Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 59, Issue 5
Displaying 1-13 of 13 articles from this issue
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Feature
The Molecular Mechanism of Pancreatic beta cell failure in Type 2 Diabetes Mellitus
Original Articles
Diagnosis, Treatment
  • Proposition of the Simplified Method Using Patients' Hands for Carbohydrate Counting in Japanese Patients With Type 1 Diabetes Mellitus
    Saeko Dokawa, Takaaki Murakami, Tomonobu Hatoko, Tomoko Kato, Yuki Mat ...
    2016 Volume 59 Issue 5 Pages 344-352
    Published: May 30, 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.11213/tonyobyo.59.344
    JOURNAL FREE ACCESS
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    Although it is known to be useful for controlling the postprandial blood glucose level of subjects with type 1 diabetes mellitus (T1D), carbohydrate counting (CC) has not been popular in Japan. We propose a method for estimating the carbohydrate content using an individual's hands as a means of introducing CC. We demonstrated that the difference between our estimation, based on this method, and the precise count based on the food substitution list was within 10 g in over 90 % of 210 diabetic diets (1200-2000 kcal/day) and 50 diet record images. Moreover, we compared 12 T1D patients who performed CC with the hand counting method with another 10 T1D patients who performed CC using the conventional method. At 12 months after the introduction of CC, although no significant differences were observed in the HbA1c value or the body mass index of the patients in the two groups, the patients who used the hand counting method showed a significantly lower frequency of hypoglycemia. The results indicate that the hand counting method is reasonably accurate and clinically useful in the management of Japanese T1D patients.
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  • Clinical Characteristics of Patients With Gestational Diabetes Mellitus Who Require Insulin Therapy
    Emi Sohara, Makoto Ujihara, Yumiko Komatsu, Yasuo Terauchi
    2016 Volume 59 Issue 5 Pages 353-359
    Published: May 30, 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.11213/tonyobyo.59.353
    JOURNAL FREE ACCESS
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    The incidence of gestational diabetes mellitus (GDM) has recently increased because of an increase in the number of people who have adopted the Western lifestyle and a change in the diagnostic criteria for GDM in 2010. We herein examined factors that determined whether patients with GDM in our hospital required insulin therapy. Sixty-eight patients with GDM were categorized as those who required insulin therapy (40 patients) and those who did not and were under diet therapy (28 patients). We collected data regarding age, gestational week, body mass index (BMI), 75-g oral glucose tolerance test (OGTT) result, and glycosylated hemoglobin (HbA1c) level from patients in both groups at the time of diagnosis and performed a comparative study. The BMI, HbA1c level, 75-g OGTT results at 60 and 120 min, and number of GDM diagnostic criteria that the patients met were significantly higher in the group that required insulin therapy than in the diet therapy group. Our findings suggest that patients who do not have a high BMI and meet only the diagnostic criterion of fasting blood sugar level among the GDM criteria can be managed with dietary therapy alone.
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Pathophysiology, Metabolic Abnormalities, Complications
  • Validation of a Simple Screening Questionnaire on Sensory Symptoms for Diabetic Neuropathy
    Kazuhiro Sugimoto, Susumu Suzuki
    2016 Volume 59 Issue 5 Pages 360-368
    Published: May 30, 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.11213/tonyobyo.59.360
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    The present study investigated the relationships between the results of a brief questionnaire survey regarding sensory symptoms in both legs, the Achilles tendon reflex (ATR), and quantitative impairment of the peripheral nerve function in 370 diabetic outpatients. Of the 49 patients (13.2 %) with sensory symptoms in both legs at the time of the survey, 93.5 % had abnormal ATR. A significantly greater impairment in the motor and sensory nerve function and heart rate variability were observed in patients with sensory symptoms compared to those without sensory symptoms. A comparison between patients with sensory symptoms and 53 patients without sensory symptoms matched for sex, age, and A1c levels demonstrated that patients with abnormal ATR had significantly decreased motor nerve conduction velocity and sensory nerve action potential, regardless of the presence or absence of sensory symptoms compared with patients without sensory symptoms and abnormal ATR. While a higher rate of abnormal ATR and a significantly decreased peripheral nerve function were observed in patients with sensory symptoms, a decreased peripheral nerve function was also found in patients with abnormal ATR but without sensory symptoms. These findings indicate that in addition to sensory symptoms, an ATR evaluation should be performed when screening for diabetic neuropathy.
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Case Reports
  • A Case of Glucocorticoid-Induced Severe Strongyloidiasis That Occurred in an HTLV-1Carrier With Type 2 Diabetes Mellitus
    Kenichiro Wakuta, Yoko Maekawa, Kurando Watanabe, Norihumi Kamiya, Tom ...
    2016 Volume 59 Issue 5 Pages 369-375
    Published: May 30, 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.11213/tonyobyo.59.369
    JOURNAL FREE ACCESS
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    An 85-year-old woman with type 2 diabetes who was treated for bullous pemphigoid with steroids for 2 months presented with a fever for 3 days before hospitalization. Following diagnostic investigations, bacterial pneumonia and ketoacidosis were diagnosed. Steroid treatment was discontinued, and treatment with continuous intravenous insulin infusion and intravenous antibiotics was initiated. However, Strongyloides stercoralis was isolated from a sputum sample on the first day after admission. S. stercoralis hyperinfection was diagnosed, and treatment with ivermectin was initiated. During the same period, her consciousness levels and respiratory status worsened because of the development of bacterial meningitis and non-cardiogenic pulmonary edema. Treatment was therefore changed to broad-spectrum antibiotics and noninvasive positive pressure ventilation. The patient was positive for HTLV-1 antibodies, which were evaluated after hospitalization. After 2 weeks of ivermectin treatment, S. stercoralis was no longer detectable in the sputum or stool samples. Following hospitalization for approximately 60 days, the patient's consciousness levels and respiratory status recovered. We believe the present case is of particular interest because of its rarity and the provision of valuable clinical information related to the successful treatment of an HTLV-1 carrier and type 2 diabetic patient with S. stercoralis hyperinfection, ketoacidosis, bacterial meningitis, and non-cardiogenic pulmonary edema.
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  • A Case of Autoimmune Polyglandular Syndrome Type 3 (APS Type 3) With Diabetic Ketoacidosis and Hyperthyroidism Accompanied With Early Disappearance of Disease-Specific Antibodies
    Naoki Gocho, Ema Aoki, Chiho Okada, Kazuki Omura, Takeshi Hirashima, H ...
    2016 Volume 59 Issue 5 Pages 376-384
    Published: May 30, 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.11213/tonyobyo.59.376
    JOURNAL FREE ACCESS
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    A 46-year-old woman was admitted to another hospital due to a fever, abdominal pain, and persist vomiting for several days. The next day, she was transferred to our hospital on suspicion of diabetic emergency. A laboratory examination showed elevated levels of white blood cells, C-reactive protein, plasma glucose and ketone bodies with metabolic acidosis and hyperthyroidism. Under a diagnosis of diabetic ketoacidosis and severe hyperthyroidism, an intravenous insulin infusion with oral administration of methimazole and iodine potassium was started immediately. Antibiotic treatment was added, because enhanced computed tomography revealed pelvic peritonitis. After her general condition ameliorated with the resolution of the above-mentioned pathologies, she was discharged with multiple daily insulin injections. She was diagnosed with type 1 diabetes and Graves' disease according to positive islet cell-related antibodies and thyrotropin receptor antibody, which constitute autoimmune polyglandular syndrome (APS) type 3. On screening for other antibodies, cyclic citrullinated peptide antibody and anti-mitochondrial M2 antibody were detected on admission, but both disappeared soon after discharge. We herein report a case of APS type 3 with diabetic ketoacidosis and hyperthyroidism complicated by a spontaneous disappearance of disease-specific antibodies. The pathogenesis of this rare case is also discussed.
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Proceeding of the Local Societies
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