Vascular complication, especially CVD, is the most serious problem in diabetes mellitus of old persons in Japan. Because of lack of ample data in this field, we attempted to find clinical as well as pathological features of complicating CVD in diabetes. For the purpose of this study, 25 male and 26 female diabetic subjects were selected at random from the autopsied series at the Yokufukai Geriatric Hospital as well as 30 non-diabetic male and 98 non-diabetic female subjects who served as controls. The mean age and its standard deviation was almost the same in each group. 1. Vascular lesions were classified into three types according to their size, location, and clinical manifestation: large or fatal, medium-sized or non-fatal with clinical manifestations and small without clinical signs. Fatal cerebral hemorrhage was observed exclusively in the non-diabetic female patients. Incidence of medium-sized and small hemorrhage was almost the same in the diabetic and non-diabetic groups. 2. Fatal cerebral infarction was almost equally found in the diabetic and non-diabetic persons. The incidence of medium-sized, small, or multiple infarction was significantly higher in the diabetic than in the non-diabetic group. 3. Of normotensive subjects, cerebral hemorrhage was more common in the diabetic than in the non- diabetic. In hypertensive subjects, fatal hemorrhage was significantly more frequent in the non-diabetic. 4. Medium-sized, small, or multiple infarction was significantly more frequent in the hypertensive diabetic than in the hypertensive non-diabetic patients. In normotensive cases, the incidence of these types of infarction was found equally in the diabetic and in the non-diabetic. The incidence of severe cerebral atherosclerosos and medium-sized, small or multiple infarctions was highest in these subjects having a combination of diabetes, hypertension, and hypercholesterolemia. 5. Incidence of hemiplegia, pseudobulbar palsy, and/or dementia, was significantly higher in the diabetic than in the non-diabetic. Motor restoration of CVD patients with diabetes was significantly poorer than that of the non-diabetic persons.
The marked amelioration in the intensity of diabetes mellitus has been frequently reported in young patients. However, little is known about the mechanism of this process. In order to throw light on this matter, serum insulin and glucose responses to various stimuli have been investigated in two juvenile diabetics with ketosis just before initiation of the therapy and six months or more after discontinuation of insulin injection. No elevation of serum insulin level was observed either after an intravenous administration of 25 g glucose plus 1 mg glucagon in one case or during an oral glucose tolerance test in another in a stage of ketosis. On the contrary, these patients showed the normal or slightly impaired insulin responses in magnitude as well as in pattern during a remission of this disease which was attained after the insulin therapy for several months in both cases. These results indicate that unresponsiveness of β-cell to the potent stimuli resulting in severe diabetes mellitus with ketosis is reversible in some cases. In addition, they suggest a close relationship between the improvement of the disturbed glucose metabolism and the restoration of responsiveness of β-cell to the stimuli.