We classified 225 type 1 diabetes (T1D) patients who were treated at The University of Tokyo Hospital from April 1 to August 31, 2017, into 3 age groups (< 65, 65-74 and ≥75 years old) to assess the current state of aging and the factors associated with severe hypoglycemia (SH). Older patients accounted for 36.0 % of all patients. The average HbA1c level in the ≥75-year-old group was significantly higher than that in the other groups. In the SH patients, the serum C-peptide level tended to lower than in those without SH. An older age was not related to hypoglycemia, as noted in the regular outpatient clinic and SH history. Our results suggest a relationship between the depletion of insulin secretion and an SH history, but in the older group it was difficult to identify the high-SH-risk group. Because the aging of the T1D patient population is ongoing and urgent, additional studies are needed.

A 39-year-old female patient with no history of diabetes mellitus received a diagnosis of gestational diabetes at 29 weeks of gestation after a 75 g oral glucose tolerance test. According to self-monitoring of blood glucose (SMBG), her fasting blood glucose level ranged from 90 to 100 mg/dL, and her 2-hour postprandial blood glucose level ranged from 90 to 120 mg/dL. Subcutaneous injections of 5 units of insulin detemir before supper were begun at 33 weeks and stabilized her blood glucose level within the target range. At 37 weeks and 4 days of gestation, SMBG suddenly showed a dramatic increase in her blood glucose level to 200-400 mg/dL. On admission, she showed blood glucose, 537 mg/dL; HbA1c, 6.4 %; pH 7.084; HCO₃^-, 4.7 mmol/L; urine ketone bodies, 3+; and C-peptide, ≤0.03 ng/mL. She received a diagnosis of diabetic ketoacidosis due to fulminant type 1 diabetes mellitus. The lack of a fetal heartbeat led to confirmation of intrauterine fetal death. The patient was started on a continuous insulin infusion, then switched to intensive insulin therapy on the fourth day of hospitalization. The present report is the first to describe a case of fulminant type 1 diabetes mellitus occurring in a pregnant woman with gestational diabetes.

We report the successful treatment of a 51-year-old man with diabetic ketoacidosis, invasive pulmonary aspergillosis, and Cushing syndrome. The patient was naturally healthy and had no medical examination history. He had been aware of thirst, polydipsia and polyuria for 6 months. He was taken to the hospital with sudden vomiting and impaired consciousness and was admitted with a diagnosis of diabetic ketoacidosis: blood glucose, 979 mg/dL; HbA1c, 11.5 %; arterial blood pH, 6.94; and urinary ketone, 4+. His blood glucose improved with continuous insulin infusion, but pulmonary mycosis was suspected based on a high inflammatory response and multiple pulmonary nodules with ground glass opacity, and treatment with voriconazole was started; however, the lung lesions did not show improvement. He was diagnosed with Cushing syndrome. ACTH-independent Cushing syndrome was suspected based on a plasma ACTH level of 4.2 pg/mL and a serum cortisol level of 30.7 μg/dL. Treatment for Cushing syndrome was started on the 24th day with metyrapone. In addition, we diagnosed invasive pulmonary aspergillosis based on β-D glucan positivity, aspergillus antigen positivity and CT findings. This is a valuable case of invasive pulmonary aspergillosis accompanied by hyperglycemia in which the patient was saved by treatment of Cushing syndrome.

Typhoon Faxai struck the Boso Peninsula in September 2019, caused a power outage of up to 26 days in Chiba Prefecture. Following the typhoon, Kamogawa City experienced three consecutive days of high temperatures. Given this situation, we suspected that some insulin that had been stored in refrigerators reached an inappropriate temperature. We therefore conducted an anonymous questionnaire survey to clarify the storage status of patients' insulin supplies during the power outage. The survey inquired about whether or not a power outage had occurred, the duration of the power outage, the status of the stored insulin, and recognition that insulin effectiveness of the re-refrigerated have not been confirmed. We received 67 responses. The power outage rate was 71 %, and the average power outage period was 3.2 days (0.2-10 days). Regarding the storage status, 79 % of insulin supplies were stored in a refrigerator, 11 % were stored in a cooler box with an ice pack, and 10 % were left out of the refrigerator. We therefore considered that a certain number of insulin preparations had reached an inappropriate temperature. In conclusion, we suggest raising awareness about insulin storage during disasters in consideration of power outages and high temperatures.