The aim of this study was to evaluate the effect of switching to a quick-acting insulin analogue (Q) from regular insulin (R) in 40 children and adolescents with type 1 diabetes. The major insulin regimens before the administration of Q were as follows: R-R-R-N (U), 28 patients (70%); and RN-R-R-N, 1 patient 2.5%, Twelve months after the use of Q, the insulin regimens were increased to twice daily injections of basal insulin: Q-Q-Q-N (U), 18 patients (45%); and QN, -Q (R)-Q (R)-N, 9 patients (12.5%). Eight patients (20%) received the modified use of a bolus of Q or R insulin depending on their life-style. The mean dose of total insulin remained unchanged during treatment with Q, but the mean basal insulin dose increased 12 months after the use of Q (baseline 25.8±12.2 U/day, after 12 months 27.1±12.6 U/day).After switching to Q, the mean HbA₁c value decreased in all patients (baseline 7.6±1.0 U/day, after 12 months 7.3±0.8%), reflecting an improvement in HbA₁c in patients with an HbA₁c value≥8% at baseline.These results indicate that the effects of the insulin regimens varied after switching from R to Q, with increases in the numbers and dosages of the basal insulin injection.The use of Q seemed to improve glycemic control in patients with a poor glucose profile under conventional insulin treatment using R.

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Oral glucose tolerance tests were performed in 202 subjects, and the correlations among glucose tolerance, brachial-ankle pulse wave velocity (baPWV) and the 10-ear risk of coronary heart disease (CHD) calculated from the Framingham risk score (FRS) were evaluated.When subjects were grouped according to the Japan Diabetes Society's diagnostic criteria, the baPWV was higher in the impaired glucose tolerance (IGT) group and the diabetes mellitus (DM) group than in the normal glucose tolerance (NGT) group.When the IGT group was grouped into an IFG-HO group and an IGT-WHO group according to the WHO diagnostic criteria, the baPWV was also significantly higher in the IGT-WHO group than in the NGT group. However, the baPWV was not significantly different in the IFG-HO and NGT groups.
Univariate regression analysis showed that baPWV was positively correlated with both the fasting plasma. glucose (FPG) level and the post-challenge plasma glucose level at 2 hours (PG-2). In addition, a multivariable regression analysis demonstrated that PG-2, but not FPG, was independently associated with baPWV. FRS was also elevated in both the IGT group and the DM group, when compared with that in the NGT group.Furthermore, FRS showed an exponential correlation with both FPG and PG-2.In conclusion, patients diagnosed as having IGT-WHO as well as DM exhibit increased aortic stiffness and have an increased risk of CHD.The PG-2 level might be independently associated with increased baPWV and FRS in subjects with IGT-WHO.

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[in Japanese]

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[in Japanese]

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A 25-year-old woman referred for postprandial hypoglycemia was found in imaging to have no findings associated with pancreatic endocrine tumors.Her fasting serum insulin was not abnormally high. No hypoglycemia or marked increase in serum insulin was observed throughout 33-hour fasting. A rapid intravenous calcium infusion test did not increase serum insulin.She reported later that her husband and she had an unsatisfactory conjugal relationship and that her condition improved after they separated, after which she became free of hypoglycemic symptoms for a year.Idiopathic reactive hypoglycemia is suggested to be induced by emotional distress.We therefore concluded that, in this patient at least, emotional distress adversely affected serum glucose.

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