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Volume 34, Issue 10
Displaying 1-12 of 12 articles from this issue
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Hiroki Yokoyama, Toshika Otani, Tadasu Kasahara, Masae Minami, Yasuko ...1991 Volume 34 Issue 10 Pages 849-855
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSIn order to clarify the time-course of insulin dependence and to evaluate the diagnostic criteria for insulin-dependent diabetes mellitus, changes of insulin dependence were followed up in non-obese patients with diabetes diagnosed under the age of 30 years. The basal C-peptide (B-CPR; ng/ml) and the insulin dose (I-dose; U/kg) were followed up at 1 month, 6 months, 1 year, 2 years, and 3 years after diagnosis, and each patient was classified at each observation as follows: Class A, B-CPR≤0.6 and I-dose≥0.5; Class B, B-CPR≤0.6 and I-dose<0.5; Class C, B-CPR>0.6 and 1 dose<0.5; Class D, B-CPR>0.6 and I-dose≥0.5. All the patients who were in Classes A and B at 1 month were classified as Class A at 3 years. Of the patients who were in Classes C and D at 1 month, 19% and 50%, respectively were classified as Class A at 3 years. The slow progression towards insulin dependence was observed more in males and in patients with positive ketonuria at the onset. We conclude that patients with a low B-CPR at 1 month will progress toward insulin dependence within 3 years.View full abstractDownload PDF (1132K) -
Yuji Aoki, Yasutoshi Yanagisawa, Kendo Kiyosawa, Seiichi Furuta1991 Volume 34 Issue 10 Pages 857-863
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDaily endogenous insulin secretion was assessed by measuring the modified urinary C-peptide (UCP) in 40 non-insulin-dependent diabetic patients (DM), 14 nondiabetic patients with liver diseases (LD), 20 patients with DM+LD and 15 normal controls (N). The ratio of the urinary C-peptide (CP) clearance to the creatinine clearance (CCP/CCR) was determined in the early morning after an overnight fast, and the 24-hour urinary C-peptide output was measured (24h-UCP). The corrected value of the fasting UCP or the 24h-UCP was calculated as the fasting UCP/(CCP/CCR×10) or the 24h-UCP/(CCP/CCR×10). Using a rate of 5 ml/kg/min as the metabolic clearance rate of CP, the proportion of the C-peptide excreted in the urine was calculated to be 7.1%(2.2-21.3) based on the measured value of the UCP, and 3.5%(2.4-5.3) based on its corrected value in the fasting state. Since a good correlation (r=0.93) was obtained between the corrected value of the 24h-UCP and the sum of the day-10ng serum CP levels, the corrected value of the 24h-UCP was also presumed to be approximately 3.5% of the secreted C-peptide during a whole day. The insulin secretion was calculated to be 54±20U/day in N, 38±23U/day in DM, 77±38U/day in DM+LD and 115±54U/day in LD when the amount of Gpeptide was simply converted into that of insulin. It was suggested that some LD patients whose insulin secretory capacity could not overcome the increased insulin requirement showed hyperglycemia.View full abstractDownload PDF (987K) -
Haruko Kitaoka, Motoko Majima, Akito Kitazawa, Haruhiko Isotani, Youic ...1991 Volume 34 Issue 10 Pages 865-871
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSIn order to investigate the characteristics of muscle cramps occuring as a symptom of diabetes mellitus, a questionaire was administered to 206 healthy subjects and 200 patients with diabetes mellitus. The frequency of muscle cramps in healthy subjects was no greater than once a day, while 4.5% of the diabetics had cramps more than once a day. The percentage of diabetics with muscle cramps occurring once a week was significantly greater than the percentage of healthy subjects (11.5% vs 1.9%, p<0.01). The frequency of muscle cramps tended to be higher in patients on insulin therapy. When we examined the relationship between muscle cramps and diabetic neuropathy, diabetics with normal motor nerve conduction velocity (NCV) and thermal discrimination threshold (TDT) were found to have more muscle cramps than patients with abnormal NCV and TDT. There was no correlation between muscle cramps and other diabetic complications such as retinopathy or nephropathy. There was no significant difference in the serum calcium and magnesium concentrations of diabetics with and without muscle cramps.
In summary, muscle cramps seems to be common symptom of patients with diabetes mellitus.View full abstractDownload PDF (1065K) -
Isao Ohsawa, Juichi Sato, Yoshiharu Oshida, Yuzo Sato, Nobuo Sakamoto1991 Volume 34 Issue 10 Pages 873-878
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTo evaluate the effect of glimepiride on insulin action in the peripheral tissues of the rat, we studied insulin-induced glucose disposal in normal rats using the euglycemic clamp technique.
Male Wistar rats were divided to four groups, i. e., CA: glimepiride treatment (0.1 mg/kg/day) for 2 weeks and before euglycemic clamp (EC); CH: glimepiride treatment for 2 weeks; AH: glimepiride administration before EC; CT: saline treatment for 2 weeks. ECs were performed at two insulin infusion rates (6 and 30mU/kg/min) in the post-absorptive state.
During physiological hyperinsulinemia (80-100μU/ml), the glucose infusion rates (GIR) in the CA group (18.7±0.7 mg/kg/min, mean±SE), CH group (18.9±2.2) and AH group (19.0±1.0) were significantly higher than in the CT group (12.6±1.4, p<0.01). During maximal hyperinsulinemia (>700μU/ml), there were no significant differences in the GIR of the CA, CH, AH and CT groups.
In conclusion, glimepiride was capable of improving in vivo insulin sensitivity in the peripheral tissues of normal rats but not insulin responsiveness. These results suggest that glimepiride may affect insulin receptor binding levels or certain kinds of coupling mechanisms.View full abstractDownload PDF (1040K) -
Trial of a Thromboxane Synthetase InhibitorYuri Ono, Masahiko Katoh, Mamoru Kudoh, Shoichi Nakagawa1991 Volume 34 Issue 10 Pages 879-885
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSConsidering the vascular factor in the progression of diabetic neuropathy, we investigated the effect of a thromboxane synthetase inhibitor on the peripheral nerve function and skin blood flow of diabetics with neuropathy to determine wthether it had any effect on the diabetic neuropathy.
Fourteen diabetic patients with neuropathy were treated with the thromboxane synthetase inhibitor CV 4151 for 8 weeks and examined for changes in nerve conduction velocity (NCV), vibratory perception threshold (VPT), skin blood flow measured with a laser Doppler flow meter, deep skin temperature in the extremities, and changes in plasma thromboxane B2 (TXB2) and plasma 6-keto-prostaglandin F1α (6-keto-PGF1α). After administration of CV 4151, plasma TXB2 levels decreased, and plasma 6-keto-PGF1α-levels increased significantly. As a result, the plasma TXB2/6-keto-PGF1α, ratio dropped significantly to a lower level than before treatment. NCV and VPT in the extremities improved significantly, as did deep skin temperature and skin blood flow. The degree of improvement in motor nerve conductin velocity in the lower extremities, of deep skin temperature in the lower extremities, and of skin blood flow in the lower extremities were significantly intercorrelated. Treatment of diabetics with thromboxane synthetase inhibitor appears to decrease TXA2 production and increase PGI2 production, improving the TXA2/PGI2 ratio; as a result, skin blood flow increases and nerve functions improve.
In conclusion, thromboxane synthetase inhibitors which improve the TXB2/PGI2 ratio and blood flow can be used in the treatment of diabetic neuropathy.View full abstractDownload PDF (1140K) -
Takao Watarai1991 Volume 34 Issue 10 Pages 887-894
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSRegulation of EGF receptor binding and autophosphorylation were investigated in high-fat (HF) fed rats in comparison with the insulin receptor. EGF binding to hepatic microsomal membranes (MP) was lower in HF-fed rats than in the controls (36.9±6.6 vs 59.9±6.2%). Scatchard analysis revealed that this was due to a decreased number of receptors (936±141 vs 1795±119pM). A HF diet did not affect insulin binding to purified receptor preparations (RP) from liver, but did decrease the insulin binding affinity of MPs. Autophosphorylation of EGF receptors in both MPs and RPs of the HF group were significantly reduced to almost 40% of control levels throughout the entire dose-response curve when adjusted for protein concentration (Control 49.6±3.1 vs HF 20.2±2.9f moles/150μg/10min at 420nM of EGF). When adjusted for receptor number, the difference in EGF receptor autophosphorylation in the HF and control group was not statistically significant. Autophosphorylation of insulin receptors was decreased to almost 50% in HF-fed rats when adjusted not only for the amount of protein but receptor number.
In summary, a HF diet caused a decrease in EGF receptor number, but EGF receptor kinase was unaffected. On the other hand, while the HF diet did not affect insulin receptor number, it did decrease insulin receptor kinase activity. These findings suggest that changes in EGF receptors differ from those in insulin receptors under high-fat alimentation conditions.View full abstractDownload PDF (2927K) -
Chieko Bannai, Eiko Satoh, Yasushi Kawakami, Yukichi Okuda, Yoh Takuwa ...1991 Volume 34 Issue 10 Pages 895-900
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSAlthough scleredema is a rare connective tissue disease characterized by symmetric thickening and/or induration of the skin of the back of the neck and upper back, we found seven cases of scleredema among 63 non-insulin dependent diabetic inpatients. Two male and five female patients, ranging from 37 to 63 years of age, had diabetes mellitus of 3 to 20 years duration. More than half of them were poorly controlled and had long-standing obesity, retinopathy, proteinuria, neuropathy and cardiovascular abnormalities. Two patients had elevated immunoglobulin levels, one because of IgA, the other because of IgG and IgM, without evidence of multiple myeloma. Histological examination on skin biopsy specimens taken from three patients revealed marked thickening of the dermis with thick and swollen collagen bundles. Colloidal iron-stained sections disclosed dense deposits of acid mucopolysaccharides between the collagen bundles, predominantly in the lower dermis. In conclusion, (1) the incidence of scleredema detected as a result of careful physical examination was quite high in diabetic patients, (2) a tendency toward severe diabetic complications and frequent association with monoclonal gammopathy should be emphasized in patients with diabetic scleredema.View full abstractDownload PDF (7588K) -
Ayuko Kuzuyama, Hiroshi Senmaru, Hisaya Mori, Kei Kashima, Takami Naga ...1991 Volume 34 Issue 10 Pages 901-906
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe phagocytic activity of the polymorphonuclear neutrophils (PMN) was studied by the rapid method using Micrococcus lysodeikticus (M. lys) of 106 diabetics (insulin: 34, oral hypoglycemic agents: 51, diet: 21) and 60 controls. Heparinized blood was incubated with M. lys in saline containing 6% hydroxyethyl starch for up to 10 minutes. During incubation, samples were taken at 1 min intervals for quantitative evaluation of phagocytosis. A phagocytosis level of 100% was found within 7 min after the start of incubation in all of the controls, and phagocytosis levels less than 100% at 7 min were assessed as impaired.
Impaired phagocytosis was found in 44.3%(47/106) of the diabetics.The duration of diabetes in patients with impaired phagocytosis was significantly longer than in those with normal phagocytosis (14.8±1.1 year vs 11.8±1.0 years, p<0.05). There wasno difference between the FPG and glycosylated hemoglobin levels of patients with impaired phagocytosis and patients with normal phagocytosis. The plasma β-hydroxybutyrate concentration of patients with impaired phagocytosis was significantly higher than in those with normal phagocytosis (81.0±14.8μmol/l vs 46.4±7.3μmol/l, p<0.05). When washed PMNs obtained from patients with impaired phagocytosis were suspended in plasma from controls, the impaired phagocytosis improved markedly.
These findings suggest that the impairment of phagocytosis in diabetics may be due to humoral factors and not to the PMNs themselves.View full abstractDownload PDF (2551K) -
Takaichi Miyakawa, Nao Kawamura, Asako Kashiyama, Sayuri Hirota, Akio ...1991 Volume 34 Issue 10 Pages 907-914
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThree patients with gastric bezoars coexisting with diabetes mellitus were analyzed in terms of their associated clinical features and the pathological characteristics of their bezoars. It is known that gastric bezoars are occasionally found in diabetics, but the incidence of this disease is rare and few cases are reported in the literature.
The first case was a 49-year-old man who was admitted to the hospital in severe metabolic alkalosis caused by upper gastrointestinal ileus. The endoscopic examination of the upper gastrointestinal system revealed a bezoar incarcerated in the duodenal bulb. The second case was a 54-year-old woman. A very large hemorrhagic gastric ulcer was demonstrated associated with a bezoar. These cases were considered to be non-persimmon phytobezoars associated with severe diabetic autonomic neuropathy. The third case was a 49-year-old man, who came to the hospital because of vomiting and precordial pain. The gastric endoscopy showed an ulcer and a bezoar in the stomach. He had eaten many persimmons a few months previously. The bezoar appeared to be a persimmon phytobezoar. Thus, although the three cases had a similar diabetic background, the clinical features and histpathological characteristics of their bezoars were different, indicating that the pathophysiology of bezoars accompanied by diabetes mellitus is complex and remains to be studied.View full abstractDownload PDF (6800K) -
Sachiko Yanase, Nagayasu Toyoda, Mika Arima, Yukitaka Uji1991 Volume 34 Issue 10 Pages 915-921
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 27-year-old woman, diagnosed with IDDM at the age of 20, was admitted to a hospital in April 1988 because of diabetic ketoacidosis, and then found to be pregnant. In May 1988, she was referred to our hospital for control of her diabetes.
At 8 weeks of pregnancy, no diabetic retinopathy was detected even though her glycemic control was poor. After normalizing her blood glucose level on the basis of self-monitoring, she developed retinopathy which progressed rapidly to the proliferative stage at 19 weeks. Photocoagulation was performed in the left eye. Continuous subcutaneous insulin infusion (CSII) was started, and the target level for glycemic control was reset slightly higher, whereupon dramatic regression of the proliferative retinopathy was observed.
It appears that the transient proliferative retinopathy in this case was caused by a rapid and large decrease in blood glucose levels.View full abstractDownload PDF (5285K) -
Takashi Nagai, Mionru Sato, Takashi Tomizama1991 Volume 34 Issue 10 Pages 923-929
Published: October 30, 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe report a case of diabetes mellitus accompanied by transient retinal hemorrhages and crescenticglomerulonephritis. The patient was a 54-years-old man. There was marked edema of hisface and legs. His Urine tested strongly positive for protdin, and the sediment contained nurerousred cells per high power field. Fasting blood glucose was 179 mg/dl. Total protein was 4.0mg/dl. Wemade a diagnois of diabetes mellitus complcoted by the nephrotic syndrome. A percutaneous pidneybiopsyspecimen revealed crescentic glomerulonephritin on light microscopy. Because the patient'sblood urea nitrogen (BUN) and creatinine had increased rapidly after admission, he was treatedwith urokinase, predonisolone, dipyridamole and cyclophosphamide whereupon his BUN andcheatinine normlized and his urine protein decreased gradually. But his insulin dose, however, gmadually increased because of insulin resistance due to predonisolone or rhortesing of insulin half-life and recovery of appetite due to the improvement in renal function . Wthin a year retinalblotches or flame-shaked hemorrhages develoked, despite the foct thsr throughout his stetrse bloodglucosc Control had been fair and his blood pressure was within the norman range. It appeors thatthe devecopment of retinal hemorrhages was due to rapidly deterating menal function and theincrease in total cholesterol indueei by predonisolone.View full abstractDownload PDF (4215K) -
1991 Volume 34 Issue 10 Pages 931
Published: 1991
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (1886K)
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