This study reviewed 135 type 2 diabetes patients (age, 74.0±10.0 years) with drug-induced severe hypoglycemia that arrived at the hospital by ambulance between November 2008 and October 2011. Their plasma glucose levels (33.7±10.3 mg/dl) correlated with their levels of consciousness at the time of admission. Six patients had irreversible brain damage, which correlated with the estimated duration of the coma. A coma lasting less than 8 hours might promote consciousness recovery, but those greater than 12 hours might not. Eighty-nine patients were treated with sulfonylurea (SU) ; 38 with insulin; 4 with both SU and DPP-4 inhibitors; 3 with both SU and insulin; and 1 with glinides. Hypoglycemia due to SU, rather than insulin, was associated with an increased prevalence and duration of comas. The SU-treated patients were older and had less knowledge of hypoglycemia than the insulin-treated patients. The HbA1c level (6.07 %±0.82 %; Japan Diabetes Society [JDS]) of the SU-treated patients was lower than that of the insulin-treated patients. Severe hypoglycemia could be mainly explained by the inadequate administration of SU and inadequate instructions regarding the symptoms of hypoglycemia to elderly patients. There were many patients with severe hypoglycemia, despite the "Recommendations for Diabetic Medications" from the JDS. Therefore, it is necessary to more clearly determine the appropriate and safe medical therapy for elderly patients with diabetes.

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The purpose of this study was to analyze the short-term and one-year outcomes of children with type 1 diabetes who participated in a diabetes camp. A national survey of the educational effects of diabetes camps (915 subjects) obtained valid answers from 247 subjects from 24 camps, which were analyzed according to the type of participation (continuous, experience, first-time, and non-participation) . The analysis revealed; (1) the appreciation of the camp was extremely high, and "making friends" was the most important goal of the camp; (2) the continuous-participation group showed a significant improvement in the score of the self-efficacy scale for diabetes after participating in the camp for one year. In addition, the participants created an environment in which they could readily ask for help when their symptoms became aggravated, by becoming more open about having diabetes and improving their relationships with people around them; and (3) the HbA1c levels continuously decreased after participating in the camp for one year in the continuous-participation and first-time participation groups. Participation in a diabetes camp is an important experience for adolescents living with type 1 diabetes which allows them the opportunity to gain confidence and an improved control of diabetes mellitus.

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A 76-year-old male was diagnosed to have diabetes mellitus at 57 years of age and oral hypoglycemic agents were started. Aspart, a human insulin analogue, was initiated because of a poor glycemic control in July 2009, at 74 years of age. He complained of dizziness and faintness caused by hypoglycemia in the early morning and afternoon. He was admitted to another hospital in August 2010; his plasma insulin levels were markedly elevated (11,000 μU/ml) , and ¹²⁵I-insulin binding rate of anti-insulin antibodies was 89.5 %.
He was transferred to this hospital in September 2010, and a Scatchard analysis of his anti-insulin antibodies showed low affinity and high capacity. The daily profiles of blood glucose were evaluated precisely by continuous glucose monitoring (CGM) . CGM showed low blood glucose levels in the early morning and afternoon, when human insulin injections were given twice daily. In addition, insulin and diet therapies were adjusted to prevent hypoglycemia, and accordingly, blood glucose control was improved. Hence, CGM is therefore considered to be useful in the management of brittle diabetes cause by anti-insulin antibodies.

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A 31-year old woman with type-1 diabetes mellitus was referred to the hospital because of poor blood glucose control. She had been treated with multiple daily insulin injections but her glycohemoglobin was 8.7 % (NGSP value) . She agreed to undergo continuous subcutaneous insulin infusion (CSII) therapy and was admitted to the ward. Continuous glucose monitoring (CGM) was performed using a CGMS Gold^® (Medtronic Minimed, USA) which assayed blood glucose at 5 time-points (before and after breakfast and dinner, and at bed time) , in order to adjust the insulin infusion rate for CSII. There was a remarkable improvement in the blood glucose level and fewer hypoglycemic episodes after instituting CSII therapy. CGM was therefore found to be very useful for the adjustment of CSII.

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This report presents a case of 54-year-old obese female with type 2 diabetes. She had been diagnosed to have diabetes at the age of 37, and immediately treated with metformin. Glimepiride and pioglitazone were added at the age of 47 and 53, respectively. However, her glycemic control remained poor with HbA1c between 11.5～12.2 %. She received 3 mg glimepiride, 750 mg metformin, and 15 mg pioglitazone, in January 2011; however, her HbA1c was 12.1 %. Liraglutide was administered at an initial dose of 0.3 mg up to 0.9 mg per day, and metformin and pioglitazone were discontinued according to the package insert of liraglutide. There was improvement of hyperglycemia and an increase in plasma insulin levels not only after fasting but also in the post prandial state. However, markers of insulin resistance rapidly worsened. Therefore, insulin resistance must be evaluated as well as glycemic control in obese patients with type 2 diabetes that are treated with insulin sensitizers if the administration of liraglutide is considered.

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The patient was an obese 44-year-old man. He developed symptoms of hyperglycemia in July 2008 and was admitted to the hospital with a diagnosis of diabetic ketosis on July 25^th. He did not consume a lot of soft drinks. Tests for the anti-GAD antibody were negative. He was gradually weaned from insulin, and discharged on oral pioglitazone. Although the HbA1c level improved to 5.6 %, subsequent weight gain led to poor glycemic control in July 2009. He was hospitalized with hyperglycemia symptoms in August 2009. The HbA1c level was 8.5 %. His urine was positive for ketone bodies. His endogenous insulin secretory function had declined from the previous year. His serum was positive for islet-associated autoantibodies. Despite an improvement with insulin therapy, glycemic control deteriorated again because the patient was not able to comply with the diet and exercise therapy, thus resulting in weight gain. The endogenous insulin secretory function showed a slight, but insufficient improvement after his discharge from the hospital. Islet-associated autoantibodies became negative in April 2011. The patient was therefore diagnosed to have ketosis-prone type 2 diabetes, based on the clinical course. There have so far been few reports of this condition in Japan. This report presents this case, along with a review of the pertinent literature.

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We studied the clinical characteristics of five Japanese patients (one male) younger than 30 years of age with onset of type 1 diabetes who died of acute myocardial infarction between 1962 and 31 December, 2010. We conducted the data analysis before the subjects' deaths. One patient had familial hypercholesterolemia (FH). All patients, except for the FH patient, had end-stage renal disease (stage 4: one patient, stage 5: three patients, BMI: 21.2±1.7 kg/m², TC: 174.8±23.8 mg/dl, HDL: 68.3±19.1 mg/dl, TG: 77.3±37.5 mg/dl[mean±SD]). The duration of dialysis in the three patients with stage 5 nephropathy was one, seven and 14 years. All of the Japanese type 1 diabetic patients who died of acute myocardial infarction, except the patient with FH, had end-stage renal disease.

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