Electrogustometry was carried out in 156 diabetics. Taste abnormalities were noted in 24% of the diabetic group. Comparison of these results with the knee jerk revealed a significantly more frequent taste abnormality in those with a decreased or absent knee jerk than in those with a normal reflex(p<0.01). In the case of precoma, a marked improvement in taste threshold was noted along with the improvement of blood sugar value. In order to study the relationship between taste abnormality and the disease picture of diabetes mellitus, changes of lingual papillae and lingual blood vessels were photographed. According to these results, the lingual papillae of diabetics are frequently flattened which is in agreement with the findings after disruption of the innervating chorda tympani. Such flat-tening of lingual papillae appears to be due to diabetic neuropathy, in view of the relation-ship of such findings to the abnormality in the electrogustometry

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Treatment of patients with diabetes usually last a lifetime, and it is important to keep good control and prevent various diabetic complications. The education of patient is also necessary for successful treatment. The goal of treatment is to be able to live a life as normal as possible.
For attaining these purpose, it is neccessary to make a long-term follow-up system for general management, chemical and physical check of patients.
As chemical index of diabetic control, it is recently noted that glycosilated hemoglobin measurement is useful for evaluation of long-term blood glucose levels in diabetic patients.
This paper summarized the data of usual management system and medical care in our clinic, and clinical implication of glycosilated hemoglobin as an index of diabetic control

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Part 1: Clinical usefulness of glucosidases inhibitors on diabetes mellitus:
Thirty-two patients were subjected to our study. They are consisted of 16 males and 16 females in the age ranged from 20 to 79 years, with a mean of 57 years. Their diabetic history ranged from 1 to 18 years, with a mean of 7.3 years. Glucosidase inhibitor, Acarbose, in form of 100mg tablets were administered 3 times daily, taken with a first bit of the meal. Medication with the test drug lasted for up to one year in some case, but in general, the duration of treatment with acarbose was about 7 weeks. We had subdivided our patients into 3 groups, according to the antidiabetic treatment prior to entering the study.
Group 1 included 10 patients on dietotherapy alone. The 2nd group of 14 patients had been treated with oral hypoglycemic drugs, alone or combination with biguanides. The last group included 6 insulin dependent diabetics. Of 32 diabetic patients subjected to our trial, 24 or 75% were effectively managed with acarbose. Eight patients did not respond conclusively to therapy. Out of the 8 nonresponders, 3 patients could not tolerate the test drug due to side effects. Medication with acarbose had to be discontinued, because of nausea in two and diarrhea in one patient.
Monitoring of renal and hepatic functions and hematology during the test drug medi-cation period did not show any abnormal changes in all 32 patients. In our trial, intestinal side effects, such as flatulence, diarrhea and eruction were reported by 12 patients, although all except 3 patients completed the study.
Acarbose, an alpha-glucosidase inhibitor proved to be valuable in the treatment of various types of diabetes in Japan.
Part 2: Comparative study of fiber and alpha-glucosidase inhibitor in the dietary treatment of diabetic patients:
In our clinical trial, we investigated the therapeutic effectiveness of acarbose 100mg tablets taken 3 times daily in obese non-insulin dependent diabetic patients.
Glucomannan, a dietary fiber, manufactured from Amorphophallus Konjac C. Koch and galactomannan(guar) 4.5-9.0g and 12.0g respectively, divided in 3 daily doses with main meals, were also included in our study.
One hundred-eleven diabetic patients were subjected to the trial. We divided the cases into 3 groups: the first, consisted of 32 patients, received acarbose (group A), the second of 57 patients took glucomannan (group B) and the third of 22 cases had galactomannan (group C). Mean duration of treatment ranged from 7 weeks with acarbose, 9 weeks with galactomannan and 4 to 12 weeks with glucomannan.
1. Acarbose and galactomannan reduced body weight of our diabetic patients.
2. HbA₁ values, a useful indicator for long-term control of blood glucose, were sig-nificantly lowered only by acarbose treatment.
3. Serum total cholesterol values reduced by all 3 test drugs.
4. A significant increase of HDL-cholesterol percentage in the HDL-cholesterol/total cholesterol ratio was observed only in patients treated with galactomannan.
5. Serum triglycerides tended to decrease in all patients.
In this study, acarbose was the most effective agent followed by galactomannan and glucomannan in that order

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It is not easy to distinguish between primary and secondary diabetes mellitus, because secondary diabetes is sometimes provocated from primary one which represents basic disease. Secondary diabetes would develope various types of complication if it was untreated. It is therefore important to find and treat the primary disease as soon as possible. As to the management of diabetes, exercise and medical treatment are necessary. Management of secondary diabetes was discussed by presenting our own cases, which developed coma induced by pancreatic diabetes due to pancreatic cancer or pancreatolithiasis, endocrine diabetes due to acromegaly, hyperthyroidism, Cushing's syndrome and pheochromocytoma and drug induced diabetes due to thiazide and steroid hormons

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The evaluation of the insulin injection technique performed by diabetics, the effective-ness on diabetic control of the use of highly purified insulin preparation or continuous sub-cutaneous insulin injection method (CSII) and the clinical usefulness of the measurement of glycosilated hemoglobin(HbA₁)in insulin treated diabetics were studied.
There were many patients who had wrong technique, unsuitable choice of the site for injection and insufficient understanding of hypoglycemia. It must be necessary to re-educate the strict diabetic regimen repeatedly in order to increase the validity of insulin therapy.
The therapy with the highly purified insulin was an effective treatment for the patients with lipoatrophy or insulin resistance. CSII was useful for diabetic control in unstable diabetic patients, but it was difficult to last for long-term, because of its large apparatus. At present time, the divided inslulin injection method was more utilizable.
HbA₁ in insulin-treated diabetes was important index to manage the carbohydrate me-tabolism, since HbA₁ was less fluctuant than fasting blood glucose

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The object of managing obese diabetic person is reduction of the body weight to the ideal weight, because weight reduction leads diabetes mellitus in good control and prevents diabetic complications.
So we will describe the important points concerning dietary therapy derived from our investigation and experience.
The results are summarized as follows:
1. The treatment of obese diabetics needs long time.
The percentage of normalization of their body weight is increased in the group who were treated over ten years.
2. Reduction of body weight is based on poor calorie diet.
In order to treat for long time, it is necessary to take enough calorie to be able to live comfortably in their daily lives.
3. Most important things in performing dietary therapy precisely is to overcome the sensation of hunger.
So it is of importance to explain the patients the adaptation of hunger completely.
4. For obese diabetics, it is also important to come to hospital regularly to treat the obesity

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(A) Graphic demonstration of ideal body weight
The concept of standard body weight [SBW] is variable depending on the purpose for which SBW is to be used. For instance, the term “SBW”, is used for evaluating the business profit of a life insurance company, for making a physical improvement plan during food crisis or for taking a countermeasure against adult diseases. The assessment of body weight is also made possible either by measuring body height and skeletal structure or by calculating the ratio of body fat mass to total body weight.
In this report, we introduce a new graphic demonstration (nomogram) by which we can make a rough estimation of ideal body weight simply by measuring skin fold thickness (∑ skin fold)and the present body weight. The nomogram composed of two parts is also to be applied for considering countermeasures against adult diseases. One of these two parts will show us a normal upper limit of body weight (preventive ideal body weight) which indicates 20% and 30% of body fat mass for men and women respectively. The other one will similarly tell us a therapeutic ideal body weight which implies 15% and 25% of body fat mass for men and women, respectively. In clinical use, these nomograms are considered useful to determine a therapeutic weight loss in obese patients.
The principle of this method introduced here is that a newly reset body weight with an ideal body fat ratio can be estimated from body fat mass and lean body mass calculated by measuring the ratio of body fat (clinically obtained by skin f old) and the patient's pre-sent body weight.
(B) Report on our clinical experience and a resetting mechanism of body weight control In our clinical experience with the patients hospitalized at our institution, it was found difficult to treat female obese patients complicated with a variety of cardiovascular diseases by giving only a protein-rich, low calorie diet, even with a 100 calorie diet. However, a satisfactory result can be expected when those obese patients are placed regu-larly on light exercise which is tolerable even for the people with heart disease and repeated 6 times a day.
The patients treated with our method showed no loss of nutritional factor, and body weight loss was found entirely dependent on the reduction of body fat mass. In some cases in which an excellent therapeutic effect was observed, the ideal body weight has been well maintained for several years even without any particular efforts. These facts indicate that there exists a weight control mechanism which can be reset to a new level after an adequate therapy is given. It is recommended that this resetting mechanism should always be kept in mind for the treatment of obesity

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The relationship between diabetic angiopathy and blood sugar, cholesterol, triglycerides, blood pressure and diabetic family history were studied on 627 diabetic out-patients.
The incidence rate of persistent proteinuria and retinopathy were increased but incidence rate of macroangiopathy did not change with the duration of diabetes.
Those who have diabetes over 11 years were divided into two groups. I: those with vascular complications, II: those without vascular complications. In group I higher blood sugar, hypertensive and hypercholesterolemic patients were more frequent.
Patients with macroangiopathy showed increased incidence of hypertension, hypertri-glyceridemia and hypercholesterolemia and those with persistent proteinuria showed hyper-glycemia in addition to them. Those with retinopathy showed the same tendency but there was no difference in the incidence of hypertriglyceridemia.
When sex, family history, duration of diabetes, blood pressure, triglycerides and cho-esterol were matched, there was no relationship between macroangiopathy and blood sugar levels, but proteinuria and retinopathy were correlated with elevated blood sugar and blood pressure. There were no relationship between diabetic angiopathy and cholesterol, trigly-cerides, positive family history

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Investigation of serum growth hormone response to arginine infusion was undertaken in 24 hyperthyroid and in 18 primary hypothyroid patients.
Growth hormone response to oral glucose or TRH was undertaken in primary hypo-thyroidism.
In untreated hyperthyroidism, basal GH levels was within normal limits and subnormal GH response to arginine infusion were observed.
In untreated hypothyroidism, basal GH levels was within normal limits and low response to arginine infusion were observed. A paradoxical GH rise to oral glucose adminis-tration or TRH was not noted.
After treatment of thyroid dysfunction, GH response increased. There was no signifi-cant correlation between ΔGH and RT₃u, T₄

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A 23-yrs-old female was diagnosed as pseudohypoparathyroidism type I because of failure to respond to the administration of parathyroid hormone with increase of urinary excretion of phosphate and cyclic adenosine-3', 5'-monophosphate (cAMP).
At the same time she was diagnosed as primary hypothyroidism. She had short stature with rounded facies and short, stubby hands and toes. The serum parathyroid hormone level was substantially elevated. The serum calcium level was subnormal and the serum phosphate level was normal.
Recently there are some reports of pseudohypoparathyroidism with normocalcemia. They have the hypothesis that a decreased serum concentration of 1α, 25(OH)₂ D₃ may be causal of the hypocalcemia and variable expression of the apparent defect in Vitamin D₃ metabolism may underlie the normocalcemic variant of this disorder.
Although we did not measure the serum concentration of 1α. 25(OH)₂ D₃, we guess that normal production of 1α. 25(OH)₂ D₃ underlies in our case

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It is clinically common that serum sodium concentration remains rather constant. We have experienced three cases of three different types of abnormality of serum sodium concen-tration. These consist of a case of SIADH having 107mEq/l of serum sodium, a case of diabetes insipidus having 205mEq/l and a case of primary adrenal insufficiency associated with excessive secretion of ADH having varying serum sodium values from 109 to 176mEq/l.
Serum electrolyte concentration tends to easily change under some endoclinologically abnormal conditions and it was also shown that abnormal secretion of ADH was responsible for the change of serum sodium concentration

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Hemoglobin A₁ concentration (percentage) was measured in 14 cases with diabetes mellitus, 12 cases with liver diseases with abnormal glucose tolerance i. e. 3 cases with chronic hepatitis, 8 cases with liver cirrhosis and a case with liver cirrhosis with hepatoma, and 15 cases with liver diseases with normal glucose tolerance i. e. 11 cases with chronic hepatitis, 3 cases with liver cirrhosis and a case with liver cirrhosis with hepatoma, and totaled 41 cases. Correlationship was evaluated among hemoglobin A₁ percentage and the blood sugar concentration after 50g of glucose loading, and varous non-specific liver function tests.
Hemoglobin A₁ concentration was as follows; the group of diabetes mellitus>the group of liver diseases with abnormal glucose tolerance>the group of liver diseases with normal glucose tolerance. And the statistical significance was found between not only the group of diabetes mellitus and the group of liver diseases with abnormal glucose tolerance but also the group of diabetes mellitus and the group of liver diseases with normal glucose toler-ance. There were no statistical correlationship among the hemoglobin A₁ percentage and non-specific liver function tests. Measurement of hemoglobin A₁ in liver diseases was the good method to reveal the abnormality of glucose metabolism

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It is well known fact that patients with pheochromocytoma are liable to develop severe circulatory difficulties particularly during operation, because of its excessive secretion of cathecholamine.
The Swan-Ganz catheter was attempted to be used for cardiovascular management in a patient having operative removal of bilateral pheochromocytoma.
The patient was 45-years-old woman with bilateral adrenal pheochromocytoma and cholecystolithiasis. Removal of the tumor with bilateral adrenalectomy and cholecystectomy were undertaken.
Twenty days prior to the operation, oral administration of Prazocin started with an initial dose of 1.5mg increasing up to 3.0mg. The blood volume measured 72.4ml/kg 5 days after the medication. During the medication, increased blood volume was suggested by weight gain and reduction of hematocrit value. Before anaesthesia, a Swan-Ganz catheter was introduced from the right antecubital vein to record pulmonary capillary wedge pressure, cardiac output and systemic vascular resistance.
During removal of the left tumor, the blood pressure rose to 240/150 torr, and sodium nitroprusside infusion started and increased up to 9 μg/kg/min. Although systemic vascular resistance was decreased, the blood pressure remained high and the cardiac index rose to 5.13. The hypertension was considered to be due to hyperdynamic state of the heart, and the blood pressure reduced to 150/100 torr by the administration of Propranolol. After removal of the left tumor, the laboratory data were almost within normal limits as follows; blood pressure of 116/88 torr, heart rate of 90/min, central venous pressure of 15 torn, and pulmorary capillary wedge pressure of 13 torr, except for cardiac index of 1.36 which was markedly depressed. The depression of cardiac index was considered to be due to myocardial depression, and dopamine started at the rate of 3-10μg/kg/min, which normalized cardiac index. Following the operation, the Swan-Ganz catheter was also used for cardiovascular management, and the patient's postoperative course was benign.
We confirmed the usefulness of the Swan-Ganz catheter in close pharmacological control of cardiovascular state particularly during removal of pheochromocytoma

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