We investigated the effect of combination therapy with preprandial rapid-acting insulin injections and α-glucosidase inhibitor (α-GI), which is known to suppress postprandial hyperglycemia, on discontinuation of insulin treatment in non-obese NIDDM patients with secondary failure on oral hypoglycemic agents.
Thirty-six hospitalized patients (17 male and 19 female) with NIDDM who showed poor glycemic control during 2 weeks of diet and exercise therapy with almost maximal doses of sulfonylureas were divided into a group treated with rapid-acting insulin injection plus α-GI before each meal (group I; n=17), and a group treated with rapid-acting insulin inlection alone (group II; n=19)
There were no significant differences in daily insulin requirements, fasting plasma glucose, HBA_1c or serum fructosamine between groups I and II. However, both meal-related and premeal glycemia was normalized in group I and the period of insulin treatment was 12.7 days shorter than in group II. Urinary CPR excretion levels were markedly lower during insulin therapy than before treatment, and systolic blood pressure also decreased significantly. Insulin therapy did not induce weight gain or increase serum lipid levels, and the incidence of hyperglycemia in group I was lower than in group II.
These observations indicate that combination therapy with preprandial rapid-acting insulin injections and α-GI can shorten the period of insulin therapy and facilitate discontinuation of insulin treatment through normalization of postprandial hyperglycemia as well as the resting state of pancreatic beta cells in NIDDM patients with secondary failure on oral hypoglycemic agents.

View full abstract

An epidemiologic survey of juvenile onset insulin dependent diabetes mellitus (IDDM) was performed by analyzing application forms for the medical care system in Kitakyusyu city for the 1989-1993 period. A total of 73 patients under 18 years of age were identified, 40 (boys 19, girls 21) of whom were classified as having IDDM. The annual incidence during the five year period was 1.98 (boys 2.29, girls 1.66) per 100, 000 with a peak incidence at ages 10-14 years. There was a seasonal variation in symptom onset, with higher rates during the winter and lower rates during the summer. The prevalence was 1.19 (boys 1.13, girls 1.25) per 10, 000 and increased with age.

View full abstract

We studied six cases of ketosis in obese NIDDM associated with excess soft drink consumption. In all six, diabetes mellitus was newly diagnosed. The HbA_1c levels ranged from 10.4% to 12.8%. They were treated with insulin, and insulin therapy could ultimately be withdrawn in all cases. In one case, urinary C-peptide excretion clearly increased from 5μg/day, the pre-therapy level, to 37μg/day after the institution of insulin therapy. There was, however, no remarkable change in the other five cases. Tests for insulin sensitivity using steady state plasma glucose (SSPG) were performed in 4 cases before and after instituting insulin therapy. The SSPG improved markedly (322±87mg/dl→84±38mg/dl) following therapy. In conclusion, in cases of ketosis associated with soft drink consumption, insulin secretory function appears to be relatively decreased, while decreasedinsulin sensitivity seems to further accelerate metabolic derangements. Following insulin therapy, insulin sensitivity is uniformly restored, but the restoration of insulin secretion as assessed by urinary C-peptide excretion varies among cases.

View full abstract

A 46-year-old man with NIDDM and pulmonary tuberculosis was admitted to our hospital because of generalized fatigue and cough. As glycemic control was poor, treatment with mixture injections of short-acting and intermediate-acting insulins twice a day was begun. After treatment with these preparations for two months, he noticed local, itchy, wheal-and-flare reactions at the sites of injection, indicative of an insulin allergy.
Human insulin-specific bound IgE was positive and insulin antibody formation was elevated to 89.8%(≤10%). Intradermal testing for insulin allergy was performed with founteen commercially available preparations of human, porcine and bovine insulins. All short-acting and intermediate-acting insulins produced allergic reactions, whereas none of the long-acting insulins was allergenic. These long-acting insulins were monoclinic insulin crystals. when decrystallized by lowering the pH from 7.0 to 3.0, even these insulins induced a positive reaction. The findings indicate that, in this case, the monoclinic crystallized structure of human insulin may have masked the antigenicity by which the short-and intermediate-acting insulins induced allergic reactions.

View full abstract

Using the survey of hospital records, the principal causes of death among 11, 648 diabetics (7, 106 men and 4, 542 women) who died in 225 hospital throughout Japan during the period of 1981-1990 were determined. There were 2, 289 autopsies among 11, 648 diabetics.
1. The most frequent causes of death were vascular diseases (39.3%) including renal failure (11.2%), ischemic heart disease (14.6%), and cerebrovascular disease (13.5%). The second most frequent cause was malignant neoplasm (29.2%) and the third was infections (10.2%). Diabetic coma due to hyperglycemia accounted for only 1.7% of deaths.
2. Concerning the relationship between age and cause of death in diabetics, diabetic nephropathy and infection were relatively common in patients over the age of 20 years.Cerebrovascular disease was the cause of death in about 10% of patients over 30 years of age.However, the high incidence of death due to ischemic heart disease was observed over the age of 60 years. Malignant neoplasm was the cause of death in about 30-40% in men over 40 years of age and in women over 50 years of age.
3. As a matter of convenience, Japan was divided into three areas: a rural district (Hokkaido and Tohoku), an urban district (six major cities, Tokyo, Osaka, Nagoya, Yokohama, Kyoto and Fukuoka), and all other districts. There were no differences between the areas in the frequency of vascular disease as the cause of death in diabetics.
4.The “poor” control of blood glucose reduced the life spans of those diabetics without malignant neoplasms or liver cirrhosis, especially those with diabetic nephropathy. In the 11, 648 patients, the average age at death was 67.3 years. The life span was two years shorter in patients with “poor” blood glucose control than in those with “good” or “fair” blood glucose colltrol.
5.As risk factors, the degree of blood glucose control and the duration of diabetes were less important in macroangiopathy than in microangiopathy.
6.Of the 11, 648 diabetics, 25.4% used oral medication only, 44.6% used insulin therapy (including cases treated with the combination of oral medication and insulin), and 21.1% used diet alone. Diabetic nephropathy was a frequent cause of death in patients treated with insulin therapy.
7.The average age at death of the 11, 648 diabetics who died between 1981-1990 was 66.5 years in men and 68.4 years in women.However, the report of the Ministry of Health and Welfare of Japan on 1990 set the average life span of the Japanese at 75.9 years for the men and 81.9 years for the women.Thus, the average life span of Japanese diabetics might be still shorter than that of the general population in Japan.

View full abstract