Endocrine Abstracts

Introduction

Metabolic syndrome is the concurrence of the metabolic risk factors for both diabetes and cardiovascular disease, namely, hypertension, hyperglycemia, dyslipidemia and abdominal obesity.

Case presentation

We report a case of 59 years old morbidly obese, Saudi lady, who had been following up at our outpatient diabetes clinic, since last many years. She had Type2 diabetes for 34 yrs, hypertension, advanced proliferative diabetic retinopathy (S/P laser), ischemic heart disease, chronic kidney disease 5-A3, dyslipidemia, osteoarthritis knees & obstructive sleep apnea (on O2 inhalation, 4 l/m & BiPAP). The patient was non-compliant to medications, diet, exercise & follow-ups. No hypoglycemic episodes at home. She had decreased hearing from both ears. There was a past history of left breast abscess (status post incision & drainage twice), recurrent urinary tract infections, acute right hemispheric stroke, following acute coronary syndrome (5 years ago, status post percutaneous coronary intervention & stenting), ischemic neuritis right ear & cataract extraction. There was a positive family history of Type 2DM and obesity. She was allergic to Ceftriaxone & Strawberries & was on Basal bolus insulin regime, Linagliptin, dual anti-platelets, statin, Hydralazine, calcium carbonate, 1 alphacalcidol & a proton pump inhibitor. On evaluation lastly on 10.11.20, the patient had moderate bilateral pedal edema (L b R) & absent vibration sensation at left ankle. Her available records had indicated the following trends for her physical & biochemical values, from 2015 to 2020:BMI (41.33–53.24 kg/m²), HbA1c (14.1–6.5%), eGFR (44–10 ml/min), Albumin/Creatinine ratio (643–1119.58 mg/g).

Conclusions

Our case depicts the legacy effect of uncontrolled diabetes (with microvascular & Macrovascular sequelae) and the tendency for recurrent infections. It’s also apparent that as the patient’s renal function progressively deteriorated, her blood glucose started coming under control, due to reduced insulin clearance thru the affected kidneys.