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Volume 55, Issue 9
Displaying 1-10 of 10 articles from this issue
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Original Article
Epidemiology
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Azuma Kanatsuka, Masahiro Mimura, Masaki Sinomiya, Naotake Hashimoto, ...2012 Volume 55 Issue 9 Pages 671-680
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSWe surveyed diabetic clinics in Chiba prefecture with a number of clinicians as the responders: board certified diabetologists of the Japan Diabetes Society (BCD); members of the Japan Diabetes Society (M); registered diabetes mellitus doctors of the Japan Diabetes Association (RDMD); and general physicians (GP). The survey was performed in 17 hospitals with 67 clinics, and 25 BCDs, 15 M or RDMD and 50 GPs participated. Of 3930 patients, those treated by BCDs were younger, compared with the patients treated by GPs (p<0.001). BCDs prescribed insulin preparations in 32 % of patients, and GPs in 10 % of patients (p<0.001). Thirty-two percent of the patients treated by BCDs and 50 % of those treated by GPs had HbA1c levels (JDS value) of less than 6.5 % (p<0.001). A total of 2357 patients were treated using anti-hypertensive drugs; BCDs prescribed more angiotensin receptor II antagonists (ARB) and GPs prescribed more Calcium (Ca) antagonists (p<0.001). BCDs and GPs together, did not examine albuminuria in 162 and 597 patients who had±proteinuria, or+proteinuria, respectively (p<0.001). BCDs contributed greatly to the use of insulin therapy, but glycemic control was poor in many patients. BCDs prescribed ARB more than others, and GPs prescribed more Ca antagonists. In 10 % and 37 % of patients examined by BCDs and GPs respectively, albuminuria for the diagnosis of incipient nephropathy should have been examined.
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Pathophysiology, Metabolic Abnormalities, Complications
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Akinori Hayashi, Tatsumi Moriya, Akifumi Ogawa, Sonomi Yoshino, Eriko ...2012 Volume 55 Issue 9 Pages 681-687
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSBackground: For diabetic patients on hemodialysis (HD), detailed glucose profiles and optimal glycemic markers are not yet available. Therefore, we elucidated the glycemic property of diabetics on HD with continuous glucose monitoring (CGM). Methods: This is a retrospective study of 28 diabetic inpatients on HD using a CGM. We evaluated the patients' glucose profiles on HD days and non-HD days and analyzed the relationships with their glycemic markers. Results: The average glucose level (AG) during a 24-h period on non-HD days (169.1±49.4 mg/dl) was significantly higher than that on HD day (150.0±36.0 mg/dl) (P=0.0346). The standard deviation (SD), as the glycemic variability marker, during the 24-h period on HD days (49.1±19.9 mg/dl) increased compared with that on non-HD days (39.1±13.2 mg/dl) (P=0.0014). AG during a 48-h period correlated with HbA1c (R=0.64, P=0.0003) and glycoalbumin (R=0.54, P=0.0031) levels. SD during the 48-h period correlated with HbA1c (R=0.46, P=0.0129), and glycoalbumin (R=0.64, P=0.0002) levels. Hypoglycemia within 24 h after starting HD was detected in 8 cases (28.6 %), and in the early phase after the HD in 6 cases (21.4 %). Conclusions: CGM showed detailed glucose profiles and can be used to achieve better glycemic control in diabetic patients on HD.
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Case Report
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Yasuhiro Terashima, Mizuki Onishi2012 Volume 55 Issue 9 Pages 688-692
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSA 49-year-old man, seen for thirst and weight loss for a month, was hospitalized due to casual blood glucose of 482 mg/ml and HbA1c of 9.0 % (JDS; Diabetes 53: 450-467, 2010) with ketosis in March 2011. He had had shown normal fasting blood glucose at an annual physical check up in June 2010. On admission, Anti-GAD antibodies were negative, but anti-IA-2 antibodies were 3.7 U/ml, yielding a diagnosis of Type 1 diabetes. Urinary CPR of 4.0 μg/day and plasma CPR of 0.1 ng/ml 6 minutes after glucagon administration indicated decreased insulin secretion. Intensive insulin therapy was started. His condition was complicated with chronic thyroiditis involving TSH of 10.46 μIU/ml, FT3 of 3.25 pg/ml, FT4 of 0.80 ng/dl, and anti-thyroglobulin antibody of 4000 IU/ml. Hormone replacement was started due to progression of his hypothyroidism 4 weeks later. Our case was interesting because it dealt with an autoimmune thyroid disease complication at Type 1 diabetes onset with negative anti-GAD antibodies and positive anti-IA-2 antibodies.
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Satoshi Sakai, Keiji Tanimoto, Mineki Onishi, Kazuhito Ueda, Hirofumi ...2012 Volume 55 Issue 9 Pages 693-697
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSA 74-year-old woman was diagnosed as having slowly progressive type 1 diabetes at age 67, and treated with insulin at that time, but the dose of insulin was gradually increased. She was admitted to our hospital because of poor glycemic control (HbA1c (JDS) 8.7 %) ) and postprandial hypoglycemia, despite the large amounts of insulin (98 units/day). With the reduction of her body weight, the required dose of insulin was decreased, but fasting hyperglycemia persisted and hypoglycemia still occurred after meals. We replaced the basal insulin one by one with insulin detemir (34 units/day), intermediate-acting insulin lispro (30 units/day), or insulin lispro (16.8 units/day) with continuous subcutaneous insulin infusion (CSII). CSII (lispro) maintained better glycemic control compared with insulin detemir. Therefore, we examined the blood glucose level and blood insulin lispro concentration and compared them between CSII (lispro) administration and single subcutaneous injection of intermediate-acting insulin lispro. CSII (lispro) made it possible to obtain higher blood insulin lispro levels even in smaller amounts, and also improved blood glucose level compared with the intermediating-acting type. These findings indicate that even when the structure of insulin is the same, an insulin formulation which remained longer under the skin had difficulty in entering the bloodstream, suggesting that insulin absorption was prevented in the subcutaneous tissue in this patient.
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Yuichiro Nishio, Taku Tsunekawa, Yuri Shinohara, Ikuko Sato, Shuko Yos ...2012 Volume 55 Issue 9 Pages 698-704
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSPassively acquired anti-glutamic acid decarboxylase (anti-GAD) antibodies were detected in three patients after administration of intravenous gamma globulin (IVIg) . Case 1: A 53-year-old man was given IVIg for treatment of Guillain-Barré syndrome had an anti-GAD level of 2.4 U/ml 30 days later. Case 2: A 67-year-old woman was given IVIg for treatment of hypogammaglobulinemia and acute respiratory distress syndrome due to bacterial infection; her anti-GAD level was 2.9 U/ml 22 days later. Case 3: A 73-year-old man was given IVIg for treatment of immune thrombocytopenic purpura (ITP) ; his anti-GAD level was 2.1 U/ml 12 days later. In these three cases, anti-GAD levels before and after IVIg therapies were normal. The anti-GAD levels in all lots of IVIg administrated to these three patients were 2.1-4.9 U/ml. In contrast, anti-GAD levels in a 79-year-old woman who was given IVIg for treatment of ITP was normal (Case 4). The anti-GAD level in the lot of IVIg administrated to this patient was 1.6 U/ml. These results indicate that the transient appearance of anti-GAD in the previous three cases was associated with IVIg administration, and suggest that evaluation of beta cell damage by measuring anti-GAD levels immediately after IVIg administration is difficult.
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Sunao Yamamoto, Yosuke Okada, Keiko Nishida, Koji Matsushita, Tadashi ...2012 Volume 55 Issue 9 Pages 705-709
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSWe report on a 67-year-old woman who suffered from severe hypoglycemia caused by excessive alcohol consumption. She was a heavy drinker from her young adulthood and had been treated with oral prednisolone for rheumatoid arthritis since 1990. In August 2007, she was found comatose in the morning after binge drinking and was transferred to our hospital. Since she was found to be severely hypoglycemic (plasma glucose 8 mg/dl, immunoreactive insulin 0.6 μU/ml) and she recovered consciousness with the intravenous administration of glucose, her diagnosis was hypoglycemic coma. Thereafter, she ate regular meals and quit drinking, with no recurrence of hypoglycemia. A fasting test demonstrated that hypoglycemia unawareness occurred at 40 hours after the start, and a rapid ACTH loading test demonstrated a low cortisol response. Thus, it was suggested that she might experience hypoglycemia unawareness during her daily life because of malnutrition due to chronic alcohol consumption, and subclinical hypothalamic-pituitary-adrenal axis suppression due to oral steroids. Given this background, we concluded that excess alcohol intake induced hypoglycemic coma in this patient through inhibition of gluconeogenesis.
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Yoshitaka Hashimoto, Shogo Kuwagata, Noriko Kato, Mikiko Niimi, Jun Na ...2012 Volume 55 Issue 9 Pages 710-716
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSA 62-year-old man with a 20-year history of non-insulin-dependent diabetes mellitus was admitted to our hospital because of the rapid deterioration of his renal function and increased proteinuria. He had swelling of parotid glands and interstitial pneumonia detected by chest X-ray and computed tomography. He had hypergammaglobulinemia and hypocomplementemia. Urinary β2-MG and NAG were elevated. A renal biopsy revealed tubulointerstitial nephritis and IgG4-positive plasma cell infiltration into the tubulointerstitium in addition to the enlargement of the glomeruli expansion of and the mesangial matrix. He was therefore diagnosed as having IgG4-related kidney disease complicated with diabetic nephropathy. Prednisolone therapy improved his renal function and urinary protein. The dosage of insulin was initially 26 units per day and was increased to 92 units per day to maintain the optimal glucose levels after the treatment. This is the first case of IgG4-related kidney disease superimposed on diabetic nephropathy. This case emphasizes the importance of early diagnosis of other kidney diseases by renal biopsy when we encounter the case of diabetic nephropathy with rapid deterioration of renal function to avoid the induction of dialysis therapy.
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M. Taguchi, Y. Kihara, S. Minami, M. Shibata, M. Yamamoto, M. Harada2012 Volume 55 Issue 9 Pages 717-721
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESS -
Hirofumi Nagao, Takuya Okada, Ayano Suzuki, Hiroyo Terakawa, Shingo Fu ...2012 Volume 55 Issue 9 Pages 722-726
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSAn increase in AST and/or ALT is often observed in patients with fulminant type 1 diabetes mellitus. However, the clinical course and mechanisms have not been fully elucidated. A 40-year-old woman presented to the emergency department of our hospital with disturbed consciousness. For two days before admission, she felt thirsty and nauseauous. Laboratory findings were as follows: plasma glucose 1063 mg/dl, HbA1c 5.6 % (JDS) , urinary ketone bodies (+) , arterial blood pH 7.19, serum C-peptide reactivity (fasting <0.1 ng/ml, 2 hours after meals <0.1 ng/ml) , and urinary C-peptide reactivity <1.70 μg/day, giving a diagnosis of fulminant type 1 diabetes mellitus. AST and ALT showed elevated levels above the normal range 7 days after insulin treatment. The maximum levels of AST and ALT were seen at day 15, and returned to the normal range at day 32. Magnetic resonance imaging (MRI) showed a fatty liver and an enlarged pancreas on T1-weighted images at day 4. At day 30, those findings had improved. Diffusion-weighted MRI of the pancreas showed a high signal intensity at day 4. The signal intensity decreased at day 30. The following report describes a case of fulminant type 1 diabetes mellitus with interesting MRI findings in the liver and pancreas.
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Proceeding of the Local Societies
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2012 Volume 55 Issue 9 Pages 727-751
Published: 2012
Released on J-STAGE: November 08, 2012
JOURNAL FREE ACCESSDownload PDF (936K)
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