We assessed the recognition of readiness for transition to adult healthcare services among adolescents with type 1 diabetes and their parents. We conducted a self-administered questionnaire survey in 27 patients with type 1 diabetes (aged 12-20 years) and their parents. The survey assessed the patient's readiness and willingness to shift to adult healthcare service. Among parents, we assessed the recognition of their child's readiness for transition and intention to have their child transition. The median total scores for knowledge about readiness were 34 (16-44) (patients) and 33 (25-41) (parents), and the scores for behavior were 29 (19-45) (patients) and 30 (21-42) (parents). These scores as well as every item score did not differ significantly. It is presumed that parents appropriately grasped their child's readiness. However, only 5 patients (18.5 %) answered that they were ready, and 6 (22.2 %) showed a willingness to transition. Only 8 parents (29.6 %) answered that they intended to have their child transition. Thus, patients should be prepared for the transition to adult healthcare services at an early stage.
We herein report a 31-year-old woman with fulminant type 1 diabetes mellitus associated with pregnancy (PF) who underwent an emergency Caesarean section early at the onset. She had no personal or family history of diabetes, and her blood glucose levels at pregnancy examinations had been normal. At 36 weeks' gestation, she presented with thirst, anorexia, and vomiting and consulted an obstetrician. Because her fetus showed late deceleration, she underwent emergency Caesarean section. The surgery was successful, and the child was cared for in the neonatal intensive-care unit and grew well. However, she suffered chest pain and dyspnea the day after surgery, and hyperventilation, hallucinations, and delusions developed the day after that; therefore, she was transferred to our hospital. Her blood glucose level, urine ketones and arterial blood pH were 676 mg/dL, 4+and 6.948, respectively. She was diagnosed with diabetic ketoacidosis, and her condition improved with immediate transfusion and continuous intravenous insulin infusion. Because her HbA1c was 5.6 %, and anti-GAD antibody and anti-IA-2 antibody were negative with a urinary C-reactive protein value of 0.4 μg/day, she was diagnosed with PF. Recently, several patients with PF have been reported to undergo Caesarean section to save the life of the fetus, so this approach should be considered in such cases.
Turner syndrome (TS) is a chromosomal abnormality attributed to a total or partial loss of the X chromosome. While TS is characterized clinically by short stature and primary ovarian insufficiency, those with a deletion of Xq often have ovarian insufficiency but no other features of TS. We herein report a case of a young adult patient with Xq partial deletion accompanied by diabetes mellitus. The patient was a 30-year-old woman who had begun hormone replacement therapy for primary ovarian insufficiency with a diagnosis of TS at 16 years of age. She was admitted to our hospital because her fasting blood sugar and HbA1c had increased to 212 mg/dL and 10.4 %, respectively. A physical examination revealed no short stature, but she was overweight, with a body mass index of 28.3 kg/m2. Her anti-GAD antibody titer was negative, and he urine C-peptide level was 76.3 μg/day. Diet restriction, exercise, and the administration of metformin and dulaglutide improved her glucose level. Karyotype determination revealed the partial deletion of the long arm. TS patients have a high prevalence of diabetes mellitus, but whether or not TS patients with Xq deletion are prone to diabetes mellitus is still unknown. This case suggests that even TS patients with an atypical phenotype and karyotype should receive ongoing care with monitoring for comorbidities.
A 59-year-old man was admitted emergently due to loss of consciousness. The patient had previously been diagnosed with chronic pancreatitis and pancreatic diabetes mellitus and was being treated with multiple daily injections of insulin. Upon arrival, the patient's serum glucose level was 29 mg/dL. Although the patient's serum glucose level increased following intravenous injection of glucose solution, his consciousness level remained low, and he ultimately died due to aspiration pneumonia on day 39. Hypoglycemic encephalopathy is an emergent illness that leads to neurological sequelae, such as irreversible disruption of consciousness, disturbance of the higher brain function, and paralysis. It is important to recognize that hypoglycemia may occasionally be fatal if prompt treatment is delayed.
(I) We studied the status of chronological blood glucose control among 118 diabetes patients who had attended our hospital for 20 years. We studied cognitive disorders using the MMSE or Mini-Cog as conventional methods and the DASC-8 as a new method. The analysis of the relationship between cognitive disorders and blood glucose control revealed that the cognitive function tended to decrease in the poorly controlled group. (II) The analysis of the association between the presence of retinopathy and cognitive function among 206 diabetic outpatients with 20-year history of diabetes who had attended our hospital for more than 10 years revealed that the cognitive function in patients with retinopathy tended to decrease in comparison to patients without retinopathy. (III) The analysis of the entire medication history of all 206 patients revealed that 43 patients with a low cognitive function (according to DASC-8) used medications suspected of causing hypoglycemia. The DASC-8 can be conducted over a shorter period of time in comparison to the MMSE, which makes it effective for classifying the categories of glycemic control targets among elderly patients with diabetes.