Factitious disorder is a psychologic problem which may cause symptoms of a disease which is non-compliance with patient physical exam. Some cases of brittle diabetes are because of underlying psychologic disorder such as factitious disorder or Munchausen syndrome. In this paper a 17-years old female is presented with factitious hyperglycemia and DKA-like symptoms such as nausea, vomiting and severe abdominal pain. Finally with subtle monitoring it was found that the cause of patient's hyperglycemia despite high dose insulin prescription was impregnating her finger into the date palm in the context of the factitious disorder. The patient had different deceptive behaviors depending on the method of treatment. She used every trick to mislead the medical team. In Munchausen syndrome, patient is unaware of his problem that mimic an episode of diabetic ketoacidosis. Thus psychotherapy is the main treatment of this factitious hyperglycemia. The main aim of this report is consideration of factitious hyperglycemia in patients with brittle diabetes mellitus.

Aim and Background:In patients with type 2 diabetes mellitus complicated with renal failure achieving good glucose control and reduction of risk of hypoglycemia should be balanced. The aim of this study was to determine the safety and efficacy of insulin glargine in type 2 diabetic patients with diabetic nephropathy.Methods: A total of 89 subjects with type 2 diabetes (mean age 62.9 ± 10.7 and diabetes duration 13.9 ± 7.6 years) who had diabetic nephropathy (mean Glomerular FiltrationR [GFR] 34.1 ± 11.5 ml/min) were included in the study. Patients who were not optimally controlled or experienced frequent hypoglycemia on Oral Antidiabetic Drugs (OAD) or NPH insulin received insulin glargine at bedtime. The starting dose was 0.1 unit /Kg and adjusted to obtain target fasting blood glucose (5-7.2 mmol/l). The medical records were obtained before and 2 and 4 months after beginning insulin glargine.Results: At the end of four month treatment period, significant reduction in glycated hemoglobin (HbA 1 c) was observed (from 8.4% ± 1.6 to 7.7% ± 1.2) (p<0.001).The treatments were associated with significant reduction in fasting glucose levels (from 159.7 ± 67 to 119.4 ± 28.4mg/dl) (p<0.001).Patients' Body Mass Index (BMI) did not increase at the end of study (26.2 ± 3.9 and 26.2 ± 3.8 kg/m 2 ) (p=0.96). Mild symptomatic hypoglycemia was seen in 12.5% of subjects. No other side effects were noted throughout the study. Conclusion:Insulin glargine improved HbA1c at short-term and proved to be safe and well tolerated in type 2 diabetic patients with diabetic nephropathy. J ou rna l o f D ia be tes & M e ta bolism

Introduction: Statins are one of the most widely used therapies in different groups of patients not only because of cholesterol-lowering properties but also due to their non-lipid related mechanisms. However, the effects of atorvastatin on inflammatory and coagulation markers in type 2 diabetic patients are not well examined. Objectives: To evaluate, the effects of two different doses of atorvastatin on lipid profile, inflammatory coagulation markers, and liver enzymes in type 2 diabetic patients. Patients and Methods: In a randomized double-blinded controlled trial, 150 diabetic patients were randomly assigned to get atorvastatin 10 mg/d (n = 74) or 40 mg/d (n = 76) for 12 weeks. The concentration of biomarkers was determined both at the onset of the study as well as at the completing time of the intervention. Results: Significant differences between the mean levels of lipid profiles, fibrinogen, interleukin-1 (IL-1) and IL-6 were observed between two groups after three months treatment with atorvastatin 10 and 40 mg/d (P < 0.05). Furthermore, significant improvement in all blood values after atorvastatin 40 mg/d ingestion was observed (P < 0.05) except for homocysteine and creatine phosphokinase (CPK) levels (P > 0.05). Conclusion: Atorvastatin therapy especially with higher dose was associated with inflammation and coagulation parameters improvement in diabetic individuals. Trial Registration: Registration of randomized double-blinded clinical trial has been approved in Iranian registry of clinical trial (identifier: IRCT201502226710N5;