Algorithm ADA/EASD for the treatment of type 2 diabetes, when compensation is unsatisfactory, recommends choosing a combination treatment and practically gives us the same level of possibility of combination treatment with sulfonylurea, basal insulin, pioglitazon and GLP-1 agonist. Treatment based on incretins interferes in the complex pathophysiology of type 2 diabetes, plays a regulatory role in the function of ß cells, affects insulin secretion, glucagon secretion, affects the metabolism of glucose, plays a role in GI motility, decreases appetite, reduces weight and generally prevents progression of the illness.
The case describes evolution of the therapy of a 45 years old obese type 2 diabetic who is undergoing treatment since the year 1998. Progressively he underwent the reduction diet therapy through the combination of metformin and sulfonylurea to the exenatid therapy to a maximal twice a day potion. However the-at-first-sight successful therapy fails after a year, the weight reductions come to a stop and the parameter of long-term compensation HbA_1c worsens, and in spite of good endogenous secretion it is imperative to pass over to therapy by long-term basal insulin analogues. The case discusses the perspective combination of metformin, incretin, insulin, which could prevent weight increments during the insulin therapy, further improve long-term compensation and preserve the positive effects of the incretin therapy.

Key words: incretins, long-term basal insulin analogue, type 2 diabetes mellitus

The modern diabetes care starts from metformin, diet, change of the life style. When the compensation is not sufficient, then vildagliptine seems to be one of good possibilities.

Key words: compensation of diabetes, metformin, vildagliptin

The case report is focused on the treatment of an obese patient with type 2 diabetes mellitus who despite enhanced education failed to be reasoned into the weight loss and his treatment with oral antidiabetic agents needed to be intensified early. The combination of exenatide and metformine enabled to decrease and consequently withdraw the treatment with sulfonylurea and it lead to the weight loss. The patient was treated with this therapy in the end of his professional career and its safety brought him a benefit of being able to work as a professional driver of the urban public transport without any limitationsn. 

Key words: type 2 diabetes mellitus, weight loss, metformine, exenatide

This case report demonstrates a positive effect of a 4-month liraglutide therapy on body mass index, glycaemic profile and on glycated hemoglobin values in a 57-year old obese woman (adequately treated for hypothyreosis) with recent evolution of metabolic syndrome. Even though the diabetes control was acceptable, the treatment with high doses of metformin and sitagliptin failed to reach sufficient reduction of body mass. 

Key words: metabolic syndrome, hypertension, type 2 diabetes mellitus, obesity, hypothyreosis, sitagliptin, metformin, incretins, liraglutide

The “crossover trial” in the titration of insulin analogues in a female patient with type 2 diabetes mellitus in our clinical practice
Summary: The following case report demonstrates that the change of proportions of prandial and basal insulin in accord with physiological principles leads to the improvement of metabolic compensation. 

Key words: type 2 diabetes mellitus, insulin titration, insulin analogues

The paper describes the improvement of parameters of compensation of type 2 diabetes mellitus (DM) in a polymorbid 66 years old patient, in whom the long term insulin analogue glargine was added to the maximal combined treatment with oral antidiabetic agents, because of insufficient parameters of compensation: fasting glycemia (FBG), postprandial glycemia (PPG), and glycated hemoglobin. After the dose titration the optimal compensation of type 2 diabetes mellitus persisted for almost three years without the need of further up-titration of insulin glargine units; and insulin glargine proved to be a completely safe part of the treatment of type 2 diabetes mellitus. The patient did not notice any severe hypoglycemia during its administration. 

Key words: type 2 diabetes mellitus, oral antidiabetics, insulin glargin

We report a case of a 40-year-old patient with insufficiently controlled diabetes mellitus type 2 in stage of long-term complications who was referred to our department for renal biopsy. After diagnosis confirmation and therapy accentation proteinuria significantly decreased and illness progression slowed down with postponing further complications. In the final part we present current treatment options of diabetic nephropathy. 

Key words: type 2 diabetes mellitus, diabetic nephropathy, ACE inhibitors, aliskiren, insulin

The presented case report of a 58 years old female patient with type 2 diabetes mellitus has been assessing the course of her underlying condition during the recent three years. It illustrates the benefits and limitations of oral antidiabetic treatment as well as of two different procedures of metabolic surgery – firstly laparoscopic adjustable gastric bandage (LAGB) and later biliopancreatic diversion (BPD). 

Key words: treatment of type 2 diabetes mellitus, bariatric surgery, metabolic surgery, gastric bandage, biliopancreatic diversion

The paper presents the continuous glucose monitoring (CGM) graphs in two patients: a woman with type 1 diabetes mellitus, and a man with type 2 diabetes mellitus. Despite several common patient characteristics (age group, time of DM diagnosis, regular lifestyle), the CGM shows different patterns in glycemic excursions, based on different pathophysiology of the two DM types. 

Key words: continuous glucose monitoring, type 1 diabetes mellitus, type 2 diabetes mellitus, dawn phenomenon

The first and the second case reports demonstrate that near whole day lasting normoglycaemia can be achieved even in a small child by using continual glucose monitoring system. On the other hand using of this technology led to the increase of psychic tension within the families (concrete reasons were different in these two families). The third case report shows a young man who is able to profit fully from this technology due to his personality. The last report illustrates how the blinded variant of the continual glucose monitoring can be used to improve eating habits of the patient with the clear positive consequence to glycaemia. 

Key words: continual glucose monitoring, normoglycaemia, psychic factors

Pancreatic cancer is a highly lethal disease, which is in most cases diagnosed too late to be treated radically. It is the fifth leading cause of death in men and the sixth leading cause of death in women in the “western world”, with median survival shorter than six months and five-year survival between 1–4 %. Diabetes mellitus is an independent risk factor of pancreatic cancer. Diabetes mellitus increases the total risk of pancreatic cancer twofold compared to non-diabetic population, eightfold during the first three years of the disease and elevenfold during the same period in patients with a positive familiar history. Smoking is the additional independent risk factor. In patients with diabetes mellitus the imaging examination of pancreas should be performed, especially in recent diagnosis; or the oncomarkers CA 19-9 and CEA should be measured. The higher risk of pancreatic cancer should be continuously taken into account. 

Key words: pancreatic cancer, diabetes mellitus, IGF-1, CEA, CA 19-9

A female patient, whose type 2 diabetes mellitus had been well controlled so far, was admitted for an acute worsening of her condition with quantitative deterioration of consciousness caused by hyperglycemic, hyperosmolar, and non-ketoacidotic state with potential contribution of COPD exacerbation. During screening examinations a tumor of pancreatic head and metastasis in hepatal hilus were diagnosed. Considering patient’s preferences, the advanced disease was left for a symptomatic treatment. 

Key words: pancreatic cancer, type 2 diabetes mellitus, decompensation of diabetes mellitus

A female patient was admitted for a recently diagnosed diabetes mellitus, and based on clinical and laboratory parameters type 2 diabetes mellitus was diagnosed. The patient was well controlled by diet and metformine; ultrasound examination was performed in the time of diagnosis with normal finding. During a six months follow-up her compensation of diabetes progressively worsened despite of the augmentation of the treatment. The imaging examination proved the pancreatic cancer with distant metastases, and subsequent chemotherapy was not successful. 

Key words: type 2 diabetes mellitus, pancreatic cancer