Since Jordan (1936) described a case of Charcot joint in diabetic neuropathy, at least 40 authors have reported a total of about 100 cases of this rare complication of diabetes. This paper reports an additional typical case of Charcot joint of a male Japanese diabetic patient. This 38 year old clerk is known to have diabetes for 9 years, and has been left in the poor control of diabetes for the first several years. He was diagnosed diabetic gastroenteropathy because of longstanding severe diarrhea which induced an episode of precoma in the past. He noticed the swelling of left ankle and was diagnosed Charcot joint 3 years ago. The clinical manifestations, etiological analysis and treatment of this case were compared with those of the reported cases in the literature.
A new carbohydrate solution, Trelan 050, was administered to the two groups of experimental subjects (normal and borderline cases after OGTT), which were divided at randomly, in dosescorresponding to 50g of glucoses in order to investigate the changes in blood suger, plasma insulin and non-esterified fatty acid level. Results were obtained as follows: (1) The two groups were thought to be comparable in age, sex and obesity. (2) No signifficant difference between the two groups was observed in the levels of blood suger, plasma insulin and non-esterified fatty acid.
Schlichtkrull and his co-worker (1965) introduced the M-value for the evaluation of bloodsugar control in diabetic patients treated with insulin. Their table of MBSBS was made for theblood sugar value determined by the method of Hagedorn and Jensen and this table is not used for the true blood sugar value. In this report, a new table of MBSBS is proposed so that it can be applied for the value obtained by the true blood sugar method such as glucose-oxidase method. The table was calculated by the following formula. MBS/BS=10×logBS/1003 Namely, the new table was made on the premise that the ideal blood sugar is 100 mg/dl. The tables were also made if the ideal blood sugar was 90 or 110 mg/dl i. e., the denominator was 90 or 110. The comparison of these MBSBS tables revealed that the M-value becomes greater if the denominator becomes smaller. Hence, the M-value would be different if the table of Schlichtkrull et al. or the new table is used. To compare this difference, the M-value was calculated in the two ways, 1) by the new table (M1), 2) by the table of Schlichtkrull et al., but the value was read at the 20 mg/dl-high corresponding value (M2). These two procedure were applied for 287 diurnal blood sugar curves of 44 diabetic inpatients, in which the blood sugar estimation was made at 7 a.m., 9 a.m., 11 a.m., 2 p.m., 4: 30 p.m., 7 p.m. and 10 p.m. The result showed that M1-value was always greater than M2-value and the following relationship was obtained by the regression analysis. Y (M1) =1.36X (M2)-0.64 Schlichtkrull et al. defined the criteria of the blood sugar control as good in the group having the M-value≤18, fair with 19-31, and poor with≥32. These values must be changed as good with≤24, fair with 25-42, and poor with≥43, when the new table is used.
The result of the treatment of diabetic patients was analysed by the diurnal blood sugar curve. One hundred ninty six hospitalized patients with primary diabetes were selected in this study and the diurnal blood sugar curve was observed with an internal of two to three weeks. The blood specimens were obtained by antecubital venipuncture for blood sugar determinations prior to and two hours after each meal. The control of the blood sugar was evaluated by mean of the M-value proposed by Schlichtkrull and his co-workers. The revised table of MBSBS was used in this study. The analysis of the relation between the diurnal blood sugar curve of the pre-treatment period and the final treatment revealed that the cases with a M-value over 30 needed insulin or oral hypoglycemic drugs, 85 percent of the cases with a M-value over 50 needed insulin injection, and if it was over 100, all cases needed insulin. The cases with an initial M-value less than 40, were in a good control at the discharge and a poor control state was seen only in the cases with an initial M-value over 100. The final state of the blood sugar control was compared with the fasting blood sugar (FBS) of the pretreatment period. The cases with an inital FBS less than 150 mg/dl had a good control after the treatment and 11 percent of the cases with the FBS over 250 mg/dl remained in a poor control state at the discharge. The poor control cases were observed in 5 percent of the cases treated with oral hypoglycemic drugs and in 18 percent of the cases treated with insulin.
Relationship between glucose tolerance and degree of obesity was studied in 924 subjects (694 male, 234 female) who received a medical close examination. Evaluation of 50 g of oral glucose torelance test was carried out according to the criteria suggested by the Japan Diabetic Society. The following findings were obtained. 1) Subjects who showed a normal, borderline and diabetic types of glucose tolerance curvewere 31.2, 57.1 and 11.8 % of the total subjects, respectively. There was little difference in the distribution between both sexes. 2) In both sexes, number of subjects showing a diabetic curves increase, whereas that of those showing a normal curve decrease with advance of age. 3) Among the individuals who were between 40 and 59 year old, those who were classifiedas diabetic type had a significantly greater degree of obesity than those who belong to the other two types. This findings suggests that obesity may play a primary role in etiology of diabetes mellitus only among the people with these ages. 4) On the contrary, in groups of individuals who were either under 40 or above 60 year old, there was no significant difference in degree of obesity among the three types. This observations indicates that factors other than obesity may contribute more greatly to the genesis of diabetes mellitus among the persons with these ages. 5) Individuals with family histories of diabetes had a higher frequency in the diabetic type and lower frequency in the normal type. However, there was no correlation between these frequencies and degree of obesity. 6) Likewise, in subjects with hypertension, the frequency of the diabetic type was higher and that of the normal type lower than the average values. Furthermore, hypertensive persons who were classified as the diabetic or the borderline types showed a significantly greater degree of obesity than that of the normal type.
In our previous reports 2 cases with insulin-autoimmune syndrome showed severe hypoglycemic attacks. This paper deals with another case with insulin-autoimmune phenomenon. The third case was a 67-year-old female showing a mild hypoglycemic symptom and a diabetic pattern in the glucose tolerance test. She was admitted as a diabetic patient in May, 1971. No insulinoma was suggested because her hypoglycemic symptom was so mild. Existence of insulin-binding antibodies in the serum was proved with a gel filtration method which separated 131I-insulin-antibody complex from free 131-insulin. Also, 125I-insulin-antibody complex was precipitated with anti-IgG serum. The binding capacity of the antibodies of the third case with human insulin seemed stronger than with pork insulin, whereas the serum proteins of other patients treated with exogenous insulin bound with pork insulin much strongly than with human insulin. The fasting serum insulin level of this case increased about 100 times of the normal concentration of insulin, and it increased significantly after glucose administration. The extracted insulin from her serum showed the immunological characteristics of human insulin or pork insulin, but not of beef insulin, in the systems of radioimmunoassay of insulin.