The "Diabetes Negative Cognition Scale" (DNCS), with seven clusters and 26 items (J. Japan Diab. Soc. 56[8]), was used to compare the clinical characteristics of subgroups of diabetes patients classified by type (diabetes type 1 or 2), gender, age, and treatment. Patients with type 1 diabetes had significantly higher scores than patients with type 2 diabetes in the following clusters: "Absence of a reason for living" and "Sense of alienation". Patients with type 2 diabetes patients had significantly higher scores for "Burden of diabetes", "Distrust toward medical treatment", and "Rejection of antidiabetic drugs or insulin". In both types 1 and 2, women had significantly higher scores than men for "Burden of diabetes" and "Sense of alienation". For type 2 diabetes, patients undergoing insulin therapy had significantly higher scores than the other treatment groups for "Absence of a reason for living", "Burden of diabetes", "Distrust toward medical treatment", and "Sense of alienation" and had a significantly lower score for "Rejection of antidiabetic drugs or insulin". The DNC score reflects the burden felt by diabetes patients. Referring to these findings, which clarify the differences among the various diabetes subgroups, will allow us to deal with our patients more appropriately, which will lead to more desirable outcomes.

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A 71-year-old man with chronic heart failure due to idiopathic dilated cardiomyopathy was diagnosed with type 2 diabetes mellitus at 63 years of age, and he started taking oral hypoglycemic agents. At 70 years of age, insulin therapy was started due to poor glycemic control. Complications of a mild itch and flare at the site of the injection arose 5 to 10 minutes after injecting insulin. He was diagnosed as having an immediate allergic reaction to insulin. The clinical physician then tried several different insulin analogues, however, the symptoms spread to his thigh and hip, and his blood glucose level remained high. He was admitted to our department a year after the initiation of insulin therapy. Considering his previous clinical course and the results of skin tests, we assumed he was allergic to insulin, zinc or protamine. We suggested continuous subcutaneous insulin infusion therapy (CSII), which would be a safer and more effective treatment for him. After he started CSII with insulin aspart, he did not show any allergic reaction and achieved better glycemic control with a decreased dose of insulin. CSII is a beneficial treatment for patients with immediate allergy to insulin preparations.

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The patient of the present study was a 37-year-old woman with a triplet pregnancy who had been diagnosed with acute-onset type 1 diabetes mellitus at 25 years of age. From 27 years of age, her diabetes was managed with continuous subcutaneous insulin infusion (CSII). She delivered her first child at 33 years of age. We herein describe the management of her diabetes during her triplet pregnancy. The insulin requirement showed a tendency to slightly increase until the 18th week of pregnancy, and increased from week 23. At the 28th week, the total daily dose of insulin was 1.9 times higher than it had been prior to her pregnancy. From week 28, we began to administer ritodrine (20 mg, orally). The patient's insulin requirement (mainly bolus insulin) increased immediately, but decreased during a few days. From week 31, we began to administer ritodrine (100 mg) by continuous intravenous infusion. The patient's insulin requirement increased again, but subsequently decreased. Triplets were delivered by cesarean section on pregnancy week 33, day 6. It was possible to precisely manage the patient's insulin levels during her triplet pregnancy. The present case showed that CSII was useful in managing the patient's insulin levels even in this case which involved a triplet pregnancy, as it allowed for the insulin dosage to be adjusted to the changeable insulin requirements throughout the pregnancy and for the fluctuations in insulin that were induced by the administration of ritodrine.

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