Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 55, Issue 12
Displaying 1-11 of 11 articles from this issue
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Lecture by the Prize Winner of 2012
Original Articles
Diagnosis, Treatment
  • Evaluation of the Sugar Content in the Side Dishes Served in Elementary School Lunches
    Miwa Yamaguchi, Akio Kuroda, Yumiko Kotani, Akiko Matsumura, Sakurako ...
    2012 Volume 55 Issue 12 Pages 952-956
    Published: 2012
    Released on J-STAGE: January 21, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.55.952
    JOURNAL FREE ACCESS
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    Kuroda et al. proposed a simple method for calculating the carbohydrate content based on a food exchange list (Shokuhin Koukanhyou), with a sugar content of dietary staples of 40 % for rice, 50 % for bread, and 20 % for boiled noodles and a side dish containing 20 g sugar. This study focused on the sugar content in in school lunches, which have a nutrient composition that is different from diabetic meals. The total energy content of school lunches and the sugar content in their side dishes were investigated in 42 school lunches served in elementary school. The average energy intake in the total lunch increased depending on the school grade (670±44 to 752±50 kcal; means±standard deviation). On the other hand, the sugar content of side dishes increased from 29.7±7.5 g in the 1st-2nd grade to 31.2±8.1 g in the 5th-6th grade, thus it could be estimated to be 30 g regardless of the energy intake. Two hundred milliliters of milk containing approximately 10 g of carbohydrate was served in every school lunch, which accounted for the 10 g increase in comparison to hospital lunches. These results indicate that the sugar content in the side dishes of elementary school lunches can be estimated to be 30 g regardless of the energy intake.
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  • The Application of Continuous Glucose Monitoring with a Fasting Test to Establish a Basal Insulin Infusion Program for Japanese Type 1 Diabetes Mellitus Patients at the Time of Switching from Multiple Daily Injection Therapy to Continuous Subcutaneous Insulin Infusion
    Yoshiki Kusunoki, Tomoyuki Katsuno, Makiko Myojin, Kana Miyakoshi, Tak ...
    2012 Volume 55 Issue 12 Pages 957-965
    Published: 2012
    Released on J-STAGE: January 21, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.55.957
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    The efficacy of continuous glucose monitoring (CGM) with a fasting test to establish the basal insulin infusion program in continuous subcutaneous insulin infusion (CSII) was examined in 18 Japanese type 1 diabetes mellitus patients that had been treated with multiple daily injection (MDI). The insulin regimen was switched from MDI to CSII following the data monitoring by CGM including a fasting test during their admission and they were then followed up after six months. The total insulin doses decreased significantly from 44.9±14.3 u/day to 33.7±7.8 u/day just after switching to CSII (p=0.0002). The basal insulin doses decreased significantly from 18.4±7.4 u/day to 12.2±4.5 u/day as well (p=0.0002), and did not change (12.6±4.8 u/day) for six months after switching to CSII. The mean HbA1c also improved significantly from 8.4±1.0 % to 7.7±1.0 % six months after switching to CSII (p=0.0095). In conclusion, the introduction of CSII after the establishment of a basal insulin infusion program based on CGM, particularly the data from a fasting test, was thus found to successfully decrease and sustain better HbA1c levels without an increase in the basal and total insulin doses.
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Case Reports
  • Improvement of Recurrent Unstable Glycemic Control Using Continuous Glucose Monitoring (CGM) in a Patient with Diabetes Complicated by Insulin Antibodies
    Toru Fukushima, Norio Harada, Mayumi Sasaki, Daisuke Tanaka, Akihiro H ...
    2012 Volume 55 Issue 12 Pages 966-972
    Published: 2012
    Released on J-STAGE: January 21, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.55.966
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    A 59-year-old man was diagnosed with diabetes mellitus at 54 years of age. Insulin therapy with the insulin analog, aspart, was started two years later, because of poor glycemic control and drug-induced liver disease due to voglibose and nateglinide. The insulin therapy improved his glycemic control. He was admitted to the hospital at 58 years of age, because he developed fasting hypoglycemia and daytime hyperglycemia. Low affinity and high capacity serum insulin antibodies were found to be causing his unstable glycemic control. His glycemic control improved by changing the insulin therapy from aspart to lispro twice a day and eating a late evening snack. However, he was admitted for 24-hour glucose monitoring using CGM at 59 years of age, because daytime hyperglycemia occurred again. The results showed a shortage of midnight basal insulin and an overdose of evening insulin lispro. The evening dose of insulin lispro was reduced and NPH insulin was started at night. The success of these adjustments was confirmed using CGM. In conclusion, CGM was found to be beneficial for complicated diabetes treatment in patients with insulin antibodies.
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  • A Case of Insulin Glargine Overdose Presenting with Transient Symptoms Similar to Osmotic Demyelination Syndrome after Recovery from Prolonged Hypoglycemia
    Hiroshi Yamaguchi, Masato Mima, Atsuhisa Shirakami, Etsuko Sekimoto, H ...
    2012 Volume 55 Issue 12 Pages 973-981
    Published: 2012
    Released on J-STAGE: January 21, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.55.973
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    A 62-year-old man was being treated for type 2 diabetes mellitus. He accidentally subcutaneously injected himself with approximately 260 U of insulin glargine. Continuous intravenous infusion of glucose for 42 hours was thus required to prevent the onset of hypoglycemic episodes. Blood tests at the time of admission revealed hypoglycemia and hypo-osmotic hyponatremia, and a correction was immediately begun. The time course of the level of serum insulin analogue was measured and peaked 32 hours after arrival. He demonstrated dysphagia, dysarthria, and mild paresis in the left leg after he recovered from hypoglycemia and hyponatremia. Severe hypoglycemia may cause neurological disturbances that can cause central pontine myelinolysis (CPM). Although MRI did not show any features consistent with CPM in this case, his symptoms were similar to CPM and gradually improved. Previous reports suggest that his symptoms may have been caused by brain edema secondary to the failure of ion pumps in the cell membrane, due to glucose deprivation, and also possibly by brain edema from the large osmotic change. Appropriate management to correct hypoglycemia, fluid replacement and electrolyte balance are required when treating patients presenting with severe prolonged hypoglycemia and hypo-osmotic hyponatremia.
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  • Two Cases of Paralytic Ileus Associated with the Administration of Liraglutide
    Tetsuhiro Kitamura, Michio Otsuki, Noriko Kubo, Yukiko Kurashiki, Dais ...
    2012 Volume 55 Issue 12 Pages 982-986
    Published: 2012
    Released on J-STAGE: January 21, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.55.982
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    Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that has been approved for the treatment of type 2 diabetes. The major side effects of Liraglutide are appetite loss and nausea. There are no reports of ileus among the patients using Liraglutide. This report presents two cases of transient paralytic ileus caused by the administration of Liraglutide. Neither patient had a history of abdominal surgery. Paralytic ileus occurred suddenly accompanied by vomiting in both cases. In addition, an influenza virus infection occurred at the same time as ileus in case 2. Both cases recovered spontaneously after the cessation of Liraglutide. The common clinical features were constipation, the long-term duration of type 2 diabetes, diabetic polyneuropathy and autonomic neuropathy. These cases suggest that physicians and patients should be aware of this serious side effect.
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  • A Case of Fulminant Type 1 Diabetes Following Acute Pancreatitis during Early Pregnancy
    Shinsuke Nakajima, Tetsuya Takahashi, Yuko Tanaka, Yuki Nishimoto, Yuk ...
    2012 Volume 55 Issue 12 Pages 987-992
    Published: 2012
    Released on J-STAGE: January 21, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.55.987
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    The patient was a 38-year old woman. She experienced epigastralgia on July 15, 2011. She was admitted to a hospital with a diagnosis of acute pancreatitis on July 20. Her plasma glucose level was 92 mg/dl at the time of admission. Although the acute pancreatitis was quickly resolved, nausea and general fatigue appeared on July 26. She was found to be in the fifth week of pregnancy, but she had a miscarriage the next day. She was discharged from the hospital on July 29, although the symptoms persisted. However, she was transported to this hospital on July 31, due to frequent vomiting that began the day after her discharge. Her plasma glucose level was 498 mg/dl at the time of admission and she had ketoacidosis. She was admitted with a diagnosis of diabetic ketoacidosis. She was diagnosed to have fulminant type 1 diabetes based on her HbA1c level (6.0 %) and low serum and urinary levels of CPR. Fulminant type 1 diabetes is associated with acute pancreatitis and pregnancy. This is an instructive case of fulminant type 1 diabetes that developed during early pregnancy (fifth week) along with the preexisitng acute pancreatitis more than 10 days before the onset of hyperglycemia.
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  • A Case of Type 1 Diabetes Mellitus Complicated by a Pulmonary Thromboembolism during Treatment for Diabetic Ketoacidosis
    Mariko Abe, Hiroyuki Ito, Tomoya Nishino, Koshiro Oshikiri, Shinichi A ...
    2012 Volume 55 Issue 12 Pages 993-997
    Published: 2012
    Released on J-STAGE: January 21, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.55.993
    JOURNAL FREE ACCESS
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    An unconsciousness 80-year-old Japanese woman was admitted in August 2010. She had been treated with intensive insulin therapy since she was 20 years old because of type 1 diabetes mellitus. Urinalysis revealed ketonuria at the time of admission, and her blood glucose and HbA1c levels (NGSP value) were 671 mg/dl and 8.8 %, respectively. An arterial blood gas analysis showed metabolic acidosis. The intravenous administration of saline and insulin was initiated based on the diagnosis of diabetic ketoacidosis (DKA), and she became alert with an improvement in the hyperglycemia. She thereafter suddenly went into shock with dyspnea on the 3rd day after admission. She was diagnosed to have a pulmonary thromboembolism (PE) because enhanced CT showed that contrast material could not penetrate the bilateral pulmonary arteries. Anticoagulant drugs were immediately administered, and the clinical symptoms and thrombus disappeared. Although there have been a few reports of patients with DKA complicated with PE, she was the first such case of a non-obese patient with type 1 diabetes mellitus. Several factors, such as hyperviscosity and enhanced blood coagulation followed by severe dehydration and endothelial injury of the blood vessels caused by longstanding diabetes, were thought to be associated with the onset of PE in this case.
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Proceeding of the Local Societies
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