Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
Volume 52, Issue 12
Displaying 1-7 of 7 articles from this issue
Mini Review
Original Article
  • Tomoko Nakagami, Taro Wasada, Sachiyo Jimba, Junko Oya, Masayuki Takah ...
    2009 Volume 52 Issue 12 Pages 941-948
    Published: December 30, 2009
    Released on J-STAGE: March 01, 2010
    JOURNAL FREE ACCESS
    This study investigated the interaction between nonalcoholic fatty liver disease (NAFLD) and cardiovascular risk factors in the general health examination cohort. Study subjects included 1,046 people with non fatty liver and 532 with NAFLD based on US scanning and alcohol consumption. Metabolic abnormalities were diagnosed based on metabolic syndrome criteria in Japan. Hyperinsulinemia was defined as the highest quartile of fasting plasma insulin (F-IRI) in subjects with normal fasting plasma glucose (FPG). Multivariate logistic regression model by gender showed that NAFLD was independently related to high TG, low HDL-C, high FPG, and hyperinsulinemia in both genders. After further adjustment for F-IRI, this result was not changed in high TG and low HDL-C in men, but changed in high FPG in both genders. BMI and F-IRI were identified as independent risk factors for NAFLD in both genders. NAFLD was thus suggested to interact directly with dyslipidemia in men, whereas it might interact with glucose metabolism via F-IRI in both genders.
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Case Report
  • Toshiaki Ohkuma, Masanori Iwase, Yasuhiro Idewaki, Yohei Kikuchi, Hiro ...
    2009 Volume 52 Issue 12 Pages 949-955
    Published: December 30, 2009
    Released on J-STAGE: March 01, 2010
    JOURNAL FREE ACCESS
    We report a rare case of glucagonoma in the elderly ameliorated by medical therapy, including anabolic steroid.
    A 74-year-old woman seen for necrolytic migratory erythema and diagnosed with glucagonoma due to hyperglucagonemia (13,000 pg/ml) and a pancreas-body tumor 3 cm in diameter also had multiple micrometastases to the liver, deep venous thrombosis, and pulmonary embolism. Her poor general condition of 16.9 kg/m2 BMI, 1.5 g/dl serum albumin, and 6.8 g/dl hemoglobin was improved by treatment with octreotide, which decreased plasma glucagon to 1,500 pg/ml and amino acid supplementation, which markedly improved necrolytic migratory erythema. To sufficiently improve hypoalbuminemia and anemia, we administered the anabolic steroid metenolone, which ameliorated hypoaminoacidemia, hypoalbuminemia, and anemia, with serum albumin rising to 2.3 g/dl and Hb to 8.5 g/dl. Insulin therapy was required to manage hyperglycemia associated with reduced endogenous insulin secretion.
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  • Ichiro Horie, Hironori Yamasaki, Shinya Kawashiri, Ikuko Ueki, Kan Nak ...
    2009 Volume 52 Issue 12 Pages 957-963
    Published: December 30, 2009
    Released on J-STAGE: March 01, 2010
    JOURNAL FREE ACCESS
    Type B insulin resistance syndrome is an autoimmune disease caused by anti-insulin receptor autoantibodies and is frequently accompanied by other autoimmune disorders. The choice of treatment modality may thus be difficult in these patients. We report two patients with type B insulin resistance syndrome associated with systemic lupus erythematosus (SLE), whose responses to therapeutic agents differed markedly. Case 1: A 50-year-old Japanese woman with a SLE activity index (SLEDAI) score of 10 had her hyperglycemia treated successfully with recombinant human IGF-1 (rhIGF-1) (10 mg/day), but not even high dose of insulin were effective. Anti-insulin receptor autoantibodies and SLE activity may be dramatically decreased by SLE therapy with prednisolone (30 mg/day). Case 2: In contrast, a 59 year-old Japanese man with a SLEDAI score of 26 had hyperglycemia resistant to IGF-1 therapy, as were anti-insulin receptor autoantibodies and SLE activities to prednisolone. Only intensive immunosuppressive therapy with cyclophosphamide and cyclosporine A was effective in reducing SLE activity, high plasma glucose, and anti-insulin receptor autoantibody titers. The clinical courses of these two patients are highly indicative of differences considering the choice of therapeutic modalities for type B insulin resistance syndrome associated with other autoimmune diseases.
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  • T. Ohama, K. Kinjo, K. Chinen, T. Fujioka, K. Soji, T. Moromizato, T-H ...
    2009 Volume 52 Issue 12 Pages 965-968
    Published: December 30, 2009
    Released on J-STAGE: March 01, 2010
    JOURNAL FREE ACCESS
  • Naoki Gocho, Makiyo Hiyama, Junichiro Adachi, Taichi Nakamura, Masatak ...
    2009 Volume 52 Issue 12 Pages 969-976
    Published: December 30, 2009
    Released on J-STAGE: March 01, 2010
    JOURNAL FREE ACCESS
    A 53-year-old woman with no significant medical history seen for general fatigue and appetite loss lasting several days had noticed asymptomatic gross hematuria two weeks earlier that had resolved immediately. Laboratory examination showed markedly elevated white blood cells, C-reactive protein, blood urea nitrogen, serum creatinine, plasma glucose, and ketone bodies. Acute renal failure with hyperkalemia and metabolic acidemia necessitated immediate continuous hemodiafiltration with continuous intravenous insulin infusion administration and antibiotic treatment. Klebsiella pneumoniae was isolated in both blood and urine culture on admission. Although her general condition gradually improved after admission, she continued to suffer from intermittent fever with pyuria. Abdominal computed tomography showed a diffusely enlarged left kidney with the normal parenchyma replaced by multiple low-attenuation masses. These typical imaging findings and clinical course yielded a definitive diagnosis of xanthogranulomatous pyelonephritis, considered refractory to conservative therapy for diffuse kidney involvement. Following total nephrectomy, postoperative histopathological findings were compatible with xanthogranulomatous pyelonephritis. Her renal function improved without postoperative hemodiafiltration support and fever and pyuria were resolved. This case is rare, demonstrating xanthogranulomatous pyelonephritis in a patient with undiagnosed diabetes, who suffered from diabetic ketoacidosis and acute renal failure requiring hemodiafiltration.
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