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Volume 57, Issue 4
Displaying 1-8 of 8 articles from this issue
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Original Articles
Diagnosis, Treatment
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Yoshiharu Tokuyama, Yoko Yanagisawa2014 Volume 57 Issue 4 Pages 227-234
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSIn order to validate the usefulness of 1,5-anhydroglucitol (AG) as an index of glycemic variability, we examined the correlation between the 1,5-AG value and the amplitude of glycemic fluctuation obtained from a continuous blood glucose monitoring system (CGM) in diabetic patients, the difference in the distribution of HbA1c and 1,5-AG among the different therapies, and the changes in the HbA1c and 1,5-AG levels before and after the administration of DPP-4 inhibitor. As a result, a significant negative relationship was observed between 1,5-AG and the standard deviation (SD) of blood glucose and between 1,5-AG and the mean amplitude of glycemic excursions (MAGE). Among the diabetic patients with 1,5-AG<10 μg/ml, the percentage of patients treated with sulfonylurea or insulin was higher than with other therapies, regardless of the HbA1c value, thus suggesting that sulfonylurea or insulin therapy could not sufficiently reduce glycemic variability. The administration of DPP-4 inhibitor decreased the HbA1c values and increased the 1,5AG values, thus suggesting that this medicine could effectively reduce glycemic variability. In conclusion, 1,5-AG is a useful and valuable index of glycemic variability and in order to suppress glycemic variability, it is desirable to adopt a treatment strategy aimed at 1,5-AG≥10 μg/ml.View full abstractDownload PDF (358K)
Pathophysiology, Metabolic Abnormalities, Complications
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Eri Ikeguchi, Takao Taniguchi, Yo Aramaki, Miki Araki, Motozumi Okamot ...2014 Volume 57 Issue 4 Pages 235-241
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSFifty-three diabetic patients were admitted to our hospital for hypoglycemia due to the side effects of sulfonylureas or insulin between January 2008 and March 2012. We retrospectively analyzed these cases based on the patients' clinical records. Forty-one patients were treated with sulfonylureas (SU group), while 12 received insulin (insulin group). The patients in the SU group were older than those in the insulin group, with a mean age of 83.0±8.7 and 74.8±10.8 years, respectively. The mean HbA1c (NGSP) level was lower in the SU group than in the insulin group (6.56±1.19 %vs. 7.64±1.20 %, respectively). The SU group required a significantly longer time for recovery from hypoglycemia than the insulin group (17:[6, 27] hours, 1.5:[1, 8.25] hours, respectively). The majority of patients in the SU group were over 80 years of age, with a serum creatinine level above 1.0 mg/dl or an eGFR below 60 ml/min/1.73 m2. Sulfonylureas should be applied carefully in elderly patients, taking into consideration changes to other oral antidiabetic drugs and/or insulin agents. In addition, clinicians should reconsider the target HbA1c level according to the patient's age and provide intensive education regarding coping methods for sick days.View full abstractDownload PDF (784K)
Case Reports
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Masahiro Asakawa, Arisa Niwa, Momoko Akihisa, Mizuho Sawada, Atsuko Mi ...2014 Volume 57 Issue 4 Pages 242-248
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSA 46-year-old male was admitted due to recurrent hypoglycemic episodes. He developed diabetes mellitus in 2000 and became insulin-dependent in 2006. Following the initiation of insulin treatment, his glycemic control stabilized (HbA1c: 6 % to 7 %). However, in 2013 (at 46 years of age), the frequency of the hypoglycemic episodes increased starting three months prior to hospitalization, which occurred after the patient experienced a low-grade fever for approximately three weeks. Symptoms such as easy fatigability, coldness, hypohidrosis and weight gain were noted concomitantly with the onset of frequent hypoglycemic episodes. He was diagnosed with primary hypothyroidism, and thyroid hormone replacement therapy was started. As a result of switching the patient's insulin therapy from multiple injections to an insulin pump in the hospital, the hypoglycemic episodes became infrequent. The patient's frequent hypoglycemic episodes were thought to be induced by primary hypothyroidism due to destructive thyroiditis complicating type 1 diabetes. Thyroid hormone deficiency delays the intestinal absorption of glucose, decreases gluconeogenesis in the liver and impairs glucagon secretion as the counterregulatory response to hypoglycemia. Accordingly, hypothyroidism can cause hypoglycemia. This case serves as a reminder that hypothyroidism should be taken into consideration as a possible cause of hypoglycemia.View full abstractDownload PDF (401K) -
Taku Tsunekawa, Shuko Yoshioka, Mariko Sugiyama, Yuri Shinohara, Yuich ...2014 Volume 57 Issue 4 Pages 249-255
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSA 79-year-old male was admitted to our hospital with a 10-day history of chorea in the head and bilateral arms. His blood glucose level was 308 mg/dl and his HbA1c level was 12.6 %. He was diagnosed with hyperglycemic chorea-ballism (HC), as the chorea disappeared a few days after achieving glycemic control with the administration of insulin therapy. Cranial CT performed on admission showed high-density areas in the bilateral putamen, while cranial MRI demonstrated high-intensity areas in the bilateral putamen on T1-weighted imaging and low-intensity areas outside the bilateral putamen on susceptibility-weighted imaging (SWI). The CT findings disappeared 14 days later, and the high-intensity areas on the T1-weighted imaging changed to low-intensity areas three months after discharge. In contrast, the low-intensity areas on SWI remained unchanged. SWI had not shown low-intensity areas in the same region 18 months before admission. Therefore, we speculate that the HC appeared due to the presence of increased reactive gemistocytes in sites of previous hemorrhage outside the putamen. There are only two previous reports describing the SWI findings of HC. SWI is useful for investigating the pathophysiology of HC.View full abstractDownload PDF (682K) -
Kenji Kamiuchi, Yoshitaka Hashimoto, Mikiko Niimi, Aki Yamashita, Mits ...2014 Volume 57 Issue 4 Pages 256-263
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSA 50-year-old female with type 2 diabetes was admitted to our hospital due to poor glycemic control and occasional hypoglycemic episodes. She became upset during admission, as she experienced hypoglycemic symptoms despite not having hypoglycemia. She sometimes forgot to bring her textbook to diabetes classes. We suspected she had ADHD and, with her consent, referred her to the Department of Psychiatry at Shiga University of Medical Science, where the diagnosis was confirmed. As ADHD can result in poor glycemic control in patients with diabetes, it is necessary to initiate appropriate treatment in such cases.View full abstractDownload PDF (478K) -
Takaaki Murakami, Taiji Koyama, Hideyuki Masui, Tomonobu Hatoko, Kiyot ...2014 Volume 57 Issue 4 Pages 264-270
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSA 56-year-old female with a six-year history of poorly controlled diabetes mellitus was admitted for septic shock with infectious diabetic foot ulcers. She was treated with antimicrobial agents, including daptomycin. Although her condition improved, she developed dyspnea and hypoxemia with bilateral pulmonary infiltrates one week after admission. She also exhibited eosinophilia and eosinophil-rich sputum. Her condition rapidly improved following the discontinuation of daptomycin. Therefore, the features of this case were consistent with a diagnosis of daptomycin-induced acute eosinophilic pneumonia. Daptomycin is a relatively new antimicrobial agent whose high degree of efficacy for diabetic skin and soft tissue infections and bacteremia has been proven in clinical trials. Increased attention should be paid to the rare but serious adverse effect of daptomycin-induced acute eosinophilic pneumonia.View full abstractDownload PDF (500K) -
Satoshi Tanaka, Ai Sato, Toshihiko Saito, Toshihiko Ohama, Kosaku Aman ...2014 Volume 57 Issue 4 Pages 271-276
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSGastric cancer was discovered in a 72-year-old man during a regular medical examination. Preoperative laboratory testing showed the patient to have diabetes mellitus, with PG 228 mg/dl and HbA1c 10.1 %. The combination of acromegalic facial features, no inhibition of GH in a 75 g OGTT, and MRI findings of a space-occupying lesion in the pituitary gland yielded a diagnosis of acromegaly. The treatment of gastric cancer was given priority, and the treatment of acromegaly was started with a long-acting formulation of octreotide acetate 20 mg/month, which successfully controlled IGF-I until they reached levels within the normal range. Intensive insulin therapy and drug treatment were started to treat the patient's diabetes. Despite a decrease in the endogenous insulin secretion after starting octreotide acetate, the blood glucose levels were subsequently well-controlled. A positive result was found for the IGF-1 receptors of the patient's gastric cancer cells, thus suggesting a relationship with acromegaly. Six months after starting the administration of long-acting octreotide acetate, the patient underwent transnasal pituitary tumor resection, which alleviated the acromegaly, and the drug treatment for diabetes was stopped. In this communication we describe the interesting clinical course of this patient with gastric cancer, diabetes mellitus and acromegaly.View full abstractDownload PDF (589K)
Proceeding of the Local Societies
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2014 Volume 57 Issue 4 Pages 277-319
Published: April 30, 2014
Released on J-STAGE: May 19, 2014
JOURNAL FREE ACCESSDownload PDF (1168K)
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