Rapid correction of chronic hyperglycemia and bone remodeling,warning against overdoing

It is widely recognized that chronic hyperglycemia decreases bone quality,although little is known about the impact of the rapid correction of chronic hyperglycemia on the quality of bone remodeling.This spotlight article explores this correlation by focusing on the stages of bone remodeling linked to glucose levels.

Rapid correction of hyperglycemia:A necessity but at what price?A brief report of a patient living with type 1 diabetes

BACKGROUND The correction and control of chronic hyperglycemia are the management goals of patients living with diabetes.Chronic hyperglycemia is the main factor inducing diabetes-related complications.However,in certain situations,the rapid and intense correction of chronic hyperglycemia can paradoxically favor the onset of microvascular complications.CASE SUMMARY In this case report,we describe the case of a 25-year-old woman living with type 1 diabetes since the age of 9 years.Her diabetes was chronic and unstable but without complications.During an unplanned pregnancy,her diabetes was intensely managed with the rapid correction of her hyperglycemia.However,over the following 2 years,she developed numerous degenerative microvascular complications:Charcot neuroarthropathy with multiple joint involvement,severe proliferative diabetic retinopathy,gastroparesis,bladder voiding disorders,and end-stage renal failure requiring hemodialysis.CONCLUSION In the literature to date,the occurrence of multiple microvascular complications following the rapid correction of chronic hyperglycemia has been rarely described in the same individual.

Influence of physiological and supraphysiological hyperinsulinemia on skin microcirculation in healthy volunteers

AIM:To examine skin perfusion in dependency on insulinemia in healthy subjects.METHODS:All volunteers were informed in detail about the procedures and signed informed consent.The protocol of this study was approved by the ethical committee.In our study,a two stage hyperinsulinemic euglycemic clamp was performed,with insulinemia 100and 250 mIU/mL and glycemia 5.0 mmol/L(3%standard deviation).Before the clamp and in steady states,microcirculation was measured by laser Doppler flowmetry and transcutaneous oximetry and energy expenditure was measured by indirect calorimetry.Results(average and standard deviation)were evaluated with pairedt-test.RESULTS:Physiological(50 mIU/L)insulinemia led to higher perfusion in both tests;hyperemia after heating to 44%-1848%(984-2046)vs 1599%(801-1836),P<0.05,half time of reaching peak perfusion after occlusion release 1.2 s(0.9-2.6)vs 4.9 s(1.8-11.4),P<0.05.Supraphysiological(150 mIU/L)insulinemia led to even higher perfusion in both tests;hyperemia after heating to 44%-1937%(1177-2488)vs 1599%(801-1836),P<0.005,half time to reach peak perfusion after occlusion release 1.0 s(0.7-1.1)vs 4.9 s(1.8-11.4),P<0.005.A statistically significant increase occurred in tissue oxygenation in both insulinemia.The difference in perfusion and oxygenation between physiological and supraphysiological hyperinsulinemia was not statistically significant.CONCLUSION:The post occlusive hyperemia test in accordance with heating test showed significantly increasing skin perfusion in the course of artificial hyperinsulinemia.This effect rises non-linearly with increasing insulinemia.Dependency on the dose was not statistically significant.

Intact fish skin graft a new hope for the treatment of diabetic foot ulcers:A case report

BACKGROUND Diabetic foot ulcers(DFUs)are a real public health problem which carry a high risk of amputation.The treatment of DFUs is based on general management such as the treatment of infection,arterial disease,and offloading,but recent studies have shown that the quality of the local covering can impact the healing rate.CASE SUMMARY We report the case of a 39-year-old man,living with diabetes since the age of 15,who developed DFU on the dorsum of his left foot,with muscle and tendon in-volvement.Conventional management with intensive diabetes control,surgery,treatment of infection and negative pressure therapy gave only limited results.The patient benefited from the application of an intact fish skin graft with com-plete epithelialisation of the ulcer after 10 weeks of treatment.CONCLUSION The use of intact fish skin graft appears to be a promising option for deep DFUs.