The Improvement of the Metabolic Regulation in a Diabetic Patient With Pulmonary Sarcoidosis Treated With Steroid

Abstract

After receiving a diagnosis of type 2 diabetes, he was diagnosed with lung sarcoidosis and steroid treatment, we present a case with chronic active hepatic disease and difficulty in metabolic control.

Thirty-two-year-old male patient was diagnosed with type 2 diabetes and diagnosed with Löfgren’s syndrome while metabolic control was good under metformin treatment. Steroid therapy started because of lung involvement. Oral antidiabetics were not used because of active liver disease. Hyperglycemia became evident when clinic and lung findings were improved. For this reason, metabolic control was attempted with basal / bolus insulin therapy.

When steroid doses of uncomplicated diabetic patients are reduced, blood glucose levels were also at optimal levels. High dose, longterm steroid use and diabetes mellitus association may lead to impaired blood glucose control in chronic lung diseases and increased complications. As in our case, it is recommended that the dose of the steroid be lowered to the lowest possible dose in the best possible time, without disrupting the treatment of diabetic patients.In addition, the use of alternative therapies instead of steroids will play an important role in the control of blood glucose levels.

Keywords

• Diabetes Mellitus,Insulin,Steroid,Sarcoidozis,Löfgren’s syndrome

Tip 2 Diyabetik Pulmoner Sarkoidozlu Bir Olguda Steroid Tedavisi Altında Metabolik Kontrolün Sağlanması

Abstract

Tip 2 diyabet tanısı aldıktan sonraki takiplerinde akciğer sarkoidozu tanısı ile steroid tedavisi alırken kronik aktif bir karaciğer hastalığı bulunan ve metabolik kontrolünde zorluk yaşanan bir olguyu sunmaktayız.

Otuzaltı yaşında erkek hasta, tip 2 diyabet tanısıyla metformin tedavisi altında metabolik kontrolü iyi iken Löfgren Sendromu tanısı aldı. Akciğer tutulumu nedeniyle steroid tedavisi başlandı. Aktif karaciğer hastalığı da var olduğundan oral antidiyabetikler kullanılamadı. Kliniği ve akciğer bulguları gerilerken hiperglisemisi belirginleşti. Bu nedenle de bazal/bolusinsulin tedavisi ile metabolik kontrol sağlanmaya çalışıldı. Komplikasyonsuz diyabetik olgumuzun steroid dozları azaltıldığında kan şekeri değerleri de optimal düzeylerde seyretti.

Yüksek doz ve uzun süre steroid kullanımı ve diabetes mellitus birlikteliği kronik akciğer hastalıklarında kan şekeri kontrolünün bozulmasına ve diabetes mellitusa bağlı komplikasyonların artışına neden olabilir. Olgumuzdaki gibi diyabetiklerde tedaviyi aksatmadan steroid dozunun mümkün olan en uygun sürede en düşük doza düşülmesi önerilmektedir. Ayrıca steroid yerine alternatif tedavilerin kullanılması kan şekerinin kontrolünde önemli rol oynayacaktır.

Keywords

• Diabetes Mellitus,İnsülin,Steroid,Sarkoidoz,Löfgren sendromu

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