Patients with short bowel syndrome (SBS) are forced to restrict their activities due to deficiency of various nutrients and severe diarrhea, and have a poor prognosis due to complications of long-term TPN. We experienced the case of a type 2 diabetic patient with SBS who used liraglutide, which has an inhibitory effect on gastric emptying, and improved his nutritional status by improving his absorption disorder. The patient was a 66-year-old man who had been diagnosed with diabetes in 2008. After partial resection of the small intestine due to small intestinal bleeding in 2015, a fistula was found in the rectum, and a stoma was constructed. The remaining small intestine was 80 cm. Since that time, oral intake and total parenteral nutrition had been performed. When subcutaneous injection of liraglutide was started in 2018, the drainage from the stoma decreased from 3000-4000 mL to approximately 1000 mL, and the renal function and serum albumin level improved. GLP-1 receptor agonists can improve the clinical symptoms and quality of life of SBS patients, and may represent a new treatment option.

As Japan is becoming a super-aged society, hypoglycemia is being observed more and more frequently in clinical practice. An 88-year-old man without a history of diabetes was admitted to the emergency department due to cognitive impairment and a vague state. His blood glucose level was 38 mg/dL, and his serum insulin level was 349 μU/mL. Anti-insulin antibody was off-scale in a binding assay and radioimmunoassay, and a Scatchard analysis revealed a low affinity and high capacity for insulin antibody. Based on these findings, insulin autoimmune syndrome (IAS) was diagnosed. His HLA genotyping was HLA DRB1*04:04. All medications he was taking, including IAS-inducible clopidogrel, were substituted for other ones. Since hypoglycemia was not ameliorated by five snacks per day or voglibose administration, prednisolone was started at a dose of 30 mg/day. His hypoglycemic symptoms disappeared, and his serum insulin and anti-insulin antibody levels decreased with the reduction of the prednisolone dose. We encountered a case of IAS in an 88-year-old man without IAS-related HLA loci.

A 23-year-old man was admitted to our hospital with a medical history of body weight reduction and hyperglycemic symptoms. His laboratory findings showed that his blood glucose level was 496 mg/dL, HbA1c 15.8 %, urine ketone bodies (3+), venous blood pH 7.15, and BMI 29.0 kg/m². He was diagnosed with diabetic ketoacidosis (DKA) in June X. He neither consumed a lot of soft drinks nor had any virus infections. Islet-related autoantibodies were all negative, but his endogenous insulin secretion was remarkably low, and his serum C peptide level was 0.37 ng/mL. Tentatively, we diagnosed him with type 1B diabetes. His endogenous insulin secretion recovered rapidly after five months with insulin therapy, which allowed him to avoid insulin treatment for the following 10 months. However, he was hospitalized again with a diagnosis of diabetic ketosis (DK) with body weight gain in September X+1. Based on his clinical course, he was diagnosed with ketosis-prone diabetes. The results of glucagon and arginine load tests revealed that his endogenous insulin secretion was severely depressed at the onset of DKA and DK but recovered clearly after six months with the increase in endogenous glucagon secretion.