To find out the psycho-social characteristics of diabetic patients, we analyzed the behavior traits of 98 NIDDM patients (mean age, 59 ±10 years; duration of DM, 8 ±7 years ; males, 46; females, 52) admitted to Osaka Rosai Hospital for a 2-week program of diabetic education and treatment. The rorschach test was given to all patients under the same conditions and by the same examiner. Results of the test were compared with the data of 83 patients (mean age, 59 ±10 years; males, 50; females, 33) admitted during the same period for coronary catheterization for heart disease. There were no significant differences in fundamental responses to the Rorschach test between the two groups. However, in NIDDM patient, responses of “lack of feedback ” and the responses to “flower categorization in colored cards ” were significantly fewer, and there were significantly more responses to shaded cards. In diabetic patients without complications, significantly more patients indicated a “pseude-integration” response to color. Significantly more poorly controlled diabetic patients (HbA1c ≥9.0%), showed a one-sided attitude.
This study suggests that application of the results of behavior trait analysis in the treatment and education of diabetic patients is essential.

View full abstract

There have been reports that a high level of GAD antibodies is associated with a low risk of clinical disease in at-risk relatives. Therefore we studied the relationships between residual β-cell function and the titer of glutamic acid decarboxylase antibodies in patients with IDDM and SPIDDM. Residual β-cell function was evaluated by the C-peptide immunoreactivity response to loading by glucagon, and the titer of GAD-Ab was determined with RIA Kits. We found that the C-peptide immunoreactivity respone to glucagon loading was positively correlated with the titer of GAD antibodies in IDDM patients with 5-years duration of diabetes (γ=0.43, p<0.05), but not in IDDM patients with duration of diabetes over 6 years. In SPIDDM patients, we found no relationship between the titer of GAD-Ab and the capacity to release insulin.

View full abstract

We extracted lipids of erythrocyte membranes from 29 healthy subjects and 27 diabetic patients. We treated the lipids with methanolysis and analyzed them by gas chromatography-mass spectrometry. The analysis showed that 2, 5, 7-cholestatriene (Tri), cholesterol peroxide was present in 23 of the 27 diabetic patients but it was not detected in the 29 healthy subjects. It has been reported that oxidative stress is increased in vivo in the diabetic state. It was assumed that the oxidative stress oxidized cholesterol to Tri. Tri was detected as a dehydrated form as a result of the methanolytic treatment. It was furthermore assumed that Tri existed as 7-dehydro cholesterol in erythrocyte membranes. No correlation was found between the relative peak levels of Tri and HbA1c values in diabetic patients. We have reported elsewhere the detection of 7-keto cholestadiene (KD), another cholesterol peroxide, in diabetic erythrocyte membrane lipid. The relative peak levels of Tri were far less than 50% of those of KD, so we suggest that Tri is an intermediate product which may be further oxidized to cholesterol-epoxide.

View full abstract

The aim of this study was to determine the effect of exercise training on serum leptin levels in non-insulin dependent diabetic (NIDDM) patients. Nineteen previously sedentary obese NIDDM patients were assigned to 4-6 weeks of aerobic exercise with diet therapy (Tr group, n=9) or diet therapy alone (Sed group, n=10). The training program consisted of walking and cycle-ergometer exercise for one hour, more than five times a week. The intensity of the exercise was maintained at 50 per cent of V0₂ max. Serum leptin concentrations (blood drawn in the fasted state at 6: 00 a. m.), HbAic, and body composition by dual-energy X-ray absorptiometry were measured bebore and after the observation period in both groups.
The two groups did not differ significantly in any variables before participation in the program. Serum leptin concentrations exhibited a positive correlation with % body fat and with fat mass in NIDDM patients before the program (% fat: r = 0.85, p<0.01 ; fat mass: r=0.60, p<0.01). After the observation period serum leptin concentrations had decreased significantly in both groups, and those standardized for % fat and for fat mass in the Tr group were significantly lower than those in the Sed group (% fat: 0.14±0.03 ng/m/ Tr vs. 0.20±0.06 ng/ml/ Sed, p<0.05; fat mass: 0.23 ±0.06 ng/ml/kg Tr vs. 0.33 ±0.11 ng/ml/kg Sed, p<0.05). Body fat and HbA1c decreased significantly in both groups.
It is concluded that exercise training reduced serum leptin levels independent of the reduction in body fat mass in obese NIDDM patients.

View full abstract

Case 1 was in a 36-year-old male with a history of operations for multiple pancreatic cysts and cerebellar hemangioblasma at the age of 23 years and 33 years, respectively who came to our hospital complaining of thirst and weight loss. Fasting plasma glucose 197 mg/dl, and HbAic was 10.7%. A diagnosis is of diabetes mellitus, was made and the patient was admitted to our hospital for glycemic control. Case 2 was in a 42-year-old female, the elder sister of patient 1. She had been diagnosed with diabetes mellitus at the age of 27 years. Abdominal CT scans in both cases showed multiple pancreatic cysts of varying sized (1 to 2 cm) and multiple renal cysts and tumors. These two siblings were diagnosed as having von Hippel-Lindau disease (vHL) based on the radiologic findings and family history.
Although vHL has been known to frequently be accompanied by multiple pancreatic cysts, there have been few reports of diabetes mellitus associated with this disorder. Our cases showed that some vHL patients may develop overt diabetes mellitus due to pancreatic endocrine insufficiency caused by multiple pancreatic cysts.

View full abstract

A 70-year-old woman was diagnosed as having NIDDM in 1989. She had been treated with glibenclamide (2.5mg/day) with poor glycemic control (in February 1996: HbA1c 10.7%). Even after admission to our hospital with strict dietary control and continuous glibenclamide (2.5mg/day), her plasma glucose level did not fall significantly. She was given voglibose (0.6mg/day) in addition to glibenclamide. Three days after administration of voglibose, the plasma glucose level decreased to 59 mg/dl. She stopped taking glibenclamide and voglibose. However, the blood glucose level continued to decrease (at its nadir: blood glucose 52 mg/dl, IRI 16.51μU/ml, CPR 5.5 ng/ml). There was no evidence of insulinoma.
In this case, hypoglycemia developed after the use of voglibose on top of glibenclamide, so that it is likely that voglibose is, at least in part, responsible for the development of prolonged hypoglycemia.

View full abstract

A 36-year-old man was hospitalized on February 24, 1997. On admission, his plasma glucose concentration was 973mg/dl, and arterial blood gas analysis revealed pH 6.981, PaCO₂ 17.8 mmHg, Pa0₂ 63.8 mmHg, HCO₃ 4.1 mmol/l, indicating severe hyperglycemia with hypoxemia accompanying metabolic acidosis. Under a diagnosis of diabetic ketoacidosis (DKA), he was immediately transfused with fluid, insulin and antibiotics. He complained of dyspnea with progressive hypoxemia, and pulmonary edema developed about 6 hours after the initiation of treatment. As his general condition deteriorated rapidly, respiratory management using mechanical ventilation was started. Diffuse infiltrative shadows appeared on the chest X-ray with elevation of serum creatine kinase and serum creatinine concentrations and reduction of platelet count. We made a diagnosis of acute respiratory distress syndrome, rhabdomyolysis and DIC. With the treatment by mechanical ventilation with positive end expiratory pressure (PEEP), hemodialysis and the administration of urinastatin and gabexate, these situations gradually recovered in about a month. Our experience with this patient suggested that the mechanical ventilation with PEEP and the suitable treatment for other severe complications such as acute renal failure and DIC were important for the survival of these patients.

View full abstract