazandan önceki 6 ay içinde saptanan atak sayısına göre fark saptanmadı. Hastalarda hiperglisemi, hipoglisemiye göre daha yüksek sıklıkla tespit edildi. Hipoglisemi ya da hiperglisemi yaşayan bireylerin oruç tutmaya devam ettikleri ve tedavilerinide değişiklik yapmadıkları belirlendi.Sonuç: Ramazan ayında oruç tutan bireylerde hem hipoglisemi hem de hiperglisemi yatkınlığı mevcuttur. Glisemik regülasyonu düzeltmek ve bu bireyleri güvenli, kabul edilebilir glukoz aralığında tutabilmek için, diyabetik bireylerin Ramazan öncesi eğitimleri ve bilgilendirilmeleri gereklidir.

Introduction: Insulinoma is the most common functional neuroendocrine tumor of the pancreas. There are different methods for the preoperative localization of insulinoma, such as Computed Tomography (CT) scan, Magnetic Resonance Imaging and Endoscopic Ultra Sonography (EUS). In this study, we report on the clinicopathological features of insulinoma in 43 patients. Methods: The hospital records of 43 patients with suspicion of insulinoma based on biochemical diagnostic criteria, referred to İmam Khomeini Complex Hospital, Tehran, Iran between 2006 and 2016, were reviewed retrospectively. Results: Of the 43 studied patients, 28 were female. The mean age of the patients was 45.4±13.3 years. The most frequent clinical presentation of insulinoma was neurogenic and neuroglycopenic symptoms (81.4%). Mean glucose, insulin, and C-peptide in patients with hypoglycemic crisis were 39.13±13.15 mg/dL, 32.15±32.53 μUI/mL, and 4.77±2.88 ng/mL, respectively. Mean tumor size was 2.13±1.22 cm. The most common site of insulinoma was the tail of the pancreas. Surgery was the treatment of choice and performed in 31 patients. Of 21 tumors studied microscopically, 7 were invasive. Conclusion: In non-diabetic patients with manifestations of hypoglycemia, a diagnosis of insulinoma should be considered. During the past decade, the diagnostic delay for insulinoma has been reduced in our country by improving imaging technologies. EUS and CT scan are the best modalities for localization and size measurement of insulinoma. Tumor size has decreased compared with previous decades, probably due to a reduced delay in diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: Congenital hyperinsulinemic hypoglycemia is a rare disease caused by uncontrolled release of insulin from the pancreas. In this study, we aimed to evaluate the clinical and genetic characteristics and prognosis of the patients with congenital hyperinsulinemic hypoglycemia. MATERIALS and METHODS: Patients who were followed up in our clinic between 2011-2020 years were included in the study. Clinical, laboratory and genetic information, imaging results, treatment approaches and prognoses were obtained from the medical records. RESULTS: Ten patients (6 girls, 4 boys) included in the study [median age; 25 (3-183) days]. While the most common symptom was convulsion (Six patients), 30% of the cases were diagnosed during routine screening. Genetic analysis was performed in seven patients. Among the analyzed genes (ABCC8, KCNJ11, GLUD1, HNF4A), four patients had variants in the ABCC8 gene (two patients heterozygous, one patient homozygous, and one patient compound heterozygous). Seven patients were responsive to diazoxide treatment, but the treatment of three patients who could not respond to diazoxide was changed to octreotide. One of these patients showed a heterozygous, the other one showed a homozygousvariant in the ABCC8 gene. Six patients underwent spontaneous remission during the follow-up (median time; 1.5 years). Three of four patients with variants in the ABCC8 gene were diagnosed as transient disease. CONCLUSIONS: In this study, the majority of cases followed with congenital hyperinsulinemic hypoglycemia were diagnosed with hypoglycemic convulsion in the neonatal period and were responsive to diazoxide. The most common variant was detected in the ABCC8 gene. [ABSTRACT FROM AUTHOR]

Multiple endocrine neoplasia Type 1 (MEN-1) is an inherited syndrome characterized by the development of endocrine tumors of the pancreas, parathyroid, and pituitary glands. Mesenchymal tumors and adrenal neoplasms might also accompany this syndrome. However, the syndrome is rarely associated with thyroid tumors in contrary to the multiple endocrine neoplasia Type 2 that includes medullary thyroid carcinoma. This case study presents a 44-year-old woman who was diagnosed with MEN-1 on the basis of her clinical characteristics, laboratory data, and the presence of endocrine tumors. Follicular thyroid carcinoma was detected in the patient when she was being operated for nodular goiter, 12 years ago. We report this rare case which is likely the third case in the available scientific literature. [ABSTRACT FROM AUTHOR]

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Suç isnat edilen kişilerin, haksız cezai yaptırımdan kaçınmak için savunmalarında sağlık problemlerini öne sürerek, suça konu eylem esnasında iradelerinin yerinde olmadığını iddia etmeleri sık karşılaşılan bir durumdur. Bu konuda akıl ve ruh sağlığı ile ilgili rahatsızlıklar en sık karşımıza çıkanlardır. Ancak, bilinç durumunu etkileyen diğer sağlık problemlerini de unutmamak gerekmektedir. Diyabet hastaları da hipoglisemi atağında işlenen suçlarda iradelerinin devre dışı kaldığını iddia edebilmektedir. Çünkü diyabet hastalarında uzun vadede gelişen görme kaybı, böbrek yetmezliği, kalp krizi, kişilik değişiklikleri gibi bilinen kronik komplikasyonlar yanında, yüksek doz insülin uygulaması nedeniyle ortaya çıkan ve bilişsel işlevlerde bozukluklarla karakterize hipoglisemi ve nöroglikopeni gibi akut tedavi komplikasyonları da mevcuttur. Mahkemeler bu nedenle kişinin cezai sorumluluğunun tespiti hususunda, adli tıp uzmanlarından bilirkişi görüşü isteyebilmektedirler. Bu makalede, diyabet hastalarında sık görülen bir tedavi komplikasyonu olan hipoglisemi ve nöroglikopeninin kişide oluşturduğu bilişsel ve kognitif bozuklukların cezai sorumluluğu etkileyebilecek bir durum olup olmadığı, etkiliyorsa hangi kapsamda etkileyebileceği hususunun, bu konuda görülmüş davalar örnek gösterilerek tartışılması amaçlanmaktadır.

Purpose: Fasting during Ramadan is a religious obligation for Muslims. Extended fasting can create undesirable acute complications of diabetes such as hypoglycemia or hyperglycemia. In this study, we aimed to evaluate the impact of fasting on glucose regulation in diabetic patients who fast during Ramadan. Materials and Methods: Patients were informed about the possible side effects of fasting for them and those who stated that they will be fasting during Ramadan were called one month after Ramadan. In this retrospective cohort study by telephone interview, the number of fasting days, daily measurements of glucose, the number of acute complications if existed and whether the patients have changed their treatments were asked. Results: Forty six patients were included in this study. Mean age was 54.3±9.5 yr. The average fasting day was 25.24±2.4. They were categorized according to the risk stratifications. The number of hypoglycemic events was not higher than detected six months prior to the Ramadan. Most of the patients had hyperglycemia rather than hypoglycemia. All of the patients who had hypo-or hyperglycemia did not interrupt their fasting and did not change their medications. Conclusion: Patients who fasted during Ramadan have a tendency both hypoglycemia and hyperglycemia. To improve glycemic regulation and keep these patients in a safe and acceptable glucose range, Pre-Ramadan education is necessary. [ABSTRACT FROM AUTHOR]

Copyright of Firat Universitesi Saglik Bilimleri Veteriner Dergisi is the property of Firat Universitesiu, Saglik Bilimleri Enstitusu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 50-year-old male was referred to our clinic for hypoglycemic attacks. He denied using oral antidiabetic drugs, insulin, or herbal substances but admitted using proton pump inhibitors, pregabalin, and alpha lipoic acid. Venous blood glucose level was 44 mg/dL, C-peptide was 15.6 ng/mL, and insulin levels were >1.000 µIU/mL. His BMI was 21.4. No evidence of pancreatic or extra pancreatic insulinoma was found in imaging studies. No diagnostic results were obtained in the selective calcium receptor stimulation test. Anti-insulin antibody test was positive. The insulin autoimmune syndrome was diagnosed with low glucose levels. The symptoms were associated with very high serum insulin levels, and the patient was positive for the anti-insulin antibody. Alpha lipoic acid and proton pump inhibitors, which may cause insulin autoimmune syndrome, were discontinued and alpha glucosidase inhibitor and diet therapy were started. During follow-up, the patient did not report hypo-glycemia. Insulin autoimmune hypoglycemia should be kept in mind in patients with very high levels of insulin and without evidence of insulinoma. [ABSTRACT FROM AUTHOR]

Olive leaf has natural bioactive compounds, mainly oleuropein, that are widely considered to have potentially beneficial effects on health. This study aimed to evaluate the effects of olive leaf extract (OLE) on the inhibition of carbohydrate digestive enzymes, and immunohistochemical study of insulin in the pancreas of in vivo streptozotocin-induced diabetic rats. Blood glucose levels, insulin, glycated hemoglobin (HbA1c), α-amylase and α-glucosidase activities, and an immunohistochemical study were performed at the end of the experiment. In the OLE treated group, blood glucose levels and HbA1c significantly decreased while insulin levels increased. Besides this, OLE treated group showed remarkable inhibitory activities on α-amylase and α-glucosidase compared with the Acarbose treated group. It was observed that OLE exhibited partial positive immunoreaction for insulin in β-cells through immunohistochemical analysis. Considering that OLE is more tolerable for digestion system compared to acarbose, it may be a better fitoformulation for antidiabetic medications. OLE could offer an additional beneficial effect for the treatment of diabetes. [ABSTRACT FROM AUTHOR]

Glycogen-storage disease Type 0 (GSD 0) is a rare, an autosomal recessive inherited disease caused by liver glycogen synthetase deficiency. It is characterised by fasting hypoglycemia accompanied by ketosis and postprandial hyperglycemia and hyperlacticacidemia. We present here two siblings diagnosed with glycogen-storage disease type 0. They and their mother and many subjects in their family had the history of hypoglycemia and its symptoms since their infancy period. Postprandial hyperglycemia was detected in the mother and in the one sibling during their followup. So the mother was misdiagnosed as Type 2 diabetes. All patients in the family had normal mental and motor development. Hepatomegaly was not present in all them. A compound heterouzygous GYS2 gene mutation (NM-021957.3) p.T379I (c.1136C>t)/p.P525T (c.1573C>A) was showed in the siblings. [ABSTRACT FROM AUTHOR]

Dispeptik yakınmaların sık görülmesi nedeniyle diyabet hastaları reçeteli ya da reçetesiz olarak proton pompa inhibitörleri PPİ grubu ilaçları sık olarak kullanırlar. Farklı hastalıklar nedeniyle çeşitli ilaç gruplarının bir arada kullanılması, azalan sitokrom p450 enzim aktivitesi nedeniyle özellikle yaşlı hastalarda, ilaç-ilaç etkileşimi ve ilaç etkisinin değişmesi riskini artırmaktadır. Bu vaka sunumunda 82 yaşında diyabetik hastada omeprazol ve gliklazid ilaç etkileşimine bağlı gelişen hipoglisemi olgusu sunuldu

Copyright of Firat Universitesi Saglik Bilimleri Veteriner Dergisi is the property of Firat Universitesiu, Saglik Bilimleri Enstitusu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recent estimates indicate that diabetes occurs in 16.5% of the Turkish population, which is in keeping with the increasing global prevalence of diabetes. Following rapid economic growth, increase in life expectancy and changes in lifestyle over the past decade have resulted in the placement of a tremendous cost burden on the Turkish economy by diabetes and associated co-morbidities, representing 20% of overall spending on healthcare. Maintaining good glycemic control is vital for effective diabetes management. Long-term studies have demonstrated the ability of intensive glucose-lowering strategies to prevent or delay co-morbidities associated with diabetes. However, insulin intensification is commonly associated with hypoglycemia, which is regarded as the most significant barrier to attaining and maintaining good glycemic control. Patients are often unaware of the potential negative impact of hypoglycemia on their long-term health, as well as on daily functions. In addition, hypoglycemia and its associated symptoms or co-morbidities greatly influence adherence and dosing behavior, patients' quality of life (QoL), and significantly affect economic productivity. The aim of this study is to review the impact of hypoglycemia in patients with diabetes, focusing on the implications of findings from international and Turkish studies for the management of hypoglycemia in Turkish patients. [ABSTRACT FROM AUTHOR]

Aim: Endocrinopathies are common in patients with thalassemia major (TM) and affect their life quality. Our aim was to identify the frequency of growth retardation and endocrine complications in these patients. Materials and Methods: Sixty-two patients aged 3-18 years with TM were evaluated retrospectively for height, weight, body mass index (BMI), and pubertal stage. Blood tests for endocrine function, and oral glucose tolerance test (OGTT) results were recorded. Results: The mean age of 62 subjects (33 females/29 males) was 10.4±3.9 years. The frequency of ≤-2 standard deviation scores was 37.1% for height, 33.9% for weight and 11.3% for BMI. Short stature, being underweight, and low BMI were significantly more prevalent in children over 7 years old (p<0.001). Delayed puberty/hypogonadism was present in 37% of 19 adolescents. Thirteen percent of the subjects had vitamin D deficiency (<10 ng/mL), hyperparathyroidism was observed in 29% of the subjects, while subclinical hypothyroidism (thyroid-stimulating hormone 5-10 IU/mL) was determined in 3 (5.5%) of the 55 subjects. In OGTT, impaired fasting glucose was seen in 7 subjects (14.5%), impaired glucose tolerance in 3 (6.3%), diabetes mellitus in 1 (2.1%), and hypoglycemia at 120-min was observed in 5 subjects (10.4%). Overall, 67.7% of the 62 subjects had height standard deviation score ≤-2 and/or at least one endocrinopathy. Conclusion: Growth retardation and endocrine problems are still a serious problem in TM patients, and develop particularly in those older than 7 years. Additionally, attention must be paid to hypoglycemia in these patients as well as diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Insulinoma is a rare, pancreatic functional neuroendocrine tumor, characterized by endogenous hyperinsulinemia, fasting hypoglycemia, and neuroglycopenic symptoms. It is diagnosed by a 72-h-fasting test, followed by localization studies. The common treatment option is the surgical excision. We hereby aim to discuss our clinical experience related to the patients of insulinoma. Material and Method: A retrospective analysis was done on the history of the patients, who were hospitalized to our clinic due to hypoglycemia and biochemically detected insulinoma (glucose <55 mg/dL, whereas insulin > 3 µU/mL and C-peptide >0.6 ng/mL), between June 2007 and May 2015. Findings: The average age of the patients was 52,6 and ranged from 18 to 85 years. Five patients were men and five were women. All of the patients presented with fasting hypoglycemia. In one patient, the tumor was detected by DOTATATE scintigraphy. Seven patients underwent surgery and were cured. One patient demonstrated metastasis. The tumor could not be localized by ultrasound, CT, and MRI in two patients, and therefore, they were subjected to surgery after localizing the tumor by advanced imaging methods. Discussion: In patients with fasting hypoglycemia and neuroglycopenia, along with Whipple's triad, insulinoma should mainly be considered and a 72-h-fasting test should be conducted for diagnosis. The localization studies should be performed if the results are < 55 mg/dL for blood glucose, >3 µU/mL for insulin and > 0.6 ng/mL for C-peptide in blood sampled during the appearance of symptoms. We found that the triphasic thin slice CT, with multi-detector, was very useful for tumor localization in the test patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the etiology of spontaneous hypoglycaemia at admissions in Nelson Mandela Central Hospital, Mthatha, Eastern Cape, South Africa. Material and Method: A retrospective review of medical records for the patients admitted with spontaneous hypoglycaemia from January 2008 till December 2015 was carried out. The medical records of patients with blood glucose levels <2.5 mmol/L were reviewed for age, gender, relevant medications, alcohol history, retroviral status, blood glucose, plasma insulin, C-peptide, ketone, cortisol, IGF-1 level, liver and kidney function, and documented etiology of hypoglycaemia. Results: There were 26 patients (65.4% females) with the mean age of 39.6±22.3 years (range 13-95 years). The mean blood glucose le¬vels during hypoglycemic episodes were 1.6±0.6 mmol/L (range 0.5-2.9 mmol/L). Half of the patients (n=13/26) were retroviral positive. Hypoglycemia was associated with the elevated or inappropriately normal plasma insulin levels in 35.3% subjects and with the suppressed plasma insulin levels in 64.7% of cases. Eight cases of spontaneous hypoglycemia were pregnancy related. All pregnancy related cases of hypoglycemia were noted in retroviral positive subjects. The main cause for hypoglycemia was hypocortisolism. Discussion: The admissions in the case of spontaneous hypoglycemia were mainly due to hypocortisolism. All pregnant and postpartum patients with spontaneous hypoglycemia were retroviral positive. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Internal Medicine / Türkiye Klinikleri İç Hastalıkları Dergisi is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Insulinomas, the most common neuroendocrine tumors of the pancreas, are usually solitary in nature. Yet, they may be difficult to localize. A 29-year-old female patient with neurologic complaints including drowsiness, meaningless speech and temporary dementia (not recognizing her relatives), was evaluated for hypoglycemia. According to the critical laboratories investigations, the patient was found to be having hyperinsulinemic hypoglycemia. After diagnosing insulinoma by biochemical tests, the tumor was localized using endoscopic ultrasonography and fine needle aspiration biopsy was performed on the insulin washout material to obtain a prompt confirmation. After localization of the tumor, subtotal pancreatectomy was performed. The patient's symptoms were relieved and did not re-occur. Thus, this case report suggests that the insulin washout from fine needle aspiration biopsy can be successfully employed during endoscopic ultrasonography to obtain a hasty diagnosis since it delivers faster results and is a much more convenient approach than the pathological examinations. It promptly confirms the tumor site and may, therefore, be employed in cases of difficult tumor localization. [ABSTRACT FROM AUTHOR]

Insulinoma is the most common type of islet cell tumor of the pancreas and its incidence is estimated at four per one million persons per year. Although fasting hypoglycemia is the typical presentation, cases with postprandial hypoglycemia have rarely been reported. A 48-year-old woman was admitted to our department for evaluation of hypoglycemia. Laboratory data suggested a state of postprandial endogenous hyperinsulinemic hypoglycemia. Abdominal computed tomography revealed a mass lesion measuring 20 mm at the distal pancreas. A decision was made to perform an arterial calcium-stimulated venous sampling for excluding nesidioblastosis coexisting with a pancreatic incidental mass. After that the patient was referred to surgery. Pathological examination revealed a low-grade well-differentiated neuroendocrine tumor with regional lymph node metastasis. Herein, we report a case of malignant insulinoma presenting with postprandial hypoglycemia and discuss the differential diagnosis and possible mechanisms of postprandial hypoglycemia in insulinoma cases. [ABSTRACT FROM AUTHOR]

Insulin autoimmune syndrome (IAS) is a disease characterized by hypoglycemia and insulin antibodies without insulin usage. We report the case of a patient diagnosed with IAS that was associated with the use of thiocolchicoside. A 62-year-old female patient was admitted to our clinic with fasting and postprandial hypoglycemia symptoms. She had a fasting glucose level of 47mg/dl, and high insulin, C-peptide and insulin antibody levels were detected. However, she had no signs of hypoglycemia during a 72 hour fasting test. In addition, the patient had used thiocolchicoside for a week a month prior to the beginning of her symptoms, but she was not taking any insulin or diabetic medications. A diagnosis of IAS was made, and the patient was puton an appropriate diet. Three months following this diagnosis, the patient's complaints have minimilized, and the insulin and C-peptide levels have decreased. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical and demographic characteristics and the causes of admission of late preterm (LP) neonates admitted to our neonatal intensive care unit (NICU). Material and Methods: This retrospective study was conducted at our NICU, between January 2012 and December 2012. Neonates born at 340/7-366/7 weeks of gestation and admitted to the NICU were included in the study. Neonates were evaluated in terms of the reasons for hospitalization and the clinical and demographic characteristics and then compared with term ones. Results: During the study period there were 17690 births in our hospital; these included 13975 (79%) term births, 1981 (11.2%) LP births. The number of neonates admitted to the NICU was 2844. The NICU admission rates for LP infants and term infants were 21.5% (n=426) and 5.5% (n=765), respectively. The mean gestational age of the LP and term neonates was 35.1 ±0.8 and 38.5±1.2 weeks, and the mean birth weight was 2384±502 and 3185±593g, respectively. The most common reason for hospitalization was respiratory distress in both groups (55.2%, n=235 in the LP neonates, 52.3%, n=400 in the term neonates). The mean duration of hospitalization was 8.2 ± 5.5 days in LP infants and 6.9 + 5.2 days in term infants. Compared with term infants, LP infants had significantly higher rates of hypoglycemia (p=0.014), polycythemia (p=0.046), and feeding difficulty (p=0.009). Conclusion: LP infants who have not completed the physiological and metabolic aspects of maturation than term infants are at risk for many complications such as hypoglycemia, polycythemia and feeding difficulty. They should therefore be monitored more closely for development of complications. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to retrospectively evaluate geriatric type 2 diabetic patients admitted to emergency services as a result of diabetes. Methods: All files of geriatric patients admitted to emergency services between January and August 2013 were analyzed. Patients admitted as a result of diabetes and related acute complications were included in the study. Results: Hypoglycemia was diagnosed in 28.2% (n=42) of patients, and hyperglycemic hyperosmolar state was found in 26.9% (n=40). Hyperglycemia, diabetic ketoacidosis, diabetic foot infection, and lactic acidosis were diagnosed in 20.1% (n=30), 16.1% (n=24), 6.7% (n=10), and 2% (n=3) of patients, respectively. Conclusion: Difficulties can occur in follow-up and treatment of diabetes mellitus in geriatric patients. Further comprehensive studies are needed on the topic. [ABSTRACT FROM AUTHOR]

Fluoroquinolones, a commonly used class of antibiotics, can impair glucose homeostasis. Hypoglycemia may be life-threatening in non-diabetic elderly patients with renal impairment. An 80-year-old female patient was admitted to the emergency department with hypoglycemia. The patient was not a diabetic and did not use antidiabetic drugs. Three days prior, she had received ciprofloxacin for a urinary tract infection. During hypoglycemic process, her insulin level was not suppressed. At follow-up in inpatient service, her insulin level had returned to the normal range. Her serum Cortisol level was normal, and pancreatic imaging was normal. After ciprofloxacin was discontinued, no further hypoglycemic episodes occurred. Physicians should be careful in prescribing fluoroquinolones in older patients who are prone to hypoglycemia. Moreover, drug-related causes should be considered in cases of unexplained hypoglycemia. [ABSTRACT FROM AUTHOR]

Patients with diabetes mellitus frequently use prescription or nonprescription proton pump inhibitors (PPI) since they commonly have dyspeptic complaints. Simultaneous use of various drug groups due to presence of different diseases in the same patient increases the risk of drug-to-drug interaction and change of drug effect secondary to decreased cytochrome p450 enzyme activity, especially in elderly patients. A case of an 82-year-old diabetic patient who developed hypoglycemia secondary to a drug interaction of omeprazole and gliclazide. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Infection / Çocuk Enfeksiyon Dergisi is the property of Journal of Pediatric Infection / Cocuk Enfeksiyon Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)