The continuous monitoring of glucose concentration in the interstitial environment is a relatively new method of checking the effect of therapy in patients with diabetes mellitus that offers significantly more data for the adjustment of therapy than common self-monitoring. This kind of instruments can measure the level of glucose concentration in the interstitial environment in a 5 minutes interval. A mild time-shift of this value compared to the glucose level in the capillary blood during rapid changes of glucose quantity in the body (particularly postprandial or during physical exertion), that can achieve 10–30 minutes, should to be pointed out.

Key words: continuous monitoring, diabetes mellitus,, hypoglycemia, closed-loop, interstitial environment

The paper deals with an effect of a real time continuous glucose monitoring (RT-CGM) in a patient with type 1 diabetes mellitus, whose diabetes was inadequately controlled by the insulin pump treatment for a long time. A regular repeated use of glucose sensor along with an improved self-management of diabetes resulted in a significant improvement of the control of the disease.

Key words: real time continuous glucose monitoring, compliance, self-management of diabetes, blood glucose variability

The response to hypoglycemia is in the first place represented by an immediate supply of carbohydrates to the body. Apart from short-term and long-term negative impacts on the nervous system, the hypoglycemia is often reflected in a destabilization of glucose levels in the next few hours, which is associated with reactive hyperglycemia that usually follows hypoglycemia. One possibility to prevent such a destabilization should theoretically be a temporary interruption of insulin administration during the treatment with insulin pump, which the insulin pump Paradigm Veo actively offers. Our paper analyses the post-hypoglycemic excursions of glycemia during the use of this device. 

Key words: insulin pump, basal dose, insulin, hypoglycemia, hyperglycemia

The case report describes a hyperglycaemia of a pregnant well educated nurse. There was a second awaited gravidity achieved after three years, while the first child had a congenital defect (agenesis of corpus callosum). Despite the major effort of patient to achieve good glycaemia control the CGMS revealed considerable hyperglycaemic excursions. The reason of these hyperglycaemic events was uncovered based on the history and glycaemia curves from CGMS on common session with the patient. 

Key words: continuous glucose monitoring (CGMS), hyperglycaemia, near hypoglycaemia, glycaemic curve, fear of hypoglycaemia, pregnancy

The paper deals with the compliance of a 57 years old male patient with type 2 diabetes mellitus and 8 years history of diabetic foot syndrome, who was repeatedly hospitalized and re-educated in both the Departments of internal medicine and surgery of Faculty Hospital of Olomouc and in the Specialized Institute of Neurology and Geriatry in Moravský Beroun. 

Key words:  diabetic foot syndrome, compliance, education

The diabetic macular edema is the main cause of practical blindness in a population in productive age in developed countries. It is caused by hyperglycemia and other risk factors that are controllable by a diabetolog treatment. An ophthalmologist usually starts his treatment by a laser coagulation of leaking microaneurysms previously detected by a fluorescein angiography. He is successful in case of a focal diabetic macular edema (the left eye of our patient). Lower successfulness of the laser treatment occurs in case of a diffuse macular edema, particularly if a long-term collection of liquid in retina creates a solid plaque of dense exudate directly in the macula (the right eye of our patient). The laser treatment then leads to a resorption of the extremely large dense exudates, but it is replaced by a glial scar. In this area a loss photoreceptors occurs and low visual acuity, which can not be therapeutically affected, is fixed. The ophthalmologists must distinguish this condition from an age related macular degeneration, which can be therapeutically affected. 

Key words: focal diabetic macular edema, diffuse diabetic macular edema, fluorescein angiography, laser coagulation

Two case reports demonstrate the effectiveness of sitagliptine monotherapy in patients in whom the treatment with metformine is contraindicated. The improved control of diabetes mellitus during the treatment with sitagliptine corresponds to recent reports. The efficacy, simple dosing, insignificant risk of hypoglycemia and minimal interactions are considered to be its important profit. 

Key words: diabetes mellitus, hyperglycemia, HbA_1c, sitagliptine, metformine

The long-term acting insulin analogues detemir and glargine have given us the possibility to bring the treatment, particularly in patients with type 1 diabetes mellitus, closer to the physiological pattern. Gradually, it has become evident that in case of detemir, there is a high percentage of patients (particularly with type 1 diabetes mellitus) requiring a twice daily administration when combining it with an ultra-short acting analogue.
This report presents a case of a young patient with type 1 diabetes mellitus, in whom the switch from detemir to glargine enabled to maintain the administration of the long-term acting analogue once daily, which was crucial with respect to his occupation with irregular work shifts. The achievement and preservation of a good compensation was documented by clinical and laboratory results (the absence of hypoglycemias as well as improved glycemic profiles and the decrease of glycated hemoglobin). 

Key words: type 1 diabetes mellitus, glargine, detemir, daily administration of insulin, physical activity

We present a case of a 60 year old woman examined at the endocrinologist for hypertension and clinical hyperandrogenism (hirsutism, androgenous alopecia). Endocrine origin of hypertension was excluded but congenital adrenal hyperplasia (21-hydroxylase deficiency, late onset form) was identified as a very probable cause of hyperandrogenism. Genetic testing was refused by the patient. After administration of low dose corticoid therapy clinical improvement of hyperandrogenic symptoms was observed. 

Key words: congenital adrenal hyperplasia, 21-hydroxylase deficiency, hypertension, hirsutism, androgenous alopecia