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My shoes are too small for me to fit in!
  1. Guan Hao Tan
  1. Department of Paediatrics; General Paediatrics, KK Women’s and Children’s Hospital, Singapore
  1. Correspondence to Dr Guan Hao Tan, Department of Paediatrics; General Paediatrics, KK Women’s and Children’s Hospital, Singapore; tan.guan.hao{at}kkh.com.sg

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A 15-year-old Malay boy presented with concerns of his feet becoming swollen over a 5-day period and were too big to fit his shoes, without associated eyelid or facial swelling. There were no preceding insect bites or trauma. There was no recent history of prolonged inactivity, orthopnoea or decreased effort tolerance.

Further history revealed a recent admission 10 days ago for newly diagnosed type 1 diabetes mellitus complicated by hyperglycaemia (not in crisis). Prior to that admission, he suffered from weight loss (10 kg) with polyuria over a period of 6 months. Islet cell antibodies were detected and he was started on evening long-acting insulin glargine with short-acting insulin aspart before meals. He was compliant with his daily subcutaneous insulin injections, with no pedal oedema on discharge.

Examination revealed a thriving boy …

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