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      Importancia del estudio del humor vítreo para el diagnóstico de diabetes mellitus y cetoacidosis diabética post mortem. A propósito de un caso Translated title: Importance of the study of the vitreous body for the diagnosis of diabetes mellitus and diabetic ketoacidosis post-mortem. About a case

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          Abstract

          Resumen La diabetes mellitus tipo 1 usualmente debuta con cetoacidosis, una de sus complicaciones que puede llevar a la muerte de forma rápida. Esta condición puede pasar inadvertida, requiriéndose la autopsia médico-legal. Dentro de las muestras de mayor interés en la autopsia se encuentra el humor vítreo, el cual se usa para detección de glucosa y electrolitos, entre otros. Presentamos el caso de una joven de 15 años de edad, sin antecedentes importantes, la cual fallece luego de presentar un cuadro de faringoamigdalitis y los hallazgos anatomopatológicos no permiten identificar la causa de la muerte. Sin embargo, el estudio de humor vítreo revela concentraciones elevadas de glucosa, y la química sanguínea muestra valores de acetona aumentados. Discutimos la importancia de la recolección del humor vítreo para el diagnóstico de enfermedades metabólicas.

          Translated abstract

          Abstract Type 1 Diabetes Mellitus usually begins with ketoacidosis, one of its complications that can lead to death quickly. This condition may go unnoticed, requiring medical and legal autopsy. Among the samples of major interest in the autopsy is the vitreous humor, which is used for detection of glucose levels, electrolytes and others. We present the case of a 15-year-old girl with no significant history, who died after presenting with pharyngotonsillitis and the pathological findings did not allow the cause of death to be identified, however, the vitreous humor study revealed elevated glucose levels and Increased blood levels of acetone. We discussed the importance of collecting the vitreous humor for the diagnosis of metabolic diseases.

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          Epidemiology of type 1 diabetes.

          This article describes the epidemiology of type 1 diabetes mellitus (T1D) around the world and across the lifespan. Epidemiologic patterns of T1D by demographic, geographic, biologic, cultural, and other factors in populations are presented to gain insight about the causes, natural history, risks, and complications of T1D. Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2% to 5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the United States by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. Although significant advances have been made in the clinical care of T1D with resultant improvements in quality of life and clinical outcomes, much more needs to be done to improve care of, and ultimately find a cure for, T1D. Epidemiologic studies have an important ongoing role to investigate the complex causes, clinical care, prevention, and cure of T1D. Copyright 2010 Elsevier Inc. All rights reserved.
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            Lifestyle and cardiometabolic risk in adults with type 1 diabetes: a review.

            Over the past decades, there has been a major upward shift in the prevalence of cardiometabolic risk (CMR) factors (central obesity, insulin resistance, hypertension and dyslipidemia) in patients with type 1 diabetes, which could have either an additive or a synergistic effect on risk for cardiovascular disease. These metabolic changes are occurring in parallel to the worldwide obesity epidemic and the widespread use of intensive insulin therapy. Poor lifestyle habits (poor diet quality, sedentary behaviours and smoking) are known to be driving factors for increased CMR factors in the general population. The objective of this review is to explore the lifestyle habits of adults with type 1 diabetes and its potential association with CMR factors. Evidence suggests that adherence to dietary guidelines is low in subjects with type 1 diabetes with a high prevalence of patients consuming an atherogenic diet. Sedentary habits are also more prevalent than in the general population, possibly because of the additional contribution of exercise-induced hypoglycemic fear. Moreover, the prevalence of smokers is still significant in the population with type 1 diabetes. All of these behaviours could trigger a cascade of metabolic anomalies that may contribute to increased CMR factors in patients with type 1 diabetes. The intensification of insulin treatment leading to new daily challenges (e.g. carbohydrates counting, increase of hypoglycemia) could contribute to the adoption of poor lifestyle habits. Preventive measures, such as identification of patients at high risk and promotion of lifestyle changes, should be encouraged. The most appropriate therapeutic measures remain to be established. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
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              Diagnostic values of combined glucose and lactate values in cerebrospinal fluid and vitreous humour--our experiences.

              The final diagnosis of death in hypoglycaemic or diabetic coma should always be done as a synopsis of anamnestic response, morphology, biochemical (glucose, lactate, HBA1c, ketonic bodies, insulin, and C-peptide) and toxicological findings. High glucose levels in vitreous humour (more than 13 mmol/L, 234 mg/dL) or combined values of glucose and lactate in vitreous humour or in cerebrospinal fluid over threshold values of 23.7 mmol/L (427 mg/dL) and 23.4 mmol/L (422 mg/dL) respectively, can be an indicator of the pre-mortem hyperglycaemic state with fatal outcome. The determination of glycated haemoglobin, acetone and other ketone bodies improve the diagnostic values of the whole procedure. Diabetic ketoacidosis (blood acetone >0.3 g/L) is more often the cause of death of diabetic patients than the non-ketotic hyperosmolal state. Hypoglycaemia is deemed fatal if the combined values are lower than 5.5 mmol/L (100 mg/dL) and can not be excluded if they are lower than 8.9 mmol/L (160 mg/dL). Two cases of detected hypoglycaemia are described further. A psychiatric patient with diabetes (Hba1c 8.4%) committed suicide with an insulin overdose. The combined values of glucose and lactate in vitreous humour and in cerebrospinal fluid were 3.3 and 4.1 mmol/l, respectively. In another case a low combined glucose and lactate value (8.7 mmol/L) in vitreous humour indicated, besides the high concentration of glibenclamide (0.9 mg/L) in the blood of a driver with a poorly controlled diabetic condition (Hba1c = 10.6%), a state of decreasing blood glucose in the time before the accident causing the driver to feel un-well and behave inappropriately.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                cmf
                Cuadernos de Medicina Forense
                Cuad. med. forense
                Asociación de Médicos Forenses de Andalucía (Málaga, Andalucía, Spain )
                1135-7606
                1988-611X
                December 2016
                : 22
                : 3-4
                : 102-105
                Affiliations
                [5] Boyacá orgnameUniversidad Pedagógica y Tecnológica de Colombia orgdiv1Escuela de Medicina orgdiv2Área de Patología Colombia
                [4] orgnameInstituto Nacional de Medicina Legal y Ciencias Forenses de Colombia Colombia
                [3] Boyacá orgnameUniversidad Pedagógica y Tecnológica de Colombia orgdiv1Grupo de Investigación en Epidemiologia de Colombia (GRECO) Colombia
                [1] Boyacá orgnameUniversidad Pedagógica y Tecnológica de Colombia Colombia
                [2] Boyacá orgnameUniversidad Pedagógica y Tecnológica de Colombia orgdiv1Grupo de Investigación Biomédica y Patología (GIBP) Colombia
                Article
                S1135-76062016000200007
                27ba37c7-672a-43de-afdc-9499096d1677

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 29 May 2017
                : 30 December 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 4
                Product

                SciELO Spain


                Diabetes Mellitus,Humor vítreo,Hiperglucemia,Diabetes mellitus tipo 1,Cuerpo vítreo,Cetoacidosis diabética,Vitreous Body,Hyperglycemia,Diabetic Ketoacidosis,Type 1

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