Abstract
A male noninsulin-dependent diabetic patient, aged 38 years, was complicated by anorexia nervosa during the course of diabetes mellitus. He was first diagnosed as having diabetes mellitus at 33 years of age, when he noticed thirst, polyuria and weight loss (60→53kg). His diabetic state has been controlled initially by insulin and later only by diet and exercise therapy. However, his body weight continued to decrease from 45 kg at 35 years of age to 40 kg at 37 years. Because of additional complication by anemia and liver dysfunction, he was admitted to our University Hospital in January, 1986. On admission, his body weight was 36 kg (45% less than ideal body weight). Organic lesions which may induce excessive loss of body weight, such as hypopituitarism, malabsorption syndrome, malignancies, etc. were ruled out. During admission, a diet of 2, 000 kcal/day was served, but he was too strict about dietary treatment and too nervous about increasing plasma glucose levels to gain weight. So his body weight remained around 36 kg. The blood glucose level and HbA1 were well controlled. Insulin secretion was very low, as assessed by urinary daily excretion of CPR as were responses of plasma IRI and CPR to oral and intravenous administration of glucose, glucagon and tolbutamide. A euglycemic glucose clamp study disclosed that sensitivity to insulin in the patient was increased to twice as much as the control. No differences were found in characteristics of the insulin recpetors on erythrocytes prepared from the patient and control subjects. Basal plasma concentrations of GH, LH and cortisol were increased and T3 was decreased. Radiological examination did not show any abnormalities in the area of the hypothalamus and pituitary gland. Psychological tests indicated a tendency of neurosis in his character. It is postulated that the patient's strict adherence to the diet in the treatment of diabetes mellitus may have accelerated the manifestation of anorexia nervosa.
