CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2023; 06(01): 037-040
DOI: 10.1055/s-0043-1761195
Clinical Vignette

Lesson of the Week: In the Nick of Time!

1   The Endocrine Clinic, Yas Clinic Khalifa City, Khalifa City, Abu Dhabi, United Arab Emirates
2   Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
3   Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
› Author Affiliations
Funding and Sponsorship None.


Management of diabetes lends itself very well to several classical rules of good clinical practice, an elaboration of which is out of the scope of this short story. However, a couple of these are noteworthy. “Diagnosis should precede treatment as much as possible except for measures of resuscitation” applies to diabetes as to all other conditions. In diabetes, diagnosis and classification are the same. Hence, a serious attempt to classify diabetes at the time of diagnosis or as soon as possible after that is mandatory.[1] In particular, when the patient's characteristics are atypical, or events do not follow the expected course, making assumptions under these circumstances can be very dangerous.[2] In this vignette, an unusual case of diabetes in a young woman is presented and discussed with an analysis of lessons to be learned. The present case report exemplifies several themes of “not expecting the expected,” “not making unfounded assumptions,” and “ignoring several alert signals.”

In the Merriam-Webster dictionary, the idiom “in the nick of time” means just before the last moment when something can be changed or something terrible will happen.[3] Many examples are medical, for instance, “The ambulance arrived in the nick of time” or “The doctor arrived in the nick of time. The patient's life was saved”. Hence, the choice of the title is not for fun, but it is perhaps the best description of the case as the story unfolds.

Patient's Consent

The author confirms that the patient provided consent for publication on totally anonymous basis. None of the published details can provide any identification of the reported case.

Author Contributions

Single author responsible for all the aspects of the article.

Compliance with Ethical Principles

Not required for single case reports made on totally anonymous basis.

Publication History

Article published online:
23 January 2023

© 2023. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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