[in Japanese]

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[in Japanese]

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[in Japanese]

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The optimum solution of tight glycemic control (TGC) in critically ill patients has not been clarified yet. In 2001, the first Leuven study showed the breakthrough outcomes of intensive insulin therapy (IIT) for adult critically ill patients, but none could demonstrate the efficiency of IIT despite having implemented a series of replication researches. The root causes are considered to having been the inevitable uncertainty of protocol-driven glycemic control with the idiosyncratic nutrition management (overfeeding) inherent in the first Leuven study but not the theoretical flaw of IIT. The academic debates over the pros and cons of IIT eventually uncovered the harmful effects of early full feeding under critical illnesses, leading to an innovative change of the nutritional guidelines as well. Now that computer-guided glycemic control is easily feasible with promoting rationalization of nutrition administration, we can open a new chapter toward unveiling the optimal TGC.

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[in Japanese]

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A man in his 70s underwent pancreaticoduodenectomy due to pancreatic head cancer six years ago. He received S‐1 for 1 year as postoperative adjuvant chemotherapy. A right lung tumor was found four years later. He underwent partial resection of the right lung by video‐assisted thoracic surgery for suspected primary or metastatic lung cancer. He was diagnosed postoperatively with lung metastasis of pancreatic cancer. He was administered S‐1 again, but his compliance was poor. He underwent partial resection of the right lung by video‐assisted thoracic surgery due to pneumothorax the following year. A sudden increase in his serum CA19‐9 level was noted in April six years later. Although no abnormality was observed on plain or contrast‐enhanced CT imaging of the chest and abdomen, he received single‐agent chemotherapy with gemcitabine in July of the same year under the strong suspicion of pancreatic cancer recurrence. Following his complaint of thirst during chemotherapy, laboratory tests revealed hyperglycemia, indicated by markedly high levels of glucose at 510 mg/dL and HbA1c at 14.3％．After he was hospitalized for diabetes mellitus and received intensive insulin therapy, his serum CA19‐9 level immediately normalized. Hyperglycemia is a known cause of high serum CA19‐9, but CA19‐9 may also increase due to secondary diabetes following pancreatectomy. However, six years had passed since the operation, and his blood glucose and HbA1c levels had not been measured recently. This case highlighted the importance of maintaining the continuity of blood glucose management after pancreaticoduodenectomy．

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