A 79-year-old single woman with suspected depression who was undergoing treatment for diabetes was transferred to our hospital due to difficulty in movement. Two days previously she had appeared well. Her plasma glucose (690 mg/dL), serum sodium (180 mEq/L), and plasma osmolality (449 mOsm/L) were high. She was diagnosed with hyperglycemic hyperosmolar syndrome (HHS). The hyperosmolar state was corrected within one week, but her outward responsiveness remained diminished. Magnetic resonance imaging (MRI) on the 8th hospital day (day 8) revealed lesions in the bilateral middle cerebellar peduncle (MCP) and the splenium of the corpus callosum, which showed high-intensity on T2-weighted and diffusion-weighted images and low-intensity on T1-weighted images, which was reminiscent of osmotic demyelination syndrome (ODS). The MRI lesions disappeared on day 26, suggesting that they represented edema rather than demyelination. Her mental disorder was diagnosed as suspected dissociative sub-stupor by a psychiatrist. To our knowledge this is the first reported case of HHS that exhibited cerebral edema in the MCP.

Hyperglycemic disorders in pregnancy are associated with risk to the mother and fetus in the perinatal period. This case report aims to promote glycemic management through a comprehensive approach in cooperation with diabetes physicians, gynecologists, nurses, pharmacists, and registered dietitians to promote safe delivery. The findings of a case report suggest that early hospitalization during which the patient reported and shared problems with the health team improved blood glucose levels. At the development of gestational diabetes mellitus in the patient's first pregnancy, the major problem was poor glycemic control. We recommended one-week hospitalization to allow the patient to receive suitable dietary treatment with the adjustment of her insulin dosage. At the development of pregestational diabetes mellitus in the patient's second pregnancy, the major problems were irregular eating habits and weight gain due to insulin therapy. Thus, we recommended short-term hospitalization. Nutrition education and a well-balanced diet for 10 days helped obtain good glycemic control without changing the insulin dosage and prevented excessive weight gain until delivery. Furthermore, the comparison of the preprandial and 2-hour postprandial glucose levels as well as M₁₀₀ values between pre-admission and post-admission, showed a statistically significant improvement. Thus, short-term admission for patient education had a beneficial effect on glycemic control in a patient with hyperglycemic disorder in pregnancy.

A 59-year-old woman was admitted to our hospital for glycemic control. She had been diagnosed with von Hippel-Lindau disease at 41 years of age. She was later diagnosed with diabetes mellitus at 45 years of age and started treatment with oral hypoglycemic agents. Her HbA1c level remained in the 7-8 % range while on treatment for years but increased to 8.8 %, which led to the patient's admission for glycemic control. Abdominal MRCP and CT imaging studies revealed a myriad of polycystic lesions in the pancreas and atrophy of the pancreatic parenchyma. Marked decreases in serum pancreatic digestive enzymes were observed and a PFD test revealed a PABA excretion rate of 33.7 %, which demonstrated severe pancreatic exocrine dysfunction. Additionally, her endogenous insulin secretion was also shown to be decreased with a fasting CPR of 0.27 ng/mL and urinary CPR excretion of 19.0 μg/day; again, she showed no increase in her postprandial insulin secretion; however, her postprandial glucagon level did not show any increase in a meal tolerance test (MTT). The insulin-/glucagon-secretory dynamics shown in the MTT were consistent with the imaging findings of the pancreatic lesions, which accounted for her endocrine-exocrine pancreatic impairment, suggesting a diagnosis of pancreatic diabetes.