During the year 1964, 128 diabetics were hospitalized in this institution. They were treated separately with insulin and SU, and the responses shown by them were closely observed, and it is possible to arrange them into the following 6 classes according to the characteristic responses to these substances.
I. Classification
A-group: excellently effective with insulin as well as SU, 43%.
B-group: refractory to insulin or SU alone, 14%.
C-group: so-called insulin dependent diabetics, non-responsive to SU, 14%.
D-group: pseudo-SU-resistant diabetics, good response to SU after repeated longterm insulin therapy, 5%.
E-group: poor response both to insulin and SU, 8%.
F -group: well-controlled under dietary restriction alone, 16%.
II. Clinical Characteristics
(a) The A-group which showed the best response to insulin as well as SU, gave the most favourable results on the GTT test done before and after the treatment; but the C- and D-groups were found to be the worst.
(b) The insulin sensitive test (judged by the variation of blood sugar after insulin subcutaneous injection) revealed in the B- and E-groups many insulin resistant patients meaning the usual insulin action was inhibited, and many others showed the insulin high rebound effect.
(c) With regard to the tolbutamide sensitive test (similar to (b) after intravenous injection of tolbutamide), no change whatever of blood sugar was seen in the C-group all through the treatments; the D-group responded at the commencement of the treatments with no lowering, but near the end of the treatments showed the lowering effect while in the others there occurred invariably the lowerings when no hepatic or retinopathic complex was accompanied.
(d) Accompanying diseases differed from one group to another: thus (1) retinopathy was found common in the C- and D-groupes, but quite less in the B- and E-groups; and (2) hypercholesteremia showed any marked differences in all the groups. Under restriction of fat diet, the relation hypercholesteremia and insulin therapy was observed, and found the high level blood cholesterol deceased in fairly many cases in the C- and D- groups.
