We present a 4-year-old newly diagnosed T1DM boy who presented with sever polyuria and polydipsia and HbA1C of 9.3%. Coincident with onset of ITM program insulin doses were tapered and the baby got free from insulin soon. Only three months after traditional anti-diabetic medications, his HbA1C improved to 5.8%.

Fanconi anaemia is a rare inherited disease characterized by congenital abnormalities, progressive bone marrow failure and predisposition to malignancy. Successful pregnancies in transplanted patients have been reported. In this paper we will describe the pregnancy of a patient with Fanconi anaemia without transplantation.
A 34-year-old nulliparous woman with Fanconi anaemia was referred to our institution. Pregnancy was complicated by progressive pancytopenia and two severe infections. C-section was performed at 36 weeks. Both infant and mother are well.
Successful pregnancy in a Fanconi anaemia patient with bone marrow failure is possible. The mode of delivery in patients with bone marrow failure should be determined by obstetric indications. The case highlights the safe outcome of the pregnancy with strict clinical and laboratory control by a multidisciplinary team.

A 6 0-year-old woman with severe obese and type-2 diabetes was hospitalized due to poorly controlled glycemia by worsening osteoarthritis of both knees. Although a diet therapy(1,200 kcal/day)was initially offered, but the body weight did not decrease. Thus, we changed VLCD therapy to LCD therapy sequentially. The weight loss made her possible not only to walk with a walker but it also improved a glycemic control. Because it was thought to be necessary to reduce her economic burden in order to continue the LCD therapy after was discharged, an inexpensive LCD menu was devised based on meal and auxiliary nutrients including trace elements. To support the LCD therapy at home, it is important to propose a simple and sustainable approach with a consideration of economic aspects as well as home environment.

BACKGROUND: A healthy, balanced diet can prevent stroke, but little is known about dietary risk factors for subarachnoid hemorrhage (SAH). We aimed to determine the relationship between common dietary habits and risk of SAH.
METHODS: In a population-based, case-control study of SAH undertaken across 4 Australasian cities, a standardized questionnaire was used to obtain information on the frequency of consumption of 15 common food items and alcohol in incident cases (n = 383) and frequency-matched community controls (n = 473). Logistic regression models were used to estimate the independent effects of these dietary factors, after adjusting for conventional risk factors for SAH. Data are reported with odds ratios (OR) and 95% confidence intervals (CI).
RESULTS: The risk of SAH rose with increasing consumption of fat or skin on meat (p trend = 0.04), being highest in those with consumption >4 times weekly compared with no fat or skin on meat (adjusted OR 1.70, 95% CI 1.09-2.66), while use of skim or reduced-fat milk (p trend = 0.01) and fruit (p trend = 0.04) was associated with a reduced risk of SAH compared with rare use. Among people with a history of hypertension, frequently adding salt to food was associated with an increased risk of SAH, irrespective of whether they were (OR 2.58, 95% CI 1.29-5.13) or were not (OR 2.88, 95% CI 1.46-5.70) currently taking antihypertensive treatment.
CONCLUSIONS: Frequent intake of fat appears to be associated with an increased risk of SAH, particularly in people with hypertension, while frequent use of skim or reduced-fat milk and fruit appears protective for SAH.

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The aim of this study was to design, implement and evaluate disease outcomes at a regional hospital- based case management program of care for patients with type 2 diabetes. A medical team and practice guidelines were established in line with the health insurance strategy of Taiwan\'s Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p< .0001), fasting glucose (p< .01) and triglycerides (p< .05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.

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Aiming to improve the quality of diet recording and instruction in primary care, we developed a simple semi-quantitative food frequency questionnaire for type 2 diabetic patients and had doctors record each other\'s diet habits with the same questionnaire. The analysis of the diet composition was given to the doctors who considered the educational model to be fun, instructive and thought-provoking. Doctors with a relatively unhealthy diet and a relatively high body weight tended to show dissatisfaction with their own diet, had poor self-assessed knowledge about nutrition, and even a wish to improve their own diet after having seen the result of the diet interview. The proportion of diabetic patients being treated with diet alone tended to decrease with their doctors\' decreasing diet counselling skills, which indicates that doctors\' attitudes may exert an effect at patient level.

BACKGROUND: It has been established that careful diabetes self-management is essential in avoiding chronic complications that compromise health. Disciplined diet control and regular exercise are the keys for the type 2 diabetes self-management. An ability to maintain one\'s blood glucose at a relatively flat level, not fluctuating wildly with meals and hypoglycemic medical intervention, would be the goal for self-management. Hemoglobin A1c (HbA1c or simply A1c) is a measure of a long-term blood plasma glucose average, a reliable index to reflect one\'s diabetic condition. A simple regimen that could reduce the elevated A1c levels without altering much of type 2 diabetic patients\' daily routine denotes a successful self-management strategy.
METHODS: A relatively simple model that relates the food impact on blood glucose excursions for type 2 diabetes was studied. Meal is treated as a bolus injection of glucose. Medical intervention of hypoglycaemic drug or injection, if any, is lumped with secreted insulin as a damping factor. Lunch was used for test meals. The recovery period of a blood glucose excursion returning to the pre-prandial level, the maximal reach, and the area under the excursion curve were used to characterize one\'s ability to regulate glucose metabolism. A case study is presented here to illustrate the possibility of devising an individual-based self-management regimen.
RESULTS: Results of the lunch study for a type 2 diabetic subject indicate that the recovery time of the post-prandial blood glucose level can be adjusted to 4 hours, which is comparable to the typical time interval for non-diabetics: 3 to 4 hours. A moderate lifestyle adjustment of light supper coupled with morning swimming of 20 laps in a 25 m pool for 40 minutes enabled the subject to reduce his A1c level from 6.7 to 6.0 in six months and to maintain this level for the subsequent six months.
CONCLUSIONS: The preliminary result of this case study is encouraging. An individual life-style adjustment can be structured from the extracted characteristics of the post-prandial blood glucose excursions. Additional studies are certainly required to draw general applicable guidelines for lifestyle adjustments of type 2 diabetic patients.

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