We studied whether plasminogen activator inhibitor 1 (PAI-1) was a risk factor for lacunar infarction in type 2 diabetic patients. Although PAI-1 was not related to HbA_1c concentrations and advanced glycation endproducts (AGEs) or fasting CPR, it was related significantly to the percent of body fat (%BF), body mass index (BMI) and average blood pressure. PAI-1 was also related to platelet count, fibrinogen level and the number of lacunar infarctions analyzed with brain magnetic resonance imaging (MRI). These results suggest that PAI-1 may be a risk factor for lacunar infarction by activating coagulation and inhibiting fibrinolysis in cerebrovascular lesions in type 2 diabetic patients.

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The blood concentration of 1, 5-anhydro-D-glucitol (1, 5-AG) has been used asa marker for diabetic control. In diabetic patients, high urine glucose competes the absorption of1, 5-AG at renal tubules and lowers its blood concentration. In general, the major source of 1, 5-AG is food and daily in take was reported to be relatively stable in Japan. Although Chinese medicines have been traditionally and widely used for many kinds of disease, it is less known well that one of their components, especially polygalae radix, contains large amounts of 1, 5-AG. We examined the effect of an extract of polygalae radix and ninjinyouei-to (TJ-108) on the blood concentration of 1, 5-AG in 5 healthy volunteers and 13 patients including those with diabetes mellitus.We found that both the extract of polygalae radix and TJ-108 increase 1, 5-AG without affecting glucose metabolism.Chinese medicines containing polygalae radix should thus be better evaluated in 1, 5-AG blood concentration as a marker of diabetic control.

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[in Japanese]

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A 38-year-0ld woman who had had 4 children was found to have glycosuria during her first pregnancy. Glucose tolerance was abnormal during each pregnancy, but became normal when the patient was not pregnant. From about August 13, 2000, dry mouth and generalized malaise developed.She was examined at the emergency department of our hospital on August 16. Blood glucose was 311 mg/dl, and the urinary ketone reaction was strongly positive. Urinary pH was 7.242 and HCO₃^-was 7.4 mmol/l.Diabetic ketoacidosis was diagnosed, and the patient was admitted. The anti-GAD antibody was strongly positive (22, 600 U/ml), and the insulin autoimmune antibody was positive, indicating a diagnosis of type 1 diabetes.Slowly progressive insuli-dependent diabetes mellitus (SPIDDM) was suspected based on the disease course.HLA-DR antigens 2, 9, and 53 were noted. The patient also had diffuse goiter, elevated T₃, decreased TSH, positive test results for anti-TSH receptor antibody, anti-TPO antibody, and antithyroglobulin antibody, and increased uptake on technetium-99 m-labeled scintigraphy. Basedow's disease was also diagnosed. Because type l diabetes was associated with Basedow's disease, the condition was classified as type III polyglandu. 1ar autoimmune syndrome (PGA). The characteristics of our patient indicated a relatively classic case of simultaneous onset of type 1 diabetes and Basedow's disease.The study of similar cases will hopefully improve our understanding of the etiology of this condition.

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A51-year-old man with a 7-year-plus history of untreated type 2 diabetes mellitus was referred to our hospital due to bilateral foot gangrene, localized swelling of the extremities and fever. On admission, plasma glucose was 738mg/dl, HbA_1c9.3%, and CRP 31.6mg/dl. Funduscopic examination showed preproliferative diabetic retinopathy, and severe sensory loss was present in the feet and hands. Radiography, computed tomography (CT), and magnetic resonance imaging (MRI) suggested septic arthritis of the left foot and knee, bilateral psoas abscess, bilateral hand abscess, and pyogenic vertebral osteomyelitis at Th 7-8, Culture of the needle aspirate of the foot lesion yielded the following bacteria: Streptococcus pyogenic group, peptostreptococcus magnus, and Pseudomonas aeruginosa In addition to the administration of antibiotics and intensified insulin therapy, debridement, and surgical drainage were effective. Laboratory analysis did not show any significant signs of cellular or humoral immunodeficiency.

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An insulin-dependent diabetic women with a 30-year diabetes duration and fair recent control (HbA1c 6-7%) using an insulin pump was for frequent vomiting and appetite loss. Intracranial lesion, internal ear disease, electrolyte imbalance, and abdominal organic diseases were excluded. Although her ketosis and blood glucose level improved by fluid and insulin infusion, her vomiting continued. Gastrointestinal endoscopy showed residual meals in the stomach without organic change, suggesting that she was suffered from diabetic gastroparesis. Euglycemic hyperinsulinemic clamp showed insulin infusion delayed after meal intake. Her vomiting disappeared and eating recovered with use of a domperidone suppository. The powdered drug administer prior to meals was also effective. The second euglycemic hyperinsulinemic clamp showed a sharp insulin infusion pattern after meal intake during powdered domperidone administration, suggesting that gastric emptying had improved. These result suggest that domperidone suppository and powdered domperidone are higly effective in treating diabetic gastroparesis with frequent vomiting. Euglycemic hyperinsulinemic clamp was also extremely useful for evaluating the alteration of gastric emptying by intervention.

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[in Japanese]

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