We examined the effects of acupuncture on the symptoms of diabetic peripheral neuropathy. The subjects in the present study included 19 patients with diabetes mellitus who had suffered from persistent abnormal sensations, such as numbness, pain, or other uncomfortable sensations in their foot for at least three months. Acupuncture was applied once a week for seven weeks (a total of seven treatments), electrical stimulation was also administered in the second to seventh treatments. The treatment points used were the bilateral GB34, LV3, SP9 and KI3. The mean (95 %CI) intensity of numbness, which was evaluated with a visual analogue scale (VAS), at baseline and at the end of the treatment period was 46.4 (36.7-56.1) and 24.7 (14.5-34.9) respectively (mean difference -22.0, 95 %CI, 10.6-33.5, p=0.001). The frequency of muscle clamp episodes was also reduced during the treatment period (p=0.045). The results suggest that acupuncture is a useful treatment for patients with diabetic peripheral neuropathy.

We describe the case of a 67-year-old man with hepatogenous diabetes caused by alcoholic cirrhosis. He was admitted to our hospital due to hyperglycemia (HbA1c 9.4 %) and basal-bolus-therapy was initiated. Although the dose of insulin lispro was increased to 64 U/day, the patient's postprandial hyperglycemia persisted due to insulin resistance, which was associated with cirrhosis. Insulin was discontinued because the patient had allergic reactions to insulin at the injection site during insulin therapy and liraglutide and voglibose combination therapy was started. However, the patient's post-lunch and post-dinner hyperglycemia showed no improvement. Thus, exenatide treatment (three daily injections before each meal) was started. Thereafter, the patient's postprandial hyperglycemia showed an obvious improvement. To identify the factors correlated with the improvement of the patient's postprandial hyperglycemia after the injection of exenatide, an acetaminophen test and test meal loading were performed. As a result, the effect of exenatide on cirrhosis-related postprandial hyperglycemia was associated with a delay of gastric emptying and the suppression of glucagon secretion, which were physiological actions of GLP-1. In addition, a glucagon test to evaluate the hepatic glucose output may help to predict the extent to which glucagon affects postprandial hyperglycemia in patients with cirrhosis. No side effects of exenatide were observed. The administration of three daily injections of short-acting exenatide was effective for treating hepatogenous diabetes in a patient with cirrhosis.

We herein report the case of an 81-year-old woman who developed type 1 diabetes after the administration of glucocorticoid. In September 2015, she was admitted to our hospital due to organizing pneumonia. The patient was treated with steroid pulse therapy followed by the oral administration of glucocorticoid. After the improvement of the patient's pneumonia, she was treated with oral glucocorticoid in an outpatient clinic. While her blood glucose level remained within the normal range in December, she suddenly complained of hyperglycemic symptoms in the middle of January 2016. Then, at the end of January, she was readmitted to the hospital due to diabetic ketosis. Her blood glucose and HbA1c levels were 432 mg/dL, and 8.9 %, respectively. Her serum pancreatic enzyme levels were slightly elevated, and she was negative for both GAD and IA-2 antibodies. The multiple daily injection of insulin (MDI) improved her hyperglycemia, but her serum C-peptide levels before and after meals were low at 0.25, and 0.56 ng/mL, respectively. She was found to have a high-risk HLA haplotype of type 1 diabetes, DRB1*04: 05-DQB1*04: 01. After discharge from our hospital, she was treated with MDI and glucocorticoid. Her serum C-peptide levels remained low during 2015 and 2016. The above findings suggest that the administration of glucocorticoid may have triggered type 1 diabetes in this patient.