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Introduction: Gitelman Syndrome (GS) is a genetic tubulopathy frequently linked with insulin resistance. The possibility of developing Diabetes Mellitus (DM) in GS increases with the causes of insulin resistance. Hypokalemia is one of the most common electrolyte disorders in GS, and most diabetic drugs can cause hypokalemia. Considering this dilemma, we presented a DM treatment experience in a GS case. Case presentation: A 47-year-old male GS patient with a potassium-rich diet complained of weight loss and dry mouth for 2-3 months. The laboratory tests revealed a higher HbA1c level, as high as 11.8%. The remaining abnormal laboratory test results (hypokalemia, hypomagnesemia, metabolic alkalosis) indicated a patient with GS. The patient was placed on a metformin+gliclazide-based treatment. Oral potassium and magnesium supplementation were started for the patient whose hypokalemia increased in the first control, and the potassium dose was doubled in the third control. In the first-month follow-up visit, it was observed that the blood potassium level was improved, and hyperglycemia was optimized. Conclusion: In brief, any treatment for DM can be selected in GS patients with DM by performing frequent electrolyte monitoring. Like our case, oral potassium supplementation was adequate for the metformin + gliclazide combination-coincidence hypokalemia.
RESUMEN
BACKGROUND: Type 2 Diabetes Mellitus is a leading cause of end stage renal disease in the worldwide. Inflammation is regarded as one of the main reasons for the progression of diabetes complications. We aimed to evaluate the association of neutrophil to lymphocyte ratio (NLR) as indicator of systemic inflammation with diabetic retinopathy and nephropathy. PATIENTS AND METHODS: This is a cross-sectional study of 114 prevalent type 2 diabetic subjects. All of the patients underwent detailed examination for the presence of diabetic retinopathy and nephropathy. Diabetic retinopathy was approved and classified according to findings based on flouresceint fundal angiography results. Estimated glomerular filtration rate (eGFR) and microalbumin to creatinine ratio were calculated to establish the diabetic nephropathy. NLR was calculated as ratio of absolute neutrophil count to absolute lymphocyte count. RESULTS: Retinopathy was present in 55 (48.2%) out of 114 patients, whereas nephropathy was present in 62 patients (54.3%). NLR was significantly higher in patients with nephropathy than in patients without nephropathy. NLR was also positively correlated with CRP (p=0.017, r=0.224) and microalbuminuria (p=0.016, r=0.257) whereas negatively correlated with eGFR (p<0.001, r=-0.337) values in the whole cohort. NLR was independent predictors for diabetic nephropathy, whereas it did not appear as an independent associate of diabetic retinopathy. CONCLUSION: NLR and diabetic nephropathy have an independent association between them whereas there was no independent association between NLR with retinopathy in type 2 diabetic patients.
