Prednisolone glucose tolerance test (PGTT) and intravenous tolbutamide test were carried out in oxyhyperglycemic patients who were proved to have no history of gastrectomy, endocrine disorders, or liver diseases. Simultaneously, the shift of the serum IRI response or glucose tolerance through prednisolone loading were also examined with special reference to the relationship between oxyhyperglycemia and diabetes mellitus. Eighty-five oxyhyperglycemic cases without gastrectomy were selected for this study. 1) Of 65 cases of oxyhyperglycemia 40 cases (61.5%) showed positive PGTT. 2) The average rate in the initial fall of blood glucose after tolbutamide infusion showed an intermediate value of normal persons and clinical diabetics, but the response was very similar to that found in the probable diabetics or chemical diabetics who showed normal fasting blood glucose level. In fact, of 17 subjects 5 cases showed the diabetic pattern in Unger-Madison's criteria. 3) Of 29 subjects of oxyhyperglycemia 3 cases were found to be nondiabetic, while, 10 cases were probable diabetic and other 2 cases were diabetic in GTT examined a year later. 4) Although many cases of oxyhyperglycemia without gastrectomy (20 out of 30 cases) showed high IRI response more than 100 μU/ml after glucose load, the initial rise of IRI at 30 minutes was less as compared to maximum, besides, the time required for reaching maximum and that required for restoring were tended to have delayed as compared to the cases with gastrectomy. Therefore, the average IRI response curve was very similar to that observed in the probable diabetics. 5) The effect of prednisolone on the serum IRI response was not observed during PGTT in the group, of 10 cases with negative PGTT, however, a marked diminution in the initial rise of serum IRI was observed with prednisolone and made the IRI curve similar to that found in the cases of chemical diabetes during GTT in the group of 14 cases with positive PGTT. 6) It was concluded from these results that the oxyhyperglycemia without gastrectomy was different in nature from that with gastrectomy because the former was considered to be a type of abnormalities appeared at the early stage of primary diabetics.
Relationships of the Serum ILA in 103 diabeticpatients to their clinical manifestations were studied. The serum ILA was measured by glucose uptake of rat epididymal fat pad. Serum samples were obtained at fasting, one two and three hours following oral administration of 100 g glucose. Results were as follows: 1) In 6 healthy people chosen as controls, the serum ILA ranged from 125 to 217μU/ml at fasting, and from 324 to 722μU/ml after glucose administration. In diabetics, the serum ILA levels varied widely, ranging from 37 to 538μU/ml at fasting and from 37 to 1980 μU/ml after glucose administration. 2) The mean fasting ILA levels in diabetics were higher than in normal subjects. Elevation of the fasting ILA was observed more clearly in mild diabetic patients than in severe patients. 3) There was a significant correlation between ΔILA (difference between the ILA at fasting and the ILA one hour after glucose loading) and glucose tolerance in diabetic patients. The ΔILA values were higher in mild diabetics than in severe cases. 4) The ΔILA values of diabetics were significantly greater in obese, tolbutamide-responsive cases and those patients under good control of the diabetes. 5) The ΔILA values were lower in the patients with diabetic retinopathy severer than grade III. However, ΔILA values were not different between the patients with mild retinopathy and those without retinopathy. 6) Juvenile diabetics and the patients with abnormal liver function had lower ΔILA values. 7) Although there was some relationship between the glucose tolerance test and the fasting ILA levels, there was no significant correlation of the fasting ILA levels to other clinical manifestations of diabetes. These results indicate that the change of serum ILA after glucose administration is the better parameter than the fasting ILA for the evaluation of the diabetic state.
Case 1: A female of 34 years old was diagnosed as diabetes at 27 years old. Her length was 130cm, body weight 30kg and I.Q. 50. Since 2 years, diabetes was controlled with Rapitard insulin 20U. per day. As the results, her body weight was increased. Case 2: A female of 56 years old was diagnosed as diabetes at 54 years old. Her length was 125cm, body weight 42kg, I.Q. 60. Retinopathy: Wagener 3 type. Diabetes was well cotrolled with Tolbutamide 1.5g per day. The lack of growth hormone which have the insulotrophic action, may induce the weak development of the islet which lead the insufficiency of the insulin secretion by some moments.
Authors have experienced a typical patient with hyperosmolar nonketotic diabetic coma, traced his clinical course and laboratory findings in details, and discussed the pathogenesis of this disorders. This patient showed neither ketosis nor acidosis although did markedly hyperglycemic and comatous state. Hyperosmolarity with hypernatremia of this patient was restored rapidly by administering large amount of regular insulin and infusion of saline and 5% of xylitol solution. The findings that serum ketone bodies, free fatty acids and other lipids were not so elevated suggested some mechanism of suppressed lipid mobilization in this disease.
In Europe and the United States, many observations have been published concerning histopathological changes of the cutaneous small blood vessels in diabetics, also many reports noted that the extensive arterial calcification in the lower extremities of diabetics. However, in Japan there have been only a few publications concerning the vascular alterations of the skin and the calcification of arteries in the extremities in diabetics. In this study the skin specimens obtained by a punch method from the calves of 157 diabetic and 176 nondiabetic subjects were examined by light microscopy, and the legs of 113 diabetics and 115 non-diabetics were examined roentgenorgraphically for finding the deposition of calcium in the arterial walls. The results in this study were as follows: 1) Significant thickening of the skin vessel walls by the PAS-positive substance was found in 41% of the diabetics and in 12% of the non-diabetics. The difference in the two groups was statistically significant (p<0.01). 2) Calcification of the arteries was found in 26% of the diabetics and in 7% of the non-diabetics. The differrence in the two groups was statistically significant (p<0.01). 3) There was a positive correlation between the degree of the PAS-positive thickening of the skin vessel walls and the severity of diabetic retinopathy, while there was no correlation between the calcification of the arteries and the severity of diabetic retinopathy. 4) In the diabetics, the degree of the PAS-positive thickening of the vessel walls showed no correlation with the sex or the age, while the arterial calcification was seen more frequently in the older subjects. 5) In the diabetics, no correlation was found between the degree of the PAS-positive thickening of the skin vessel walls and the calcification of the arteries of the lower extremities.