Six brothers and sisters whose parents were diabetics were studied from the view points of glucose metabolism and ophthalmoscopic examinations including fluorescein fundus photography.
The followings are the results of the present investigation.
1) Results of 100 g oral glucose tolerance test showed that two of them were diabetic and four were borderline hyperglycemic. The response of serum IRI was low in cases with diabetic glucose tolerance curve, but there was no significant difference of serum IRI between in the borderline group and in the control group who had neither abnormal glucose tolerance nor family disposition of diabetes including obesity. The level of NEFA at fasting state was higher in all cases than that of normal control group, but the pattern of falling level of NEFA after glucose loading was similar to that of normal group except one case. There was no significant difference of the value of NEFA at fasting state in comparision with that of group who had similar glucose tolerance but had no family history of diabetes.
2) None of them had abnormal Ophthalmological findings through opthalmoscopic examination and photography by fundus camera, but abnormal fluorescent dots suggestive of pathological change of capillary bed were found in all by fluorescein fundus photography.

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A simple assay method was developed to detect for insulin antibody. Small and uniform size of biologically inert polyaminostyrene was combined chemically with insulin through diazo-coupling, and polyazostyrene insulin (PAI) particles were produced under various conditions changing the weight ratios of insulin to polyaminostyrene. 1 g of PAI particles of No.1 to No.4 contained 31.1, 45.2, 46.5 and 49.5 mg of insulin, respectively. The PAI particles with the highest amount of insulin proved to have immunologic reactivity very similar to that of crystalline insulin. As a polyantigen in latex method, the PAI particles were easily linked together with insulin antibody to form visible aggregates in two hours on an immunoplate.
The validity of this latex method was studied by comparing with the results of two conventional assay methods for insulin antibody, i. e. radioelectrophoretic and ethanol precipitation method. 21 insulin treated diabetics in our Diabetes Clinic were selected and their insulin antibody titers in sera were measured by the above three methods. The subjects having insulin binding capacities over 25 u./l. serum by electrophoretic method and insulin antibody titers over 65% by ethanol precipitation method showed positive PAI agglutination test.
But the subjects having insulin binding capacities of 10 u./l. serum showed either positive or negative in PAI test.
It was shown that this PAI agglutination test was simple and accurate method and had practical value on the estimation of insulin antibody in sera of insulin treated diabetics.

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Achilles tendon reflex (ATR) was recorded in 86 diabetic patients by a modified Lawson's electromagnetic method described in the previous paper. The recorded ATR curves were investigated in comparison with those in healthy subjects of corresponding sex and age groups and in relation to the clinical states.
1) According to the prolongation of ATR time (repaesented by SD-interval of the curve) and to the diminishing of M-value (the ratio of contraction height to tapping height), the patients were grouped as follows.
A. ATR time normal: 28 cases (33%).
i. with normal M-value: 20 cases.
ii. with lowered M-valne: 8 cases.
B. ATR time moderately prolonged: 20 cases (23%).
i. with normal M-value: 3 cases.
ii. with lowered M-value: 17 cases.
C. ATR time markedly prolonged: 12 cases (14%).
i. with normal M-value: 5 cases.
ii. with lowered M-value: 7- cases.
D. Areflexia: 26 cases (30%).
i. relaxed type: 14 cases.
ii. rigid type: 12 cases.
2) Based on the previous observations in the healthy subjects, the following conclusions were drawn on diabetics:
a) In general, the SD-interval was prolonged in both sexes, and it was related to the duration of the disease.
b) Diminished amplitude ratio was found in both sexes and especially frequently in the groups of prolonged ATR time with longer duration of the disease.
c) Areflexia was found more than three times as frequently as in normals, and it seemed to be related to the duration of the disease, hyperglycemia, hypercholesterolemia, degenerative complications and poor control. But there were no differences between relaxed type and rigid type of areflexia clinically.
d) Abnormal ATR was improved to some extent by appropriate therapy.
e) The electromyographic abnormalities were found in all of 15 diabetics. It is thought at present that the diminution of ATR showed neurogenic pattern and the prolongation of ATR showed myogenic pattern mainly.
3) The prolongation of SD-interval was caused by the prolongation of reflex latency and contraction phase, but for the most part by the latter which corresponds to the muscle dysfunction considerably. The prolongation of reflex latency was considered to be in agreement with the decrease in nerve conduction velocity reported in literatures.
4) It is assumed that the abnormal ATR in diabetics demonstrates not only diabetic neuropathy but diabetic myopathy.

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A case of hyperosmolar nonketotic diabetic coma in 18 years old man with no history of diabetes mellitus was described.
Laboratory data: blood glucose 1, 320 mg. per 100 ml; serum sodium 140, potassium 6.9, calcium 3.7 mEq. per liter ; NPN 91.4 mg. per 100 ml ; total cholesterol97 mg per 100 ml ester ratio 46.4%; GOT 46 U, GPT 26U ; Amylase in serum 8 U, in urine 4 U; total protein 9.5 g per 100 ml ; alb. 46.1%, gamma-gl. 22.3%; urine: protein 2+, sugar 4+, no ketones. Estimate gave a value of 382 milliosmoles per liter.
In this syndrome it is unusual that he was a young man and had no hypernatremia. He had, however, extreme hyperglycemia and hyperosmolarity, further no ketones in urine and low serum cholesterol level. He died from diabetic coma, circulatory disturbance and hemorrhagic diathesis on the 7th day in hospital.
In autopsy pancreas was small and islands were found small in number, and about them it seemed to be congenital anomaly. Kidney had only a little pathological change. In liver markedly fatty degeneration was found. In our case the finding of fatty liver with hypocholesterolemia was of interested from the view point of nonketotic state and fatty metabolism.

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