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Volume 24, Issue 1
Displaying 1-12 of 12 articles from this issue
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Shigeo Kaneko, Hidetoshi Matsumoto, Sadamu Hiraide, Kunihiro Doi, Akir ...1981 Volume 24 Issue 1 Pages 1-9
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe effect of propranolol on reactive hypoglycemia was observed in 4 postgastrectomy patients for a variable time ranging from 2 to 7 months. Before the propranolol therapy was started, a 3-hours oral glucose tolerance test (OGTT) was given using 50 g of glucose. Each patient had a repeat OGTT on subsequent days at 15 min. after the oral administration of propranolol (10 mg). Propraolol preadministration reduced the mean peak blood glucose from 221.3 ± 23.7 mg/dl (mean±SE) to 174.0 ± 17. 8 mg/dl and the mean peak of immunoreactive-insulin from 126.8 ± 39.9μU/ml to 68.5±10.6μU/ml. It raised the lowest blood glucose from 69.5 ± 4.9 mg/dl to 78.3 ± 6.6mg/dl. However the mean plasma glucagon and human growth hormone remained unchanged.
During the treatment with propranolol, all patients sohwed favorable clinical results as well as a significant increase in 2-hour postprandial blood glucose levels. However, no significant changes were observed in fasting and 2-hour postprandial mean plasma insulin and catecholamine levels.
The improvement of clinical status induced by propranolol therapy may reflect hepatic changes of glucose metabolism that are not yet well understood. On the other hand, inhibition of insulin secretion appears to be the main reason by which improvement of clinical status is achieved.
From a clinical viewpoint, propranolol therapy may be useful in postgastrectomy hypoglycemic patients.View full abstractDownload PDF (1391K) -
Hiroaki Horie, Hisako Fushimi, Hitoshi Kawaradani, Toshiaki Kikkawa, M ...1981 Volume 24 Issue 1 Pages 11-17
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSAbnormal heart function in diabetics and diabetic cardiomyopathy have recently been described but their pathogenesis and relationship to microangiopathy have not yet been clarified. In order to determine the cause of abnormal heart function in diabetics, studies on ultrasonic and pathologic changes were made.
A Toshiba Sonolayer 11 A with a 2.25 MHz focused transducer and strip chart recorder were used for ultrasonic cardiography (UCG) to measure the interventricular septal thickness (IVST), posterior wall thickness (PWT), ejection fraction (E.F.) and stroke index (S.I.). Autopsied hearts after formalin fixation were subjected to IVST/PWT measurements and histologic studies. High contrast pictures of the H.E.-stained heart septum and anterior wall were analyzed using a Quantimet 720 Image Analyzing Computer (Cambrige Instruments). The diameters of the heart muscle fibers were also estimated.
The UCG studies revealed that the ratio of the interventricular septal thickness (IVST) to posterior wall thickness (PWT) in diabetics was significantly larger than that in controls (p<0.005), and that of diabetics with microangiopathy (1.10 ± 0.04) was significantly larger than that of those without microangiopathy (0.94 ± 0.04), (p<0.01). The E.F. and S.I. were significantly decreased in the diabetes-with-microangiopathy group, suggesting decreased heart function.
Postmortem studies confirmed the above findings and the diameters of the muscle fibers in diabetics (12.9 ± 0.1 μm) were significantly smaller than those in controls (14.4 ± 0.1μm), (p<0.005).
Gradual narrowing of the small coronary vessels (e.g. diffuse coronary microangiopathy) is thougtht to cause a mild degree of diffuse myocardial ischemia, which tends to induce cardiac dilatation and hypertrophy. Increase in the interstitial space and atrophy of myocardial fibers may derive from chronic myocardial ischemia and a decrease in the excretion of metabolites.
The present ultrasonic and pathologic studies suggest that the thickness of the septum is increased in diabetics and this might be related to microangiopathic changes.View full abstractDownload PDF (2615K) -
Mikio Kikuchi, Ryuzo Kawamori, Yoshimitsu Yamasaki, Motoaki Shichiri, ...1981 Volume 24 Issue 1 Pages 19-25
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTo assess further the role of insulin in alpha cell dysfunction in human diabetes mellitus, the glucagon response to intravenous arginine was studied in 5 noninsulin-dependent diabetics (NIDDM) and 5 insulin-dpendent diabetics (IDDM) whose blood gluose responses and plasma insulin simulated those in healthy subjects with the aid of the artificial beta cell system originally developed by us.
In both the 5 NIDDM and 5 IDDM, the blood glucose responses and plasma IRI after arginine challenge were made equivalent to those in healthy subjects with this system. Then, exaggerated glucagon responses were made completely similar to the response in healthy subjects.
These results strongly suggest that the abnormal glucagon responses to arginine observed in diabetes mellitus may be a consequence (either direct or indirect) of insulin lack, and perfect normalization of the response is achieved only when the plasma insulin concentration and glycemic control stimulate those of healthy subjects.View full abstractDownload PDF (1006K) -
Sadao Arai, Yoshikazu Goriya, Ryuzo Kawamori, Toshihito Yagi, Norimich ...1981 Volume 24 Issue 1 Pages 27-33
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTo make a therapeutical assessment of subcutaneous insulin infusion with an open-loop system, a comparative evaluation of the following 5 different insulin treatments was performed in diabetics: treatment with an artificial beta cell system (Closed-Sysiem), intravenous infusion with an open-loop system (IV Open-System), subcutaneous infusion with an open-loop system (SC Open-System), multiple short-acting insulin injections (S-A Injections), and intermediate-acting insulin iniection (I-A Iniection).
A 24-hour glycemic control was attempted in 6 newly insulin-requiring diabetics for 5 consecutive days by the aforementioned insulin regimens.
Similar insulin infusion to the Closed-System was repeated in the 1 V Upen-6ystem with a Preprogrammable Insulin Infusion Pump. In the SC Open-System, 1.3 to 1.5 times as much insulin as in the IV Open-System was commenced 30 mill prior to each meal. The amount of insulin required in the SC Open-System was given in the S-A and I-A Injections.
1) Perfect normalization with a physiological plasma insulin profile could be achieved with the Closed-System. The IV Open-Systm was capable of maintaining glycemia within the normal range. Plasa insulin and glucagon were almost normalized.
2) Diabetic control, as assessed from the mean plasma glucose, M-value and mean amplitude of glycemic excursions, was in the favorable order of Closed-System, IV Open-System, S-A Injections, SC Open-System and I-A Injection, respectively.
3) With the insulin infusion programme used in the present study, the SC Open-System could not simulate the physiological plasma insulin profile. In terms of diurnal glycemic regulation, the SC Open-System was shown to be superior to the I-A Injection, but was of no advantage over the S-A Injections, except in nocturnal glycemic control.
The above results indicate that the development of an original and suitable insulin infusion programme for the SC Open-System is urgently required.View full abstractDownload PDF (1205K) -
Reiko Kawahara, Teiko Amemiya, Tadasu Kasahara, Tomonori Komori, Yukim ...1981 Volume 24 Issue 1 Pages 35-40
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe correlation between levels of HbAI and red cell 2, 3-DPG and microangiopathy was studied in 229 diabetic patients and 28 normal subjects.
The diabetics were divided into three groups, as follows;
Group A: Diabetics without retinopathy and albuminuria (n=123)
Group B: Diabetics with background retinopathy (Scott Ia, II, IIIa, IIIb) and albuminuria (n=67)
Group C: Diabetics with proliferative retinopathy (Scott IV, V, VI) and albuminuria (n=39)
The following results were obtained:
(1) The levels of 2, 3-DPG were significantly higher in group A than in normal control subjects (4.453 ± 0.069 μmol/ml RBC and 4.103 ± 0.07 μmol/ml RBC, respectively: p<0.05). The average hematocrit in group A was within normal limits.
(2) The 2, 3-DPG levels in group B were lower than those in group A, but the difference was not significant. The average hematocrit in group B was significantly decreased compared to normal control subjects.
(3) There was a significant decrease in 2, 3-DPG levels in group C compared to the other two groups. In this group also, the levels of hematocrit were significantly decreased.
(4) In group C, a significantly lower level of 2, 3-DPG was found among diabetics with more than 10% HbAI than among those with less than 10% HbAI.
These results suggest that tissue hypoxia may be accelerated by reduction of the 2, 3-DPG levels and is compounded by an increase in HbAI levels in diabetics with severe microangiopathy.View full abstractDownload PDF (836K) -
Etsuko Takatori, Teiko Amemiya, Tomoko Yokosuka, Yukimasa Hirata1981 Volume 24 Issue 1 Pages 41-47
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSIn order to determine whether erythrocyte 2, 3-DPG has any causal relationship to the development of diabetic retinopathy, erythrocyte 2, 3-DPG levels were measured with a 2, 3-DPG kit in diabetic patients without diabetic ketoacidosis.
The results obtained were as follows.
1) The erythrocyte 2, 3-DPG levels in diabetic patients were not significantly different from those of healthy subjects.
2) In cases without diabetic retinopathy, the 2, 3-DPG levels of the poor control group of diabetes were significantly higher than those of the good control group. When the 2, 3-DPG concentrations before and after treatment of diabetes were compared in 18 untreated diabetics, the levels before treatment were significantly higher than those measured at the time of well controlled diabetes for 3 months after the treatmet of diabetes.
3) The levels of 2, 3-DPG were lower in conjunction with the development of diabetic retinopathy irrespective of the control of diabetes. The difference in 2, 3-DPG concentrations between the Scott 0 group and the group with severer than Scott IV was statistically significant in cases with poor control of diabetes.
4) The erythrocyte 2, 3-DPG in non-diabetic anemic patients was statistically significantly higher than that in normal subjects. However, the 2, 3-DPG levels in diabetic anemic patients with severer than Scott IV were lower than those in normal subjects, and the difference in 2, 3-DPG levels between non-diabetic anemic patients and diabetic anemic patients with severer than Scott IV was statistically significant.
5) High serum Pi levels were found in the group with severer than Scott IV whose erythrocyte 2, 3-DPG concentrations were lowest among the groups of diabetics classified according to stage of retinopathy, irrespective of the control of diabetes. In particular, in cases of fair and poor control the serum Pi levels in patients with severer than Scott IV were significantly higher than those in diabetics without diabetic retinopathy.View full abstractDownload PDF (2618K) -
Yoichi Sakamoto, Shigeru Saito, Manabu Narimiya, Junichi Yokoyama, Nao ...1981 Volume 24 Issue 1 Pages 49-56
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe purpose of the present study was to investigate the frequency of insulin allergy and insulin lipodystrophy as observed in 335 diabetics (196 male, 139 female) who were treated with commercial insulin and to clarify the clinical profile of the patients. The therapeutic effects of highly purified insulin on insulin allergy and insulin lipodystrophy were also examined. The results obtained were as follows.
1) Insulin allergy was seen in 26 out of the 335 cases (7.8%). All were skin type allergy (7 gneralized, 19 localized) and there were no sex/age differences.
2) Insulin lipodystrophy was seen in 22 out of the 335 cases (6.6%). Eighteen out of the 22 revealed lipoatrophy alone and the remainder showed both lipoatrophy and lipohypertrophy. Females represented 17 out of the 22, indicating a clear sex difference. On the other hand, no age difference was observed.
3) Highly purified insulin enabled insulin therapy to be continued in the cases with insulin allergy. In all these cases, the symptoms disappeared within 6 months.
4) Highly purified insulin was effective for insulin lipoatrophy and 80% were healed after one year of the treatment.
The data obtained thus that indicated insulin allergy and insulin lipodystrophy were present at a frequency of 7-8% in diabetics treated with conventional insulin and that highly purified insulin was very effective in treating the unfavorable symptoms.View full abstractDownload PDF (1085K) -
Akito Kitazawa, Yoshitaka Hishitani, Junta Takamatsu, Kiyoshi Nakata, ...1981 Volume 24 Issue 1 Pages 57-63
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA case of diabetes mellitus in a 41-yr-old man associated with the syndrome of “kwashiorkor” is described.
The patient had been treated irregularly with sulfonyl ureas for 5 years and showed gradual development of severe diabetic neuropathy including glove-and-stocking type sensory deficit in the four extremities, loss of libido and nocturnal diarrhea since about one year before admission.
On admission, he was pale and emaciated with sparse reddish hair, dry and atrophic skin, gneralized edema and ascites. His liver was 1.5 qfb enlarged with a smooth surface. The muscles of the extremities were tender and atrophic, and he was unable to walk due to muscular weakness.
Examinations revealed a malnutritional state due to malabsorptin with steatorrhea and a typical intestinal “malabsorption pattern” on X-ray films, advanced diabetes mellitus with retino-and neuropathy, and pancreatic insufficiency due to alcoholic pancreatitis with calcification.
There was familial occurrence of diabetes mellitus, and an increased response of pancreatic glucagon after arginine loadng was demonstrated. The patient's diabetic state was thus diagnosed as primary.
Administration of large doses of pancreatic enzyme preparation improved the steatorrhea. It was concluded that the malnutrition in the present case was due to a combination of diabetic gastroenteropathy and pancreatic insufficiency in view of the history and presence of advanced diabetic neuropathy.
It is noted that severe protein malnutrition tends to be very rare even in diabetics with associated chronic pancreatitis if they have no severe diabetic gastroenteropathy.
Kwashiorkor is seen mainly in children with very poor uptake of dietary protein. In adults, only few cases of “Kwashiorkor” syndrome after gasterectomy have been reported. The present case is interesting in that it shows that “Kwashiorkor” syndrome can be evoked in adults by a combination of diabetic gastroenteropathy and chronic pancreatitis.View full abstractDownload PDF (5617K) -
Akimasa Nagahara, Toshiaki Uchida, Hitoshi Harada, Shingo Kinoyama, Ya ...1981 Volume 24 Issue 1 Pages 65-71
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThree cases of diabetic scleredema were studied. All of the patients had severe adult-type diabetes mellitus with obesity. The scleredema was not accompanied by acute infection and did not show any at convalescence.
Our 3 diabetic patients were reviewed in conjunction with 45 cases previously reported. They comprised 25 males, 22 females and the sex was unknown in one. The age of the patients ranged from 37 to 79 years. The duration of the diabetic state ranged from 1 to 34 years. The patients exhibited the following various complications: retinopathy (35%), hypertension (27%), neuropathy (15%), cataract (13%), and hyperlipemia (10%). About 60% of the patients had at least one of these complications.
The metabolic disturbance accompanying a severe diabetic state may have decreased the metabolic rate of acid mucopolysaccharide in the skin and contributed at least in part to the development of scleredema.View full abstractDownload PDF (3247K) -
Masaru Usami, Susumu Seino, Hiroshi Nakahara, Junko Takai, Yutaka Sein ...1981 Volume 24 Issue 1 Pages 73-75
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe direct effects of saccharin sodium, cyclamate sodium and stevioside on insulin and glucagon secretion were investigated using the isolated perfused rat pancreas. Following preperfusion with 2.8 mM glucose and respective sweeteners (cyclamate sodium: 440 μM, saccharin sodium: 50 μM, stevioside: 15 μM) for 20 min, L-arginine hydrochloride (to give a final concentration of 19.2 mM) was introduced through a side arm for the next 30 min. The addition of arginine to the perfusate of 2.8 mM glucose without any sweeteners caused a biphasic increase in the insulin and glucagon concentrations. The perfusion of 2.8 mM glucose plus cyclamate sodium revealed no significant change in insulin and glucagon secretion as compared to glucose alone.
Saccharin sodium and stevioside produced a slight increase in the insulin and a slight decrease in the glucagon secretion induced by arginine, although the changes were not significant, as compared to those with glucose alone. These resultssuggest that cyclamate sodium, saccharin sodium and stevioside have no direct action on pancreatic A and B cells.View full abstractDownload PDF (333K) -
Yoshiki Sakai, Kiyoshi Watanabe, Takaaki Takebe, Kaneo Ishii1981 Volume 24 Issue 1 Pages 77-79
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSSixty-four newborn Chinese hamsters were divided into three groups. Group A received injection of monosodium glutamate (MSG) at a dose of 4 mg per g of body weight during 3 days after birth, and was fed the standard diet containing 0 1% synthetic trypsin inhibitor, N, N-dimethylcarbamoylmethyl 4-(4-guanidinobenzoyloxy)-phenylacetatej methansulfonate. Group B received 3 days injection of MSG, and was fed the standard diet. Group C received saline injection and was fed the standard diet. The mean plasma glucose level in group B was significantly high compared to that in group C at the 11th week. A slight significant difference was noted between groups A and C. Hyperglycemia of over 160 mg/dl was seen in 5.6% of group A, 44.4% of group B and 0% of group C at the 7th week. At the 11th week, hyperglycemia of over 300 mg/dl was observed in 63.0% of group B, but none was noted in groups A and C. These results suggest that the synthetic trypsin inhibitor may suppress MSG-induced hyperglycemia in newborn Chinese hamsters.View full abstractDownload PDF (430K) -
1981 Volume 24 Issue 1 Pages 81-90
Published: January 30, 1981
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (2154K)
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