Factors affecting the blood glucose and urinary ketone levels were investigated in 44 patients with gestational diabetes mellitus (GDM) using continuous glucose monitoring (CGM). The patients received nutritional guidance to eat three small- to moderate-sized meals and one or more snacks each day before the CGM assessment. The amount of nutrient intake was calculated based on the subjects' food records. The ratio of ingested/suggested calories was 88±17 %. The proportion of ingested carbohydrates among total calories was 46±10 %, while that of ingested protein and lipids was 37±9 % and 17±3 %, respectively. A total of 13 patients (30 %) exhibited a ratio of ingested carbohydrates of more than 60 %. Meanwhile, hyperglycemia was observed in 14 subjects (32 %) and was significantly more frequent in the patients with an excessive intake of carbohydrates (64 %) than in those without (13 %). The ingested/suggested calorie ratios were significantly lower in six patients with ketonuria (69±10 %) than in those without (91±17 %). It is therefore important to pay attention to the intake of carbohydrates, not simply the number of ingested calories, in patients with GDM.

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The patient was a 71-year-old woman who had been diagnosed with type 2 diabetes at 34 years of age. Intensive insulin therapy was started at 65 years of age; however, this therapy frequently resulted in hypoglycemic attacks despite adjustments to the dose of insulin. Therefore, the insulin was changed to liraglutide, a GLP-1 receptor agonist. However, the patient then suffered from a gradual loss of appetite and consequent reduction in dietary intake. These changes were associated with the onset of a taste disorder that manifested in terms of the inability to detect sweetness and umami. The patient also experienced an uncomfortable feeling in her eyes, which was subsequently diagnosed as a bilateral diffuse corneal disorder of the epithelium. Due to possible side effects, the administration of liraglutide was discontinued. An immediate improvement was noted in the patient's taste and corneal epithelial disorders. Given that she presented with manifestations of a dissociated taste disorder affecting only the sensations of sweetness and umami, a disorder of salivation or nerve fiber dysfunction was judged to be unlikely. As such, liraglutide-induced dysfunction of the GLP-1 receptor is the most plausible explanation for the symptoms observed in this case. Additionally, a drug-induced illness was strongly suspected based on the occurrence of the bilateral diffuse corneal disorder.

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As of 2013, a total of 66 patients have won the Lilly Insulin 50-year Award, which has been granted annually in Japan since 2003. Of these 66 patients, 16 (24 %) (13 with type 1 diabetes, two with type 2 diabetes and one with another type of diabetes) are visiting or have visited the Diabetes Center at the Tokyo Women's Medical University School of Medicine on an outpatient basis. The average HbA1c value in patients with type 1 diabetes from 1983 to 2013 was 8.4 %. A total of 10 patients (77 %) had hypertension and five patients (38 %) had dyslipidemia. Meanwhile, two patients (15 %) had no retinopathy and nine patients (69 %) underwent photocoagulation, whereas no patients had proliferative retinopathy. In addition, six patients (46 %) showed abnormal urine albumin levels; however, no patients progressed to Stage 4 (renal failure) diabetic nephropathy. In terms of medical history, four patients (31 %) had a cerebrovascular disorder and one patient (8 %) had coronary artery disease. The subjects suffered from various diseases, including diabetes, and have overcome an extremely poor environment to lead a normal daily life with insulin treatment.

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A 78-year-old woman was admitted to the hospital with severe hypoglycemia. Her serum IRI level was moderately high, and computed tomography revealed a large lung tumor. She was subsequently diagnosed with non-islet cell tumor hypoglycemia (NICTH) following the identification of a high serum IGF-II level on Western immunoblotting. Surgical treatment for the lung tumor was not feasible due to the patient's general status, and managing the hypoglycemia was difficult based on the required large volume of glucose infusion. We therefore started her on glucocorticoid therapy and evaluated the treatment effect using continuous glucose monitoring (CGM). Consequently, the hypoglycemia disappeared immediately and the blood glucose level became stable, with no increases in the serum IGF-I level or decreases in the serum IGF-II level. This case suggests that steroid therapy is effective for inoperable NICTH cases and that CGM is useful for evaluating the effects of this therapy.

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A 21-year-old woman was admitted to our hospital with a history of fever, fatigue, headache, palpitations and nausea lasting for one month. On a physical examination, her vital signs were as follows: T=38.5 °C, P=106/minute and BP=186/133 mmHg. Laboratory data revealed diabetes, with a random glucose level of 256 mg/dl and HbA1c level of 8.2 %, as well as both elevated C-reactive protein (40.21 mg/dl) and interleukin-6 (100 pg/ml) levels. In addition, computed tomography of the abdomen indicated a left adrenal tumor, while ¹²³I-MIBG scintigraphy demonstrated accumulation of the isotope in the same region. Based on the patient's clinical data and elevated catecholamine levels, a diagnosis of pheochromocytoma was made. Consequently, almost immediate resolution of the fever followed by gradual normalization of the levels of clinical inflammatory markers was achieved after seven weeks of treatment with naproxen, doxazosin and propranolol. Furthermore, the C-reactive protein and interleukin-6 levels decreased to 0.15 mg/dl and 1.7 pg/ml, respectively, after increasing the dose of naproxen up to 600 mg, and the patient's glucose tolerance improved, enabling her to successfully stop insulin treatment prior to surgery. Therapy with naproxen for interleukin-6-producing pheochromocytoma is effective for improving secondary diabetes mellitus and may subsequently lead to reductions in the rates of perioperative complications associated with glucose intolerance.

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