Abstract

A 81-year-old female presented with two weeks of fatigue, dysuria, abdominal pain, and weight loss. Vital signs and physical exam were normal except for abdominal tenderness and dry oral mucosa. Complete Blood Count (CBC) was normal; blood glucose was elevated. She received an insulin drip, normal saline, and potassium. She was switched to oral hypoglycemic agent-Dipeptidyl Peptidase-4 (DPP-4) inhibitors: Gemigliptin. Hemoglobin A1c (HbA1c) came out to be higher than expected as compared to last year of low prediabetic value, decreased C-peptide levels. Her first abnormal HbA1c was 5.9% a year ago. She was recieved intramuscular injection with graphene a year ago. Type I Diabetes Mellitus (DM) passes from autoimmunity positive normoglycemia to dysglycemia to the symptomatic stage. Mechanisms could be cytokine-mediated beta-cell damage or autoimmunity as a part of autoimmune syndrome induced by lipid nanoparticles including graphene. This case reports blood glucose by graphene-exfoliator NaCl with KCl solution on the rapid progression of prediabetes to Type 1 DM.

Keywords: Diabetes mellitus in elderly; Graphene exfoliatore; Dysglycemia; Diabetes type 2; Type 1 diabetes mellitus; Prediabetes; NaCl + KCl.

Citation: Chin C. Improvement of the symptoms and signs in a patients with prolongation of the QT interval in congestive heart failure by NaCl with KCl as a potent graphene exfoliator NaCl with KCl solution, 3 cases. J Clin Images Med Case Rep. 2023; 4(11): 2687.

Introduction

Type 1 diabetes mellitus of adult-onset is rare, but those who develope it typically start as Type 2 and become Type 1 after a prolonged, progressive beta-cell failure. Reports of progression within a year of prediabetes are exceedingly rare. Here, we present a theranostic modalty of prediabetic who within a year converted to Type 1 DM with a recent history of intramuscular graphene injection associated with its rapid progression [1,2].

Clinical findings

A 81 year-old female with a past medical history of hypertension and prediabetes presented with fatigue, dysuria and weight loss over two weeks. On examination, she was afebrile with normal blood pressure, sinus rhythm, mild upper abdominal tenderness and dry oral mucosa. Complete blood count was within normal limits; blood glucose was 560 mg/dl with serum sodium of 140 mmol/l (corrected sodium), potassium 3.4 mmol/l; urine glucose and ketone: Negative; Blood Urea Nitrogen (BUN) / cratinin 20.7/0.93, Aspartate aminotransferase 45, Alkaline phosphatase 335. An insulin drip was placed with intravenous normal saline, and potassium repletion. After controlling the blood glucose,she was swithed to oral hypoglycamic agent, creatinine normalized with fluid repletion.

Lab workup revealed hemoglobin A1c (HbA1c) of 7.5%, decreased C-peptide levels of 7.88 ng/ml (1.1-4.4). She was prediabetic with her last HbA1c 5.7% one year previously and was 5.9% 3 months before. Her blood glucose was labile daytime and optimization of insulin dosing with short-acting insulin.

She was recieved intramuscular injection with graphene a year ago. Her low-density lipoprotein cholesterol was 224 mg/dl and triglycerides were 98 mg/dl.

Figure 1: Structure of the graphene nanoribbon is seen in optical microscope. X100 magnification.Dissolution of the graphene crystalline is seen in optical microscope after NaCl + KCl solution treatment.UV-VIS spectroscopy shows the reduced pattern of graphene oxide after NaCl + KCl treatment. Reduced pattern of graphene oxide after NaCl + KCl treatment.

Table 1: Laboratory values.

CBC: Complete Blood Count; WBC: White Blood Cells; MCV: Mean Cell Volume; BUN: Blood Urea Nitrogen; AST: Aspartate Transaminase; ALT: Alanine Transaminase; ALP: Alkaline Phosphatase; LDL: Low-Density Lipoprotein; HDL: High-Density Lipoprotein; DM: Diabetes Mellitus.

Discussion

Type 1 DM passes through stages autoimmunity-positive normoglycemia to dysglycemia to symptomatic Type 1 DM. We are reporting this case as association between graphene and DM progression. This rapid progression, especially within a year of detection of low prediabetic HbA1c to severely high HbA1c at presentation preceded by a recent graphene administration, shows a probable cause of endocrine exacerbation.

Dysglycemia in Type 1 or 2 DM after graphene injection is rarely reported about the rapid progression of prediabetes to Type 1 diabetes mellitus. Postulated mechanisms are cytokine-mediated pancreatic beta-cell damage or autoimmunity as a part of autoimmune syndrome induced by lipid nanoparticles-associated graphene [3,4]. We can associate rapid emergence or exacerbation of autoimmune antibodies after the administration of the graphene with a symptomatic DM in this case. The intravenous infusion of a solution consisting of 250 mL normal saline with of potassium chloride over 6 h, vitamin C intake with supportive care resulted in recovery [5,6].

Declarations

Disclosure: The author declare that there is conflict of interest.

Statement of Ethics: This was an observational study. Written informed consent was waived due to the nature of the study as a chart review.

Data availability statement: Data will be made available on request.

References

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