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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The most common cause of bacterial skin infections in relation to diabetes is Staphylococcus aureus. Fungal skin infections in diabetic patients are usually caused by Candida albicans. Diabetic blisters often occur with diabetic neuropathy. Acanthosis nigricans is the result of being very overweight or obese. Necrobiosis lipoidica diabeticorum, like diabetic dermopathy, is caused by blood vessel changes. Eruptive xanthomatosis is caused by poorly managed diabetes when there are high levels of cholesterol and fat in the blood.
Flexures
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
This is a rare condition but it is important because when it occurs in patients over the age of 40, you should look for an underlying malignancy – carcinoma of the lung, stomach or ovary. In younger patients, it is usually associated with obesity and insulin resistance. It is then called pseudoacanthosis nigricans. The skin of the flexures becomes dark brown, dry, and thickened with a papillomatous velvety surface. In the malignant form the skin changes are often associated with marked itching, and there may be widespread lesions that look like viral warts. Treatment involves finding the cause and treating this. Weight loss is necessary for pseudo acanthosis nigricans.
Dermal manifestations of diabetes
Published in Robert A. Norman, Geriatric Dermatology, 2020
Acanthosis nigricans is a condition that can be associated with disorders of insulin resistance such as diabetes, obesity37 and occasionally with paraneoplastic syndromes7. It has been reported to occur with an incidence approaching 74% in otherwise healthy obese adults38, 66% in primary school children who weigh 200% of ideal body weight, 28% of children weighing 120% of ideal body weight, and 7.1% in an unselected population of primary school children39. It has also been demonstrated to occur with higher frequency in certain ethnic populations. Native Americans have an incidence of acanthosis nigricans of 54%, and it occurs at an incidence of 40% in Hispanic populations40.
COVID-19 and hyperglycaemic emergencies: perspectives from a developing country
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2022
Raisa Bhikoo, Marli Conradie-Smit, Gerhard Van Wyk, Sa’ad Lahri, Elizabeth Du Plessis, Jaco Cilliers, Susan Hugo, Ankia Coetzee
Mr KT was clinically unwell with notable tachypnoea and Kussmaul breathing on arrival. Oxygen saturation was 89% in ambient air, with a heart rate (HR) of 100 bpm (bpm) and a blood pressure (BP) of 110/50 mmHg; he also appeared dehydrated. Metabolic features included acanthosis nigricans and central adiposity with a body mass index (BMI) of 30 kg/m2 (World Health Organization category obese).19 Bilateral fine late inspiratory crackles were audible mainly at the lung bases, with no signs of congestive cardiac failure. The point-of-care (POC) fingerprick blood glucose was 21 mmol/l. Urine dipstick indicated 3+ ketones, 4+ glucose and 3+ protein. Arterial blood gas (ABG) analysis on 40% face mask oxygen indicated a P02 of 14 kPa (PaO2/FiO2 ratio = 236) and a metabolic acidosis (Table 1). The ß-hydroxybutyrate (BOHB) and chloride levels were not performed.
Familial clustering of metabolic phenotype in brothers of women with polycystic ovary syndrome
Published in Gynecological Endocrinology, 2019
Karthik Subramaniam, Archana Tripathi, Preeti Dabadghao
The clinical and anthropometric data of 41 brothers and controls are shown in Table 1. Brothers had a higher prevalence of acanthosis and had higher diastolic BP. Baldness was not different in both groups. Prevalence of elevated blood pressure (7 vs. 1, p = .03) and increased waist circumference (12 vs. 5, p = .04) was significantly higher in brothers as compared to controls, respectively. Fasting insulin, C-peptide, and HOMA-IR were also significantly higher in brothers (Table 2). Interestingly, brothers had a higher DHEAS level as compared to controls. Fasting and 2-h plasma glucose, lipid profile or prevalence of any kind of glucose tolerance abnormality were similar in brothers and controls. Of the probands, 15 (37%) were of phenotype A, 12 (30%) of phenotype B, 10 (24%) of phenotype C, and 4 (10%) of phenotype D of Rotterdam criteria. There were no significant differences in any clinical or biochemical characteristics among these phenotypes and their brothers. In Spearman’s correlation, while BMI (r = 0.25, p = .03) had positive correlation with DHEAS, BMI (r = 0.23, p = .04) and LDL (r = 0.4, p<.001) had a positive correlation with HOMA-IR.
Monogenic forms of lipodystrophic syndromes: diagnosis, detection, and practical management considerations from clinical cases
Published in Current Medical Research and Opinion, 2019
Camille Vatier, Marie-Christine Vantyghem, Caroline Storey, Isabelle Jéru, Sophie Christin-Maitre, Bruno Fève, Olivier Lascols, Jacques Beltrand, Jean-Claude Carel, Corinne Vigouroux, Elise Bismuth
Lipodystrophies are rare diseases, and the diagnosis is often overlooked33. LMNA-related lipodystrophy characteristics (e.g. generalized or partial fat atrophy with metabolic changes and insulin resistance) may be due to altered differentiation of adipocytes or changed fat structure34. The principal feature of FPLD2 is loss of fat, commencing at about pubertal age in women, in the buttocks, hips, limbs, and trunk, together with accumulation of fat in the axillae, back, face, labia majora, and visceral region. This distribution of fat, coupled with enhanced and well-defined musculature, means that affected women take on an android appearance. Further, phlebomegaly is often present in the upper and lower limbs, and the hands tend to be broad with small digits. Acanthosis nigricans in the axillae and neck and acrochordons, as signs of insulin resistance, are not infrequent. Women with FPLD2 frequently present with gynecologic disorders such as gestational diabetes, miscarriage, polycystic ovarian syndrome, and stillbirth35. In men, the abovementioned fat-loss changes occur later and are less evident; indeed, men with FPLD2 are typically diagnosed from female kin. Although subcutaneous lipomas are not present in all cases36, their presence should make physicians suspect FPLD2 when a background FPLD phenotype exists. The cardiovascular diversity of FPLD2 is broad and includes early atherosclerotic disease, arrhythmias, hypertrophic cardiomyopathy, and valvulopathies. Atherosclerotic disease and metabolic disturbances are less frequent in men than women with FPLD237.