We examined the effect of a low-carbohydrate diet with high- or average-fat on glucose and lipid metabolism in young healthy female subjects. In this randomized crossover study, the 10 subjects were provided breakfast test meals: a control meal (carbohydrate [C], 60 %; fat [F], 25 %), a low-carbohydrate average-fat (LCAF) meal (C, 30 %; F, 25 %), and a low-carbohydrate high-fat (LCHF) meal (C, 30 %; F, 45 %). Four hours later, all the participants were fed the same standard lunch. Blood was collected for the measurement of glucose, insulin, non-esterified fatty acids (NEFAs), triglycerides, ketone bodies, and the pre-heparin lipoprotein lipase mass. Although both the LCAF and LCHF meals improved glucose tolerance at breakfast, in the post-lunch analysis, the LCHF meal increased the area under the curve value for glucose, and the serum concentrations of NEFA and insulin. We concluded that the LCHF meal (breakfast) induced insulin resistance at the second meal (lunch) and was associated with an increased level of NEFAs.
A 77-year-old woman presented with a 2-week history of an exacerbation of symptoms of dry mouth, polydipsia and polyuria that had been present for 2 months. Her urinalysis showed positivity for ketone bodies, casual blood glucose of 582 mg/dL and HbA1c of ≤16.0 %. After admission, she was treated with insulin therapy, and her condition improved. Although she was insulin-dependent, she and her family refused to continue the insulin therapy, and oral hypoglycemic agents were started on day 11 of admission; however, this proved ineffective. Anti-IA-2 antibody was positive, and after delivering a detailed explanation to the patient and her family, insulin therapy was restarted on day 21. Involuntary movements of the left upper and lower limbs were noticed on day 24. Magnetic resonance imaging of the brain showed T1-weighted hyperintensity in the right putamen, and a diagnosis of diabetic chorea was made. Diabetic chorea in elderly patients with type 1 diabetes is rare, and the present case was believed to have been triggered by the fluctuation of glucose levels over a short-term period. We herein report a rare case of diabetic chorea in an elderly patient with type 1 diabetes negative for anti-GAD antibody and positive for anti-IA-2 antibody.