Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 55, Issue 5
Displaying 1-12 of 12 articles from this issue
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Feature
Energy Expenditure and Metabolic Disorder
Original Articles
Epidemiology
  • Study on the Clinical Features of Emergency-room Cases of Hypoglycemia
    Takanori Kudo, Takako Moriyama, Yoshifumi Kakizaki, Nobuhiko Kasai
    2012 Volume 55 Issue 5 Pages 316-321
    Published: 2012
    Released on J-STAGE: June 13, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.316
    JOURNAL FREE ACCESS
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    Diabetes mellitus pharmacotherapy may trigger severe hypoglycemic attacks. This study involves 33 of 51 subjects with type 2 diabetes seen in the emergency room for hypoglycemia between October 2009 and September 2010. Age 78.8±3.9 years vs 70.3±11.2 years and prevalent sulfonyl urea (SU) pharmacotherapy of 47.1 % vs 13.3 % were significantly higher in HbA1c (JDS) of <6.5 % than in HbA1c≥6.5 %. The incidence requiring hospitalization was significantly higher than those not at age 77.5±8.5 % vs 69.5±10.3 % and in prevalent SU pharmacotherapy, i.e., 52.6 % vs 7.1 %. SU pharmacotherapy is widely used in subjects with type 2 diabetes. Strict SU glycemic control may however, increase hypoglycemia risk in the elderly. Our results suggest the need to be aware of this risk in SU pharmacotherapy. Efforts should thus be directed to hypoglycemia risk and measures against it.
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Health Service, Medical Economics
Case Reports
  • Octreotide Therapy Improves Acromegaly-associated Dilated Cardiomyopathy in a Diabetes Despite "Uncontrolled" Blood Glucose; with A Case Report
    Masako Sakamoto, Mei Uemura, Taro Yasuma, Ryoma Sasaki, Yuki Onishi, T ...
    2012 Volume 55 Issue 5 Pages 328-334
    Published: 2012
    Released on J-STAGE: June 13, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.328
    JOURNAL FREE ACCESS
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    Dilated cardiomyopathy with acromegaly is a rare clinical entity potentially associated with both elevated GH and IGF-1 plasma levels and with chronic hyperglycemia. A 52-year-old man undergoing insulin therapy for diabetes mellitus was diagnosed with acromegaly-associated dilated cardiomyopathy. He had high plasma GH and IGF-1 levels, and computed tomography (CT) showed a pituitary tumor. GH and IGF-1 plasma levels and tumor size decreased after octreotide treatment. Clinical symptoms, plasma BNP, left ventricular diastolic dimension, and ejection fraction assessed by ultrasonography were also ameliorated after 3 months of octreotide therapy. The insulin dose had to be increased, however when blood glucose control decreased due to excessive caloric intake. Octreotide therapy improved cardiac dysfunction and GH and IGF-1 levels despite high blood glucose levels. These observations suggest that dilated cardiomyopathy may thus be affected by diabetes-mellitus factors other than metabolic abnormalities. Octreotide therapy appeared effective in improving cardiac dysfunction in subjects with diabetes mellitus and acromegaly-associated dilated cardiomyopathy.
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  • A Case of Pregnancy Complicated by Diabetes Mellitus in Diabetes Insipidus Manifested during Late Pregnancy
    Yuki Fukuoka, Takuma Narita, Masaki Ogawa, Akira Sato, Yukihiro Terada ...
    2012 Volume 55 Issue 5 Pages 335-339
    Published: 2012
    Released on J-STAGE: June 13, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.335
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    Diabetes insipidus complicating pregnancy is rare, occurring in 1 out of 40,000 to 300,000 pregnancies, so we report a thought-provoking case. A 35-year-old pregnant woman with polycystic ovary syndrome and diabetes mellitus developed thirst, polydipsia, and marked polyuria in gestational week 34. HbA1c (JDS) was maintained at 5-6 % with insulin treatment. Drink restriction only for 5 hours after breakfast increased serum sodium from 138 mEq/l to 144 mEq/l, and plasma osmolality exceeded urine osmolality of 213 mOsm/kg at 293 mOsm/kg. Plasma arginine vasopressin (AVP) was 0.9 pg/ml, without any increase. The woman was hospitalized for suspected central diabetes insipidus. Tentative intranasal desmopressin decreased urinary output to about 2 l/day. After delivery, desmopressin was discontinued. Urinary output returned to prepregnancy levels. Head magnetic resonance imaging (MRI) showed decreased high signal intensity in the posterior pituitary gland, and insufficient AVP increase was observed in a hypertonic saline loading test. Partial diabetes insipidus may have been partially manifested during late pregnancy, since increased AVP demand due to placental vasopressinase activity enhanced by pregnancy was not fully compensated for.
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  • A Case of Autoimmune Polyglandular Syndrome Type 3 with Plasma Glucose and C-peptide Levels Observed before and after Diabetes Onset
    Yukie Soeda, Kumiko Tanaka, Yoshifumi Saisho, Shu Meguro, Akira Shimad ...
    2012 Volume 55 Issue 5 Pages 340-344
    Published: 2012
    Released on J-STAGE: June 13, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.340
    JOURNAL FREE ACCESS
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    Changes in metabolic parameters before type 1 diabetes onset remain unclear, so we report the case of a natural history of adult-onset type 1 diabetes. A 59-year-old man with autoimmune polyglandular syndrome type 3 had his plasma glucose and C-peptide levels observed before and after diabetes onset. He was diagnosed with Hashimoto disease in 1991, and LT4 replacement therapy was started. Due to weight gain, levels of plasma glucose, C-peptide, and glycosylated hemoglobin were measured since 2002. In 2005, he was hospitalized for diabetic ketoacidosis, and insulin therapy was started. We then confirmed that he was positive for islet-related autoantibodies and diagnosed him with type 1 diabetes.
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  • A Case of Insulin-Deficient Diabetes Mellitus Associated with Circular Colonic Ulcer and Ketoacidosis Triggered by Excessive Soft-Drink Intake
    Kenro Imaeda, Takashi Kato, Aki Ichiyanagi, Haruka Kitada, Soji Iwase, ...
    2012 Volume 55 Issue 5 Pages 345-351
    Published: 2012
    Released on J-STAGE: June 13, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.345
    JOURNAL FREE ACCESS
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    A 63-year-old man reporting general fatigue, thirst, and vomiting for 7 days was hospitalized after losing consciousness following excessive soft-drink intake. He had not been diagnosed with diabetes mellitus previously. Laboratory data on admission showed plasma glucose of 1425 mg/dl, pH of 7.092, HbA1c of 10.4 % (JDS), and urinary ketone body of 2+, resulting in a diagnosis of diabetic ketoacidosis (DKA). The possibility of fulminant type 1 diabetes mellitus was cautiously considered based on negative anti-GAD antibody, a low serum CPR level of 0.08 ng/ml, and a high s-Amy level of 387 U/l. This was not suitable, however, for the high HbA1c level. He was finally diagnosed insulin-deficient diabetes mellitus associated with DKA triggered by excessive soft-drink intake. Abdominal CT showed a thickened ascending colon wall, and hemoglobin in feces was strongly positive. Endoscopy showed multiple circular ulcers scattered throughout the colon. Infectious colitis was denied because there was no evidence of bacterial infection. Colonic ulcers disappeared after hydration alone, suggesting that they had occurred in ischemia due to dehydration caused by ketoacidosis. This case is noteworthy in that colonic ulcers due to ischemia appear to be possibly caused by DKA triggered in excessive soft-drink intake.
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Proceeding of the Local Societies
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