Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 53, Issue 11
Displaying 1-8 of 8 articles from this issue
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Lecture by President of 53rd Annual Scientific Meeting
Lecture by the Prize Winner of 2010
Original Article
  • Insulin Resistance and Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Coexisting Hepatocellular Carcinoma
    Fumi Umeoka, Hiroaki Miyaoka, Yuichiro Oka, Nobu Inada, Takeshi Okada
    2010 Volume 53 Issue 11 Pages 798-802
    Published: 2010
    Released on J-STAGE: December 17, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.798
    JOURNAL FREE ACCESS
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    The frequency of hepatocellular carcinoma (HCC) with underlying nonalcoholic steatohepatitis (NASH) is increasing, and insulin resistance due to underlying obesity and diabetes is suspected of playing a role in hepatic carcinogenesis. This study divided 80 patients with type 2 diabetes and coexisting chronic liver disease into patients with HCC (n=36) and without HCC (n=44) , then compared insulin resistance and frequency of use of insulin and oral hypoglycemic agents (insulin secretion-stimulating drugs, and metformin) . Fasting serum insulin was 14.5±5.5 μU/ml in the HCC group and 8.65±5.0 μU/ml in the non-HCC group. The homeostasis model assessment-insulin resistance index was 4.34±1.74 in the HCC group and 2.53±1.21 in the non-HCC group. In both cases, values were significantly higher in the HCC group (P<0.05) . In addition, the frequency of metformin use was significantly lower in the HCC group than in the non-HCC group. This suggests that treatment of insulin resistance with metformin may reduce the incidence of HCC.
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Case Report
  • A Case of Adult-onset Nesidioblastosis with Severe Hypoglycemia Treated Effectively with Long-term Use of Diazoxide
    Tadashi Arao, Yosuke Okada, Akiko Yoshimura, Keiko Nishida, Yoshiya Ta ...
    2010 Volume 53 Issue 11 Pages 803-809
    Published: 2010
    Released on J-STAGE: December 17, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.803
    JOURNAL FREE ACCESS
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    The patient was a 58-year-old man, who presented with a history of occasional episodes of loss of concentration before dinner since 2002. In 2003, fasting hypoglycemia was identified without suppression of insulin secretion. He was admitted subsequently to our hospital for further evaluation the hypoglycemia. The ratio of IRI to plasma glucose (PG) was 0.8-1.0. Abdominal CT showed no pancreatic tumor, and angiography of the splenic artery showed no definite tumor stain within the pancreas. However, based on the results of selective arterial calcium stimulation and hepatic venous sampling, the provisional diagnosis was a small insulinoma in the pancreatic body. The patient underwent subtotal distal pancreatectomy. However, histopathological and immunohistochemical examinations of the resected tissue showed hypertrophy the islets of Langerhans and β-cells around the pancreatic ducts. The final diagnosis was adult-onset nesidioblastosis. Postoperatively, the patient continued to exhibit hyperinsulinemia and nighttime hypoglycemia (30-40 mg/dl). Diazoxide treatment which was not approved in Japan for the management of nesidioblastoma, was started after obtaining informed consent, and demonstrated a noticeable effect immediately. To date, treatment with 200 mg/day diazoxide has resulted in amelioration the patient's nocturnal hypoglycemia and other symptoms. In conclusion, we experienced a rare case of adult-onset nesidioblastosis. Since preoperative diagnosis of adult-onset nesidioblastosis is difficult to confirm, there is no standardized management for this condition. The implemented treatment strategy in this patient suggests that diazoxide may be effective for nesidioblastosis in adults and could be useful for long-term treatment of patients with hypoglycemia and hyperinsulinemia after pancreatectomy.
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  • A Case of Slowly Progressive Type 1 Diabetes Associated with Ulcerative Colitis
    Hideyuki Tsuji, Tsuyoshi Kuroda, Yuichi Orita, Kunihiko Nakamura
    2010 Volume 53 Issue 11 Pages 810-816
    Published: 2010
    Released on J-STAGE: December 17, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.810
    JOURNAL FREE ACCESS
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    The patient was a 51-year-old female. She had developed Graves' disease at the age of 20 years, slowly demonstrated progressive type 1 diabetes at 37 years, and had been followed up while undergoing insulin injection therapy twice/day. She developed diarrhea from June 2008, demonstrated the aggravation of diarrhea and abdominal pain from the middle of October, and frequently showed hypoglycemia unawareness due to a poor appetite. She was referred to our hospital for close examination and treatment. After oral antibiotic administration, no improvement was observed. Colonoscopy showed findings of total-colitis-type ulcerative colitis accompanied by cytomegalovirus infection. Total parenteral nutrition with no oral intake was initiated, and the blood glucose level was controlled by continuous intravenous infusion using an insulin syringe pump and the sliding-scale method. The administration of intravenous ganciclovir injections (14 days) and oral 5-aminosalicylate agents was initiated. Then, 2 courses of steroid pulse therapy were performed. Subsequently, continuous steroid therapy was conducted, and the symptoms gradually improved. The patient tested positive for both anti-GAD antibodies and anti-TPO antibodies, but negative for anti-IA-2 antibodies and TSH-R antibodies. She also had HLA-DR4 which has been recognized as a susceptibility HLA for type 1 diabetes in Japan.
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Co-medical, Short Report
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