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 8
Displaying 1-14 of 14 articles from this issue
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Feature
Diabetes and Cancer
Original Article
Diagnosis, Treatment
  • Efficacy of Monotherapy with a Three Times-Daily Injection of 50/50 Premix Insulin Analogue in Untreated Patients with Diabetes Mellitus
    Kenichi Ida, Masaru Usami, Yuko Kimura, Takayuki Komatsu, Mitsuaki Kod ...
    2012 Volume 55 Issue 8 Pages 599-605
    Published: 2012
    Released on J-STAGE: September 12, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.599
    JOURNAL FREE ACCESS
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    We compared two insulin treatments among untreated type 2 patients with diabetes mellitus. One was a 50 % premixed insulin analogue (50/50 premix insulin analogue of intermediate insulin and insulin lispro) three times daily (TID) injection monotherapy and the other was basal-bolus insulin therapy. Those two treatments had almost the same efficacies in the daily profile of plasma glucose levels and HbA1c and therefore both improved the blood glucose levels. However, some advantages were found in the mixed insulin treatment. 50/50 premix insulin analogue TID allowed easier initiation and flexible dose for once or twice a day compared with the basal-bolus regimen.
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  • Screening for Dementia and Prescription Style in Elderly Diabetic Patients Aged over 75 Years
    Rie Ueki, Sadae Katakai, Shizuko Iwanaga, Shinobu Motohashi, Koichi Ka ...
    2012 Volume 55 Issue 8 Pages 606-613
    Published: 2012
    Released on J-STAGE: September 12, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.606
    JOURNAL FREE ACCESS
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    The support for observance of medication is important for elderly diabetic patients. We therefore investigated the relation between the score of screening for dementia by Urakami's method and the prescription style in 220 diabetic patients aged over 75 years. One dose packages which mean are associated with a simple and easy way to take medication were prescribed for 10 (14.9 %) of 67 patients in the suspected dementia group and 7 (4.6 %) of 153 patients in the normal range group (p=0.013). Adjusting the other clinical characteristics, we found a relationship between the score of screening for dementia and prescription style (odds ratio 4.61, 95 % confidence interval 1.32 - 16.15, p=0.017). Our findings suggest that screening for dementia will be useful to identify elderly diabetic patients in whom support for taking their medication is required.
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Case Report
  • A Case of Hypothalamic Syndrome Complicated by Rhabdomyolysis and Pulmonary Embolism on Subsequent Hyperglycemic Hyperosmolar Syndrome
    Naoki Gocho, Yoshitaka Sato, Tomoko Kondo, Takeshi Hirashima, Akihiro ...
    2012 Volume 55 Issue 8 Pages 614-620
    Published: 2012
    Released on J-STAGE: September 12, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.614
    JOURNAL FREE ACCESS
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    A 47-year-old man who had undergone hypothalamic meningioma surgery one year earlier and postoperative hormone replacement therapy for panhypopituitarism and diabetes insipidus was seen for general fatigue and lethargy. Laboratory examination showed markedly elevated plasma glucose with few ketone bodies. Chest computed tomography (CT) showed ground-glass opacity of the lung. He was admitted in an emergency and diagnosed with hyperglycemic hyperosmolar state and pneumonia, for which he was administered continuous intravenous insulin infusion and antibiotics. Although his general condition improved immediately as plasma glucose decreased, laboratory examination showed severely elevated creatine phosphokinase and serum and urine myoglobin, indicating rhabdomyolysis. Early volume loading was started and rhabdomyolysis was cured without severe acute kidney injury. On day 7, he suffered sudden chest pain with hypoxemia. Emergency CT with contrast medium showed multiple bilateral perfusion defects consistent with pulmonary emboli and underlying deep vein thrombosis of the lower left leg. Anticoagulation therapy with heparin and warfarin was conducted immediately. His respiratory status improved gradually as pulmonary emoboli decreased. This report is a rare case of hypothalamic syndrome complicated by rhabdomyolysis and pulmonary embolism on subsequent hyperglycemic hyperosmolar syndrome.
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  • A Case of Type 1 Diabetes Diagnosed 17 Months after Soft-drink Ketosis Onset
    Kaoru Yamashita, Yuka Kobayashi, Eiko Yoshida, Ayumi Yoshifuji, Takama ...
    2012 Volume 55 Issue 8 Pages 621-626
    Published: 2012
    Released on J-STAGE: September 12, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.621
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    Laboratory data on a 41-year-old man hospitalized in January 2008 for "soft-drink" ketoacidosis showed that no glutamic acid decarboxylase (GAD) antibody had been detected and that urinary C-peptide (CPR) was within a normal 115.2 μg/day. These results yielded a diagnosis of type 2 diabetes. He was treated with biphasic insulin aspart 30 mix twice and metformin orally and discharged. His insulin requirement gradually decreased to a single oral hypoglycemic agent. Glycemic control remained good for the next 17 months. In June 2009, however, glycemic control worsened despite treatment, necessitating hospitalization. Laboratory data was positive for both GAD antibody and for other islet cell autoantibodies. Urinary CPR had also fallen to 33.1 μg/day. Human leukocyte antigen (HLA) typing detected A24 and DR9. These observations yielded a diagnosis of type 1 diabetes. This is an extremely rare case of type 1 diabetes diagnosed 17 months after "soft-drink" ketoacidosis onset.
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  • A Case of Hemoglobin Variant (Hb J-Lome) Complicated by Abnormally Low HbA1c at the Onset of Fulminant Type 1 Diabetes Mellitus
    Yasuhiro Ono, Kyosuke Yamamoto, Masao Ohashi, Taijiro Okabe, Koichiro ...
    2012 Volume 55 Issue 8 Pages 627-631
    Published: 2012
    Released on J-STAGE: September 12, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.627
    JOURNAL FREE ACCESS
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    Fulminant type 1 diabetes mellitus (FT1DM), a new type 1 diabetes subtype, is characterized clinically by acute almost complete pancreatic β cell destruction. In contrast to markedly elevated plasma glucose, HbA1c is normal or only slightly elevated at FT1DM onset. We report the case of a 47-year-old man with FT1DM complicated by abnormally low hemoglobin. At diabetic ketoacidosis onset, glycated albumin (GA) was 25.3 %, HbA1c abnormally low at 3.6 %, and the GA/HbA1c ratio markedly high at 7.0. We identified a Lys → Asn mutation in 59 of the β-chain globin gene, yielding a diagnosis of Hb J-Lome. A complication of abnormal hemoglobin is thus to be suspected in cases of FT1DM with abnormally low HbA1c or a markedly high GA/HbA1c ratio.
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  • 14-Year Follow-up of a MODY3 Patient with HNF1A/P291fsinsC
    Yukiko Mori, Kunimasa Yagi, Junji Koizumi, Yuki Matsumoto, Aya Fujimot ...
    2012 Volume 55 Issue 8 Pages 632-637
    Published: 2012
    Released on J-STAGE: September 12, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.632
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    A 27-year-old woman, who presented with glycosuria at the age of 12, had shown impaired glucose tolerance with decreased insulin secretion on 75 gOGTT at the age of 13. She had a family history of diabetes from both her father and paternal grandmother. She had developed diabetes mellitus and was diagnosed as having MODY3 with HNF1A/P291fsinsC mutation at the age of 14. She had been treated with diet modification until the age of 27 when she was admitted to our department because of an elevated HbA1c level of 6.5 %. She showed a decrease in CPR response (ΔCPR from 0.8 ng/ml to 1.8 ng/ml) on glucagon loading and showed a marked elevation of glucagon response (IRG from 133 pg/ml to 600 pg/ml) on arginine loading. Due to these results, insulin treatment was initiated. In addition, no diabetic complications have been detected until now. This report discusses the variance of clinical features in patients with the same MODY3 mutation. The clinical characteristics of MODY3 with HNF1A/P291fsinsC in our case are relatively milder over more than ten years of diabetes than those reported in the literature.
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  • A Case of Slowly Progressive Type 1 Diabetes Mellitus Complicated with Several Autoimmune Diseases and Megasigmoid
    Shinya Morita, Yuichi Maeda, Hiroshi Fujiwara, Shunji Miki, Masashi Hi ...
    2012 Volume 55 Issue 8 Pages 638-644
    Published: 2012
    Released on J-STAGE: September 12, 2012
    DOIhttps://doi.org/10.11213/tonyobyo.55.638
    JOURNAL FREE ACCESS
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    We report on a 74 years old woman with type 1 diabetes mellitus complicated with Sjögren's syndrome, primary biliary cirrhosis, systemic sclerosis, idiopathic thrombocytopenic purpura and megasigmoid. She had been diagnosed as having diabetes mellitus at the age of around 55 and insulin treatment was started at around 65. At 72 years old, she suffered from diabetic ketoacidosis and at that time was diagnosed as having volvulus of the sigmoid colon. We diagnosed her having slowly progressive type 1 diabetes mellitus because of very low serum and urinary C-peptide levels and elevated anti-GAD antibodies. Clinical and laboratory findings revealed that she also had Sjögren's syndrome, primary biliary cirrhosis and systemic sclerosis. At 74 years old, she suffered from obstructive ileus due to dilatation of the sigmoid colon, and underwent an operation. Resection specimens showed reduction of Auerbach's plexus and Meissner's plexus, and thinning and fibrotic change of the muscle layer. At 9 days after the operation, she developed idiopathic thrombocytopenic purpura. Although type 1 diabetes mellitus is sometimes complicated with other autoimmune diseases, the complication with Sjögren's syndrome, primary biliary cirrhosis, systemic sclerosis and idiopathic thrombocytopenic purpura has not been reported. Furthermore, the present case demonstrated the reduction of Auerbach's plexus and Meissner's plexus of megasigmoid, which is also an interesting observation suggesting the influence of diabetic neuropathy and that of autoimmune disorders.
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Letters to the Editor
Proceeding of the Local Societies
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