Abstract
A 60-year-old woman had been experiencing thirst and fatigue since the spring of 1991. The symptoms gradually increased, and she was treated by a local medical doctor. The first diagnosis of diabetes mellitus was made at this time, and an oral hypoglycemic agent was administered. However, she consulted the medical service of our hospital because of increasing symptoms. Her height and body weight were 155 cm and 35.5 kg (BMI 14.8). The first examination in our hospital revealed a fasting plasma glucose level of 366 mg/dl and an HbA1c level of 14.3% while the urine was strongly positive for glucose and ketones. Intensified conventional insulin therapy was started. Thirty units of insulin controlled her glucose levels, and the daily doses of insulin for effective glycemic control gradually diminished thereafter. After the initiation of insulin therapy, she entered into total remission in about 1 month. Urinary CPR secretion increased from 19.5 μg/day to 43 μg/day. However, a gradual decline of C-peptide values has been observed since the remission period. Marked elevations of blood glucose recurred, and a total of 6 hospitalizations were required. The insulin dose was increased during each subsequent hospitalization. The endogenous insulin secretion was impaired in 1996. Urinary CPR was 7.6 μg/day, and ΔCPR6 during a 1-mg iv glucagon load was 0.1 ng/ml. ICA were negative while anti-GAD antibodies were positive witha value of 45 U/ ml (normal value: less than 5U/ml) in 1996. DR4 was detected in her HLA haplotype. In summary, we report a rare case of IDDM in an elderly patient who entered into remission 3 times.
