ID 109940
Title Transcription
ヒトウニョウビョウセイ ジンフゼン デ イジ トウセキチュウ ニ キュウセイ ハッショウ 1ガタ トウニョウビョウ オ ハッショウ シタ コウキ コウレイシャ ノ 1レイ
Title Alternative
A late elderly patient who developed acute-onset type 1 diabetes in the course of maintenance hemodialysis for non-diabetic renal failure
Author
Oe, Reika The Center for Clinical Education, Tokushima Prefectural Central Hospital|Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital
Yamaguchi, Hiroshi Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital
Bando, Tomoko Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital|The Postgraduate Center, Tokushima University Hospital
Harada, Takafumi The Center for Clinical Education, Tokushima Prefectural Central Hospital|Department of Cardiology, Tokushima Prefectural Central Hospital
Shirakami, Atsuhisa Department of Diabetology and Metabolic Medicine, Tokushima Prefectural Central Hospital
Inai, Toru Department of Urology, Tokushima Prefectural Central Hospital
Komatsu, Ayumu Komatsu Urology Clinic
Keywords
acute-onset type 1 diabetes mellitus
hemodialysis
late elderly
on-diabetic renal failure
Diabetic ketosis
Content Type
Journal Article
Description
We herein presented a case of a 75-year-old man who was referred to our hospital for hyperglycemia in a drowsy state following a convulsive seizure after receiving hemodialysis at another clinic. He had been receiving maintenance hemodialysis for non-diabetic renal failure from the age of 73 years. He was diagnosed with diabetic ketosis because his blood glucose level was 707mg/dl, HbA1c 8.3%, glycoalbumin 40.5%, serum osmolality 323mosm/kg, and 3-hydroxybutyric acid 5.8 mmol/l. Continuous intravenous insulin infusion therapy was immediately initiated and was changed to intensive insulin therapy on the 7th day after his admission. He did not have metabolic acidosis or serious dehydration associated with the acute metabolic derangement observed on arrival because fluid corrections for acid-base and electrolyte imbalances in the blood had been achieved by hemodialysis prior to his referral to our hospital. ΔCPR at six minutes in the glucagon loading test was hardly affected, indicating that his endogenous insulin secretory capacity was markedly reduced. The GAD antibody was negative. He had the haplotype of HLA DR4, which is considered to reflect disease susceptibility for type1diabetes in Japanese individuals. Acuteonset type 1 diabetes mellitus was diagnosed based on the diagnostic criteria for acute-onset type1 diabetes mellitus (2012) by the Committee of the Japan Diabetes Society. At the time of his discharge, 8 units of insulin lispro were being administered prior to each meal in addition to 2 units of insulin glargine before sleeping. He was transferred to a local clinic on the 23rd day after his admission. Although glycoalbumin had been measured every six months in the present case, it was not useful for detecting new onset diabetes. Therefore, blood glucose measurements before dialysis need to be regularly performed, even in dialysis patients with non-diabetic renal failure, in order to detect the new onset of diabetes at an early stage.
Journal Title
四国医学雑誌
ISSN
00373699
NCID
AN00102041
Publisher
徳島医学会
Volume
71
Issue
5-6
Start Page
149
End Page
154
Sort Key
149
Published Date
2015-12-25
FullText File
language
jpn
TextVersion
Publisher