Abstract

JASMINS, Clara; MENDES, Ana Rita  and  MELO, Gonçalo. A case of diabetes hard to control. Rev Port Med Geral Fam [online]. 2019, vol.35, n.5, pp.412-416. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v35i5.12083.

Introduction: Latent autoimmune diabetes of the adult (LADA) is characterized by the presence of diabetes mellitus in individuals under 50 years old, with initial polyphagia, polydipsia and/or polyuria, BMI < 25 kg/m² and a personal or family history of autoimmune diseases. Case report: Male, 46 years old, male, unemployed, with a personal history of cognitive impairment, toxic substance abuse, and depressive and anxiety disorders. He has a family history of diabetes mellitus diagnosed to his father at 40-years old. He also has a conflicted relationship with his sister. On October 2012, presented with fatigue, xerostomia, dry mouth, hyperphagia, polydipsia, polyuria and weight loss with new episodes of alcohol and tobacco abuse, and inappropriate behaviour. We hypothesize this was an inaugural diabetes mellitus condition, with an HbA1c of 12% and fasting glucose of 254 mg/dL. He started treatment with metformin and nateglinide. However, due to inappropriate control of the disease, we had to intensify therapeutic gradually, starting insulin administration two months after diagnosis. He was referral to a diabetology appointment, but he missed for several times both their and our appointments until he was diagnosed with latent autoimmune diabetes of the adult (LADA), on February 2015, when he had positive anti-GAD65 antibodies. Due to extreme poverty he missed many meals suffering some episodes of hypoglycaemia. By that time, he felt tired and irritable. On January 2016 he was admitted in the emergency room because of diabetic ketoacidosis. Since that episode, his social support improved, he had no further symptoms of hypoglycaemia, although remains with inadequate levels of HbA1c. Comment: This case report shows the impact of social-economic conditions, personal history and familiar relationships on the treatment of chronic diseases like LADA. Inadequate eating habits, with scarce and irregular meals and poor adherence to health care and therapy, have led to ineffective disease control. With this case report, we want to highlight the importance of hold the patient responsible for his treatment, as well as involving his closest family. In this particular case, the conflictual relationship with his sister proves to be a disturbing factor to achieve a successful therapy accomplishment.

Keywords : Diabetes; Autoimmune; Diet; Socioeconomic factors.

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