Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 57, Issue 9
Displaying 1-15 of 15 articles from this issue
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Feature
Diabetes in Older Adults
Case Reports
  • A Case of Type 2 Diabetes Associated with Orbital Apex Syndrome Induced by Invasive Aspergillosis
    Ayako Yokota, Junko Sato, Atsushi Arakawa, Aiko Kurisaki, Chie Omura, ...
    2014 Volume 57 Issue 9 Pages 699-705
    Published: September 30, 2014
    Released on J-STAGE: October 07, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.699
    JOURNAL FREE ACCESS
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    We herein report the case of woman who suffered from orbital apex syndrome induced by invasive aspergillosis. The patient's initial presenting symptom was blepharoptosis, and she was subsequently diagnosed with oculomotor nerve paralysis due to diabetes mellitus. One month later, she lost her sight in the right eye, and an orbital tumor was confirmed on MRI. A biopsy was suggested; however, the patient refused this treatment and was observed as an outpatient. Three months later, she admitted to the hospital in a physically weakened state, and the tumor was found to have extended into the brain. A biopsy was finally performed under a diagnosis of orbital apex syndrome in order to confirm the presence of invasive aspergillosis. Treatment with voriconazole with strict glycemic control reduced the size of the lesion and improved the patient's symptoms. This is a rare case in that a diabetic patient without severe immune insufficiency suffered from invasive aspergillosis of the central nervous system. Therefore, physicians should consider the possibility of orbital apex syndrome in patients with diabetes mellitus who exhibit a disturbance in ocular motility.
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  • A Case of Diabetic Ketoacidosis Subsequent to Diabetic Muscle Infarction in the Upper Arm
    Yuki Matsuda, Takuo Nambu, Takaaki Murakami, Koji Matsuo, Shin Yonemit ...
    2014 Volume 57 Issue 9 Pages 706-713
    Published: September 30, 2014
    Released on J-STAGE: October 07, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.706
    JOURNAL FREE ACCESS
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    We herein report the case of a 42-year-old woman who experienced sudden right upper arm pain, followed by polydipsia and fatigue with the gradual development of disturbed consciousness. Five days later, she visited our emergency room. The detection of a high HbA1c level (15.8 %) and hyperketonemia led to a diagnosis of diabetic ketoacidosis; thus, insulin injection therapy with hydration was initiated. The acute onset of bruising in the patient's right upper arm and cubital region after admission was diagnosed as diabetic muscle infarction (DMI) on magnetic resonance imaging and managed with conservative therapy. DMI, the acute onset of painful swelling of the affected striated muscle, is a rare complication of diabetes thought to be caused by vascular injury and/or abnormalities in the coagulation-fibrinolysis system. Although DMI has a favorable therapeutic outcome, the prognosis may be poor if the patient has severe diabetic vascular complications. Therefore, physicians should consider the possibility of DMI in diabetic patients presenting with limb pain and/or swelling.
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  • A Case of Severe Postprandial Hypoglycemia Suspected to be Caused by Hepatitis B and Liver Cirrhosis
    Kana Miyake, Yuichi Takashi, Yoko Matsuzawa, Takumi Kitamoto, Kenichi ...
    2014 Volume 57 Issue 9 Pages 714-721
    Published: September 30, 2014
    Released on J-STAGE: October 07, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.714
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    A 64-year-old woman, who had previously been diagnosed with chronic hepatitis B, developed postprandial hypoglycemia. She had refused to take antiviral drugs. The HbA1c level was 5.7 % according to the NGSP value. On a 5-hour 75-g OGTT, hyperglycemia (314 mg/dl) with hyperinsulinemia (195.4 μU/ml) appeared at 1.5-2 hours and symptomatic hypoglycemia (44 mg/dl) appeared at five hours. On a 25-g IVGTT, hyperglycemia (396 mg/dl) appeared at five minutes, followed by hyperinsulinemia (40-50 μU/ml) at 10-90 minutes with symptomatic hypoglycemia (50 mg/dl). The possibility of an insulinoma was considered to be very low, as no hypoglycemic events were induced during an 18-hour fast and no pancreatic tumors were detected. The prescription of a divided diet and treatment with voglibose was effective in reducing the patient's hypoglycemia. A splenorenal shunt and arterioportal shunt were subsequently detected on a CT scan. Conclusions: In the present case, delayed hyperglycemia and hyperinsulinemia were observed on a 75-g OGTT. Changes in the patient's hemodynamic state due to the presence of shunt vessels and alterations in glucose-insulin metabolism were thought to be the cause of severe hyperglycemia and hypoglycemia in this case.
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  • Subcutaneous Injection of 300 IU of Glargine during a Suicide Attempt in a Man with Mitochondrial Diabetes
    Ichizo Tsujino, Akiko Hayashishita, Taku Watanabe, Asuka Yamada, Takah ...
    2014 Volume 57 Issue 9 Pages 722-728
    Published: September 30, 2014
    Released on J-STAGE: October 07, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.722
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    A 35-year-old man with depression and diabetes mellitus was admitted to our department following a suicide attempt in which he subcutaneously injected himself with 300 IU of insulin glargine. We closely monitored the patient's glucose level and administered oral/intravenous glucose as needed, and he subsequently recovered from hypoglycemia approximately 50 hours after admission. He was also found to have hearing loss, hypertrophic cardiomyopathy and a mutation in the mitochondrial DNA at nucleotide position 3243, thereby fulfilling the diagnostic criteria for mitochondrial disease. Clinically, both the patient's diabetes mellitus and depression were considered to be caused by this underlying disease. In the present report, we discuss the possible role of mitochondrial disease in the present case as well as the appropriate management of insulin overdoses and issues regarding concurrent depression in diabetic patients.
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  • Comparison of Continuous Glucose Monitoring (CGM) Values before and after Adrenalectomy in a Case of Adrenaline-producing Pheochromocytoma
    Takeshi Kondo, Akio Kuroda, Kimiko Sogabe, Yukari Ohguro, Kiyoe Kuraha ...
    2014 Volume 57 Issue 9 Pages 729-735
    Published: September 30, 2014
    Released on J-STAGE: October 07, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.729
    JOURNAL FREE ACCESS
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    A 77-year-old woman was incidentally found to have a left adrenal mass measuring 2.5 cm in January 2012. The urine metanephrine concentration was 3.0 mg/day (normal range, 0.04-0.19 mg/day), and an iodine-131 metaiodobenzylguanidine (MIBG) scan showed uptake in the area of the left adrenal gland, leading to a diagnosis of pheochromocytoma. In addition, the patient had a history of diabetes mellitus for nine years, with gradually worsening blood glucose control since 2010. The patient was subsequently admitted to our hospital for perioperative care. On admission, her fasting blood glucose level was 121 mg/dl and her HbA1c level was 8.5 %. She was treated with basal-bolus insulin therapy during hospitalization and underwent adrenalectomy at the urology department after her glycemic control had improved. The total daily insulin dose was immediately decreased from 50 to 14 units after the adrenalectomy procedure. In addition, the mean glucose level on preoperative continuous glucose monitoring (CGM) had been 141 mg/dl with a standard deviation (SD) of 54. However, after the operation, the mean glucose level increased to 153 mg/dl while the SD decreased to 24; thus, the range of glycemic fluctuation markedly decreased after surgery. Therefore, excess endogenous adrenalin primarily contributed to the glycemic fluctuations observed in this patient with pheochromocytoma.
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Letters to the Editor
Proceeding of the Local Societies
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