Context: Diabetes is a major public health problem with increasing morbidity due to complications. There have been reports regarding the association of serum magnesium (S. Mg) with diabetic complications but they are few and inconclusive. Aims: The aim was to find the status of S. Mg in patients of type 2 diabetes mellitus (type 2 DM) and study association of S. Mg with glycemic control and diabetic complications. Settings and Design: This was a cross-sectional observational study carried out in a tertiary care hospital in rural area. Subjects and Methods: All patients of type 2 DM were included. Detailed history was taken and all were subjected to routine investigations and S. Mg level. Patients were also screened for complications of diabetes. Statistical Analysis Used: Data were analyzed for any association between S. Mg levels and diabetic control (hemoglobin A1c [HbA1c]) and also for the correlation with diabetic retinopathy and nephropathy. Results: Mean S. Mg was significantly less in patients having uncontrolled diabetes (HbA1c ≥7%) as compared to those with HbA1c <7% (78.8% vs. 21.2%;P= 0.001). There was a negative correlation between S. Mg and HbA1c (r = −0.499;P= 0.001). We also found a statistically significant association of hypomagnesemia with retinopathy (odds ratio [OR] = 4.871;P= 0.001) and nephropathy (OR = 5.4;P= 0.001). Conclusions: Hypomagnesemia is associated with uncontrolled HbA1c and diabetic complications. Routine monitoring and correction of S. Mg levels in type 2 diabetes patients may help in better control of HbA1c and delaying progression to retinopathy and nephropathy.

Diagnosis of pulmonary tuberculosis is challenging till today. Smear microscopy is the easiest, commonest and widely employed tool for confirmatory diagnosis of pulmonary tuberculosis, but it has low sensitivity and specificity. Sputum culture can increase the diagnostic yield by 20-40%, but it takes long duration of 2-8 weeks to give result. The role of newly introduced cartridge based nucleic acid amplification test (CBNAAT) in the revised national TB control program (RNTCP) is highly promising with a higher yield of bacteriological diagnosis in sputum negative pulmonary tuberculosis patients with detection of rifampicin resistance rapidly. However, it also has some limitations which may result in false negative results. Case of a 50- year-old-male was reported who was initially managed for community-acquired pneumonia in view of negative sputum and CBNAAT but was later confirmed to have TB but by then he had developed cavities in lung and had transmitted the infection to his son.

Although the most common cause of recurrent hypoglycaemia is diabetes mellitus as patient is on antidiabetic medications which can be prevented by modification of antidiabetic doses, nutrition therapy and lifestyle modifications. Some endogenous hyperinsulinemic conditions like insulinoma, functional beta cell disorders and insulin autoimmune syndromes, hormonal deficiencies can cause serious and sometimes life threatening hypoglycaemia. So further laboratory evaluation like plasma/serum glucose levels, c-peptide levels, insulin levels, insulin antibodies and imaging studies are needed to evaluate unexplained hypoglycaemia. Here we report a case of insulin autoimmune syndrome in a 67 year old Indian male who had presented to us with multiple episodes of spontaneous hypoglycaemia. On further workup, the patient was found to have endogenous hyperinsulinemic hypoglycemia. As the patient’s abdominal imaging revealed no apparent cause of EHH, on further evaluation he came positive for insulin antibodies. Patient was diagnosed as IAS and he was given frequent small meals and complex carbohydrate diet and he had improved symptomatically. The incidence of IAS is most common in Japan and very few cases have been reported from India, so it should be kept in differential diagnosis of recurrent hypoglycaemia.