Abstract
Case 1: A 63-year-old man. Body weight (BW) 106.3 kg, BMI 39, waist circumference 116 cm, blood pressure (BP) 138/92 mmHg, blood sugar (BS) 181 mg/dl, and daily insulin dosage 100 units (U). Upon admission, the patient was advised to adhere to a 1,200 kcal diabetic diet and an exercise regimen of 10,000 steps. When the BW decreased to 99 kg, the metabolic syndrome (MS) resolved. Insulin could be withdrawn, when the BW decreased to 94.5 kg.
Case 2: A 41-year-old man. BMI 32.8, waist circumference 112 cm, BP 154/90 mmHg, BS 171 mg/dl, and daily insulin dosage 68 U. With the above treatment, the MS resolved when the BMI decreased to 31. Insulin could be stopped when the BMI decreased to 28.
Case 3: A 61-year-old woman. BMI 24, waist circumference 90 cm, triglyceride 203 mg/dl, BS 162 mg/dl and daily insulin dosage 36 U. With the above treatment, the MS resolved when the BMI decreased to 22.8. Insulin could be withdrawn, when the BMI decreased to 22.1.
Even one year after discharge, the three cases could maintain their reduced weight, and their respective HbA1c values were 5.4, 6.3, and 6.2 even without insulin injection.
During admission, we realized that all of them overate for stress which caused significant increase of weight and the daily dosage of insulin. We administered stress management therapy, including diet and exercise treatments. We think such combined therapy was the main reason for the successful reduction of the body weight, with not only resolution of the metabolic syndrome but also withdrawal of insulin.
