The traditional Japanese diet is known for its appropriate nutrition thanks to its balance of rice, soup, and main and side dishes and low fat content. Few reports have been made, however, on its actual health effects. We studied the effects of a low-fat, low-calorie Japanese diet on body fat, metabolic syndrome indices, energy metabolism, and sympathetic nervous system (SNS) parameters using power spectral analysis of heart rate variability.
Subjects were 11 young lean women with excessive body fat (21.7±0.5 yrs; BMI, 21.0±0.5 kg/m²; body fat, 29.8±0.7%) who were administered a Japanese diet of 20% fat, 60% carbohydrates, and 20% protein at 400 kcal per meal prepared in our laboratory three times a day for 2 weeks. Physical activity was maintained for the experimental period. Body weight, body fat, waist circumference, blood pressure, blood biochemical markers, resting metabolic rate, insulin resistance (HOMA-IR), and SNS activity were measured at baseline and 2 weeks. Results showed significant improvement (p<0.001) in body weight (-2.3±0.2 kg), body fat (-1.7±0.2 kg), and waist circumference (-3.7±0.6 cm). Fasting glucose, glycoalbumin, and HOMA-IR decreased significantly. Fat oxidation and SNS activity increased significantly (p<0.05), and serum triglyceride decreased, significantly (p<0.01), suggesting increased overall lipid metabolism. In conclusion, despite short-term, modest energy restriction, a low-fat, low-calorie Japanese diet contributes significantly decreasing body fat and waist circumference and improving insulin resistance, and enhances overall lipid metabolism. Our results suggest that appropriate nutritional intervention is useful in regaining desired body composition among young women with excessive fat, thus possibly preventing future metabolic syndrome.

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A 69-year-old man with type 2 diabetes treated with biphasic insulin aspart 30 from March 2004 and admitted due to repeated episodes of fasting hypoglycemia and postprandial hyperglycemia and poor glycemic control had markedly increased plasma total insulin of 3,360 μU/ml with positive antiinsulin antibody (93.7%) and antiinsulin receptor antibody. Insulin administration was switched to insulin analog lispro, which gradually improved fasting hypoglycemia. Scatchard analysis of insulin binding to the patient's antiinsulin antibody showed that reduced binding capacity at high-affinity sites had become normal after 8 months. High antiinsulin antibody titers gradually decreased together with the lack of antiinsulin receptor antibody. The significant inhibitory effect of ¹²⁵I-insulin binding to the human placental membrane by the patient's serum was abolished by the removal of endogenous insulin by dialysis, but induced by the addition of exogenous insulin to control serum in a concentration equivalent to the patient's plasma. These findings suggest that antiinsulin receptor antibody observed in this man's case was most likely due to marked hyperinsulinemia in the presence of antiinsulin antibody.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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A 62-year-old man with a decade-plus history of diabetes mellitus admitted for fever and right lower limb swelling had hyperglycemia (515 mg/dl) with a 11.0% rise in HbA₁c. Abdominal computed tomography showed a 9.0×9.0 cm abscess in the right hepatic lobe. Magnetic resonance imaging of the right limb showed multiple abscesses. Cultures of blood and abscess fluid from the liver and right lower limb grew Klebsiella pneumoniae. The man responded successfully to percutaneous drainage of the liver abscess, surgical debridement of the foot, antibiotics, and insulin. Pyogenic liver abscess caused by Klebsiella pneumoniae is more frequent in diabetic than nondiabetic patients and tends to cause more metastatic lesions than non-Klebsiella pathogens. Physicians should therefore consider this condition in the management of septic diabetic patients with lower limb swelling.

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We report a thin 70-year-old woman with type 2 diabetes mellitus and liver cirrhosis suffering from a giant subcutaneous hematoma caused by a badly administered insulin injection. She had watched a major league baseball player on television inject insulin directly without removing his uniform, i.e., directly through the cloth. Imitating him, she injected her abdomen without holding the skin taut, and soon felt pain at the injection site and dizziness. Three hours later, her consciousness declined and she was admitted. She was found upon examination to have severe anemia, wide-ranging subcutaneous bleeding, and a giant subcutaneous hematoma. We speculated that severe bleeding from the insulin injection may have been caused by her thinness and platelet loss due to liver cirrhosis and also due to using a Humacart ^®Kit, which had high infusion resistance as an insulin delivery device.
Although injecting insulin through the clothing may be reported as safe and convenient, patients who are thin and have complications such as liver cirrhosis should be carefully instructed about techniques and special attention required for insulin injections.

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[in Japanese]

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Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. Some 3% of all pregnant women with GDM cies are diagnosed annually in Japan. Exposure to maternal hyperglycemia during pregnancy is associated with birth defects and perinatal complications and other adverse effects on childhood growth and glucose regulation, necessitating adequate GDM screening and diagnosis. A lack of international consensus remains on the screening, diagnosis, treatment, and follow-up of GDM among panels including the American Diabetes Association (ADA), World Health Organization (WHO), and the American College of Obstetricians and Gynecologists (ACOG). This lack of agreement continues to cause confusion about the ideal clinical approach to GDM. The committee of the Japan Diabetes Society has therefore evaluated the definition, screening, and diagnostic criteria of GDM in Japan. We must reevaluate them again after establishment of hyperglycemia and pregnancy adverse outcome (HAPO) studies.

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