The aim of the present study was to investigate the exocrine pancreatic function in 74 diabetics. For this purpose, BT-PABA (Pancreatic Function Diagnostant Test: PFD Test) soft tablets were given to the diabetic patients. The exocrine pancreatic function was assessed with special reference to the duration of diabetes. differences in therapy, and stage of diabetic retinopathy.
1) The recovery of PABA in 24 normal subjects was 74.9±9.7%, while that in diabetics was significantly lower than this value (p<0.001).
2) The recovery of PABA in patients who had suffered from diabetes for over 5 years was 42.5±20.3%, which was significantly lower than the values for other subgroups.
3) The recovery of PABA was 53.5±43.6% in the group with fasting glucose levels of 80-140mg/dl, and 50.10±21, 5% in the group with fasting glucose levels of more than 140 mg/dl. This difference was not statistically significant.
4) The recovery of PABA was 58.5±21.7% in diabetics who were on dietary therapy alone, 55.1±29.6% in those receiving oral hypoglycemic agents, and 46.9±21.0% in those on insulin therapy The value in the insulin therapy group wassignificantly lower than those in the other two groups.
5) The exocrine pancreatic function in the diabetics as determined by the PFD test tended to decrease as the stage of diabetic retinopathy progressed.
In conclusion, it can be said that the PFD test is useful for detecting the exocrine pancreatic dysfunctions associated with diabetes mellitus.

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The detailed effects of anti-insulin hormones in relation to insulin requirements have not yet been elucidated. The aim of the present study was to clarify the relationship between insulin requirements and diurnal changes of anti-insulin hormones. The patients comprised 18 diabetics in cluding 8 IDDM and 10 NIDDM. The blood glucose levels of the patients were normalized with an artificial endocrine pancreas (Biostator®) and blood samples were taken before each meal to measure the levels of plasma cortisol and serum growth hormone. Each meal was of identical size and composition (25-30 kcal/kg/day).
The results obtained were as follows.
(1) The insulin requirements after breakfast were significantly high (21±9 U) as compared to those after lunch (11±7U) and after supper (12±5 U)(p<0.01).
(2) The plasma cortisol levels before breakfast were significantly higher (137±40 ng/ml) than those before lunch (102±38 ng/ml, p<0.02) and before supper (81±38 ng/ml, p<0.001). However, in the case of the serum growth hormone levels, no significant differences were observed.
It was found therefore that the circadian rhythm of cortisol could affect the insulin requirements, indicating that much attention should be paid to the cortisol levels and caloric intake, especiallythe ratio of breakfast to total daily intake. We suggest that the percentage of insulin dosage in the morning should be raised when determining the insulin regimen.

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Plasma human pancreatic polypeptide (hPP) responses to test meal stimulation were studied in 42 diabetic patients (21 juvenile-onset type, JOD; 21 maturity-onset type, MOD) and age-matched normal controls (17 younger group; 8 older group).
The following results were obtained.
(1) A similar biphasic hPP secreting pattern was found in both the normal young and old control subjects, although the older group revealed a more significant hPP hyperresponse (p<0.05) than did the younger group. The integrated hPP responses to the test meal during 2 hr were correlated with age (p<0.05).
(2) Various hPP secreting patterns were found in the diabetic patients. Although the secreting patterns in JOD gradually altered with the duration of the disease changing to lower responses and a monophasic pattern, a biphasic hypersecreting pattern was observed even at the onset or early stage of JOD before insulin treatment. Three unstable type JOD patients with a duration of 6 to 12 years showed no hPP response to the test meal stimulation. A biphasic pattern similar to that of normal controls was noted in non-insulin-treated MOD. On the other hand, a delayed response of the first phase was observed in insulin-treated MOD, and a typical monophasic pattern which almost abolished the first phase of the hPP response was observed in MOD with diabetic neuropathy.
These results suggest that the abnormal hPP responses to test meal load were affected mainly by disorders of the neural regulatory system of diabetes as well as by the duration and insulin treatment of the subject's diabetes.

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The components of the HbA_I fraction were determined by high-performance liquid chromatography using both phosphate buffers with pH 6.65 and pH 6.45 without containing KCN. The HbA_Ia+b and HbA_Ic components were expressed as percentages of the total Hb.
The HbAic component occupied a greater part of the HbA_I in diabetic patients than in normal subjects. Although patients with renal failure showed higher HbA_I values, no difference in the ratio of the components in HbA_I. was noted between these patients and normal subjects. Determinations of the HbA_I components of young and old erythrocytes indicated that HbA_Ic component occupied a greater part of the HbA_I in old than in young erythrocytes. Quantification of the HbA_I content revealed that the HbA_I fraction fluctuated rapidly through rapid change of blood glucose concentration and it was mainly HbA_Ic component.
The above results sggest that determinations of HbAi components should be carried out in various pathophysiological conditions.

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It has been reported that fasting, especially depletion of carbohydrate intake, induces a low triiodothyronine (T₃) syndrome and that this low serum T₃ is the outcome of decreased conversion of thyroxine (T₄) to T₃ in the peripheral tissues. In the present study, the levels of serum T₃, T₄, reverse triiodothyronine (rT₃), and thyrotropin (TSH) and their changes during the clinical course of treatment of ketoacidosis (KA) in three female insulin-dependent diabetics were investigated, since the body is assumed to be under carbohydrate hunger in diabetic KA due to absolute insulin deficiency.
(1) In the KA state of the three cases (Case 1, 21 yrs; Case 2, 27 yrs; Case 3, 18 yrs, associated with chronic focal thyroiditis), extremely low levels of serum T3 of 34-35, 19-38, and 56-64 ng/dl (normal, 89-177), respectively, and low T4 concentrations of 3.5-4.0, 2.3-4.2, and 4.7-5.9 μg/dl (normal, 5.4-12.6), respectively, and slightly high rT₃ values of 20.5-22.8, 48.0-45.7, and 45.6-48.5 ng/dl (normal 15.4-38.2), respectively, were observed. Within one day after the disappearance of KA following treatment of low dose insulin, fluid, and electrolytes, these abnormalities in serum T₃, T₄, and rT₃ concentration still remained within almost the same ranges as those in the KA, although they tended slightly towards normal values.
(2) After 3 to 7 weeks of sustained good control (GC) of the diabetic state with insulin, all the abnormalities in T₃, T₄, and rT₃ in the cases disappeared and the values remained within normal limits.
(3) On the other hand, the levels of basal serum TSH were within the normal range in all diabetic states in all cases, and the TSH responses to TRH (500 μg, iv) in the GC state were also normal, except for a slightly exaggerated one in Case 3.
These results indicate that, during the diabetic KA and soon after improvement of the KA with treatment, there were markedly low T₃, low T₄, slightly high rT₃, and normal basal TSH values, and that these abnormalities were ameliorated in the GC state. Decrease in secretion and/or synthesis of hormones in the thyroid per se, probably concomitant with a temporary shift of the hypothalamic-pituitary axis, rather than decreased conversion of T₄ to T₃, may contribute to this phenomenon.

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In the diagnosis of insulinoma, several methods have been employed to stimulate B-cells. However, such tests sometimes showed false-positive or false-negative results, and often caused profound hypoglycemia. Theoretically, it should be possible for autonomous hyperfunction of endocrine adenoma or cancer to be easily diagnosed by suppression tests. As suppression tests, IRI determinations after fish insulin injection and CPR determinations after intravenous injection of porcine insulin have been described. However, these methods require the use of special insulin preparations or a special infusion pump.
This report describes the results of an insulin suppression test using CPR as a marker of the endogenous insulin secretion after intramuscular injection of porcine insulin (0.2 U/kg). In 8 healthy volunteers, the serum CPR decreased in response to hypoglycemia but in 4 patients with benign insulinoma the serum CPR levels were abnormally high even when hypoglycemia was induced. After excision of the insulinoma, their CPR was suppressed to that of normal subjects. During the tests, no patient showed profound hypoglycemic symptoms probably due to the slow induction of hypoglycemia.
The insulin suppression test may represent a reliable test for the diagnosis of insulinoma.

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Diabetes mellitus is known to be a risk factor for coronary atherosclerosis. However, the relation among such factors as the type of coronary atherosclerosis defined by coronary arteriography, the severity of impaired glucose tolerance and other risk factors, has not yet been established In the present study, the relation among coronary risk factors was analyzed in patients with myocardial infarction as a typical ischemic heart disease.
1) The subjects comprised 102 patients (mean age, 54 years) with myocardial infarction, who revealed significant changes on their coronary arteriograms, and 90 healthy adults were used as controls for the coronary risk factors.
2) Three groups were distinguished according to the number of involved vessels. The OGTT curves were the same in all the groups. The border-line type amounted to 55% and diabetic type to 27%, indicating a high incidence of impaired glucose tolerance. Clinical diabetes was diagnosed in 10% of the patients of each group, all of which were mild cases of diabetes mellitus. The incidence of the diabetic type was significantly higher in the age group over 50 and increased with aging compared to the controls. The coroary atherosclerosis was classified as a segmental lesion or a diffuse lesion, and a comparison was made between these two groups as regards glucose tolerance. No difference was noted between theme. The frequency of the coronary risk factors was found to be higher in the patients, especially those who had myocardial infarction with multiple vessel involvement: smoking habit (62%), hypertension (49%), hypercholesterolemia (32%), obesity (29%), and diabetic type OGTT (28%).
3) The patient group with one vessel involvement in myocardial infarction was found to be the only group showing a significant correlation between impairment of glucose tolerance and thecoronary obstructive lesions based on statistical analysis by regression coefficient evaluation.

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Two cases of diabetes mellitus with renal and retinal involvement developed acute renal failure after undergoing head computerized tomography. The first case was a 62-year-old male who had been diagnosed as having diabetes 25 years before. He had diabetic retinopathy of Scott IIIb. Before head computerized tomography, the serum BUN was 37 mg/dl, and creatinine was 4.1 mg/dl. Oliguria began immediately after the scanning and continued for 48 hr. The serum levels of BUN and creatinine rose to 106 and 7.7 mg/dl, respectively. Case 2 was a 49-year-old male who had been diagnosed as having diabetes 15 years before. He showed Scott IIb and IV retinopathy. The BUN and creatinine levels in the serum were 32 and 2.3 mg/dl, respectively. After receiving head computerized tomography, he developed oliguria and remained oliguric for 48 hr. During that period, the serum levels of BUN and creatinin were elevated to 112 and 7.5mg/dl, respectively. Fortunately, both of these patients recovered from the oliguria without resorting to hemodialysis. The iodine contrast medium routinely used for contrast enhancement in the head computerized tomography was implicated in the acute renal failure of these patients.
Only elevn cases have so far been reported in the literature who developed acute renal failure following computerized tomography. In view of the three or four times greater dosis of iodine contrast medium employed in computerized tomography compared to intravenous pyelography, the acute incidence of such complications might be much higher. Among the thirteen cases including the two reported here, as many as eight were diabetic. It is well recognized that the incidence of acute renal failure after intravenous pyelography is particularly high in cases of diabetic nephropathy. Head computerized tomography using iodine contrast media in cases of diabetic nephropathy should therefore be performed with utmost caution.

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