Abstract
A 39-year-old man was admitted to our hospital because of diabetic ketoacidosis and pneumonia. He had been diabetic for five years, and was not on treatment. The blood glucose value on admission was 602 mg/dl, and HbA1 was 16.4%. His fundi showed only a few dot hemorrhages. He was treated by continuous intravenous insulin infusion, followed by subcutaneous injection of intermediate insulin. On about the 8th hospital day, pretibial edema, visual distrubance and pleural effusion developed, then disappeared until the 25th hopsital day. After the disappearance of insulin edema, many linear hemorrhages and soft exudates developed over the radial peripapillary capillary area. Since fluoresein angiography showed many non-perfusion areas in the midperipheral area, photocoagulation therapy was administerd. Paresthesia of the lower limbs, orthostatic hypotension and tachycardia also appeared, and the mean difference between maximal and minimal heart rate during deep breathing was small. Furthermore, he began to complain of diarrhea, impotence and hyperhydrosis in the upper trunk. Ten months later, his fundi showed neovascularization on the peripapillary area, but remained rather stable. Symptons of diarrhea and orthostatic hypotension slightly improved, but the autonomic function was still markedly impaired.
This is a case in which rapid tight control of blood glucose led to insulin edema, followed by rapid development of proliferative diabetic retinopathy and peripheral and autonomic neuropathy.
