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Muscle cramps are characterized by sudden, painful involuntary contraction of the muscles. The cramps sometimes become disabling and the prevalence is more in the elderly. The etiology of the cramps are diverse and some time the cramps are idiopathic. There are many underlying pathophysiological disorders like hypocalcemia, hypomagnesemia, hypothyroidism, and hepatorenal dysfunction which causes muscle cramp. Similarly, diabetes mellitus results in muscle cramps due to electrolytic imbalance, hypoglycemia, peripheral arterial insufficiency, and neuropathies. Persistent muscle pain in diabetic patients degrades the quality of life of those patients. Although the pathophysiology and etiology of the muscle cramp are understood to some extent, the same is less explored from diabetes mellitus perspective. Hence the objective of this review is to explore the underlying factors responsible for muscle cramps in diabetes so that proper strategy for pharmacotherapy can be made to manage this condition.

Background. Peaks and nadirs of blood glucose level varying daily in a person is referred to as glycemic variability (GV). GV associated with diabetics has been recently linked to cardiovascular disorders (CVD) or even chronic kidney disease (CKD) progression. Faster-acting insulin aspart is the latest ultra-rapid acting bolus insulin which has shown much lesser intra- and inter-patient variability as compared to conventional bolus insulin. Material and methods. However, inadequate data exist regarding GV in patients with advanced stages of CKD. Hence, with this objective, the present case study was undertaken with eight patients divided into two equal groups, wherein faster-acting insulin aspart and insulin aspart were used as the boluses, respectively. Continuous glucose monitoring data of the patients were taken for the initial four days to calculate mean amplitude of glycemic excursion (MAGE) of the total four days for each individual (mmol/L) to see the difference in GV. A value of > 3.607 mmol/L (65 mg/dL) was considered to be statistically significant. Results. In this case study of eight stage 4 CKD type 2 diabetic patients, statistically significant lower GV was observed in the faster-acting insulin aspart arm when compared with the insulin aspart arm. The pvalue was 0.0004 in unpaired t-test and < 0.05 for U in Mann-Whitney U test after ruling out the baseline confounding factors. Conclusions. This study confirms the stable pharmacokinetic and dynamic properties of faster-acting insulin aspart and subsequent studies with larger numer of patients are required for a conclusive outcome.

Introduction. Hypertension is commonly occurring in type 2 diabetes and metabolic syndrome and inflammation are a well-known part of this disease entity. The data of using remogliflozin in Indian patient is not known as this is a very recently approved molecule for the treatment of type 2 diabetes. Here we look into a case series of five patients who had their ambulatory blood pressure monitoring (ABPM) done at baseline and again after 14 days of therapy of adding remogliflozin etabonate to recent onset antihypertensive druges. Methods. We analysed the ABPM results of five patients after taking their informed consent at baseline and two weeks post-treatment initiation with remogliflozin alongside with recent onset antihypertensive drugs. We used paired t test for statistical analysis of the two readings of each patient to come to a conclusion. Results. We found a statistically significant decrease in mean arterial pressure (MAP) reflected by a p value of 0.0277 and the reduction in mean awake time systolic blood pressure (SBP) was also very close to statistical significance as seen by the p value of 0.0541. Conclusions. Remogliflozin etabonate when co-prescribed with antihypertensive drugs shows a significant reduction in MAP as well as reduction in SBP although most of the contribution seems to be coming from the antihypertensive molecule itself.