Endothelial and platelet markers in diabetes mellitus type 2

Diabetes mellitus(DM) is an extremely common disorder which carries a risk of vascular impairment.DM type 2(DM2) can be characterized by the dysfunction of haemostasis manifesting by stimulated coagulation process,disorder of platelet function and decreased fibrinolytic activity.These all are the reasons why DM2 is the most common acquired thrombophilia.Endothelial dysfunction along with platelet hyperactivity are unquestionably involved in the hyperactivation of platelets and clotting factors in DM.As a natural consequence of continuous investigation,many markers of endothelial dysfunction and diabetic thrombocytopathy have been identified and considered for implementation in clinical practice.Endothelial function can be assessed by the evaluation of endothelial markers,circulating molecules synthesised in various amounts by the endothelium.These markers precede the signs of evident microangiopathy.Platelets have an ethiopathogenic relation to the microangiopathy in DM.Their increased activity was confirmed in both types of DM.Predictors of endothelial and platelet disorder could improve the screening of individuals at increased risk,thus leading to the early diagnosis,appropriate treatment,as well as to the effective prevention of the complications of DM2.In the article we deal with the mechanisms involved in the pathogenesis of endothelial and platelet functional abnormalities,endothelial and platelet markers of DM2 considered for implementation in clinical practice and possibilities of their detection.

Insulinoma presenting with postprandial hypoglycemia and a low body mass index:A case report

BACKGROUND Insulinomas are the most common type of functioning endocrine neoplasms of the pancreas presenting hypoglycemic symptoms.Patients characteristically develop symptoms while fasting,but some patients have reported symptoms only in the postprandial state.Repeated and prolonged hypoglycemic episodes can reduce the awareness of adrenergic symptoms,and patients may have amnesia,which delays diagnosis.CASE SUMMARY We describe a case of a 24-year-old underweight patient who showed hypoglycemic symptoms for almost 6 years.Although patients with insulinoma characteristically develop symptoms while fasting,this young man had hypoglycemic symptoms up to one hour postprandially,especially after highsugar meals and after physical activity.The fasting tests and imaging methods performed at local hospitals were evaluated as negative for abnormal results.However,brown adipose tissue exhibited increased metabolic activity,and some muscle groups had histological changes as indicated by positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography.Glycogen deficiency was also histologically confirmed.The patient’s symptoms progressed over the years and occurred more frequently,i.e.,several times a month,and the patient had reduced awareness of adrenergic symptoms.The follow-up fasting test was positive,and the imaging results showed a tumor in the head of the pancreas.The patient underwent laparotomy with enucleation of the insulinoma.CONCLUSION Weight gain and fasting hypoglycemia are not necessarily characteristics of insulinoma.In prolonged cases,adrenergic symptoms can be suppressed.