Hypoglycemia in diabetic patients is usually caused by excessive exogenous insulin or the administration of an insulin secretagogue relative to the prevailing glucose concentration. Thus, the clinical manifestations of hypoglycemia are usually not observed in diabetic patients after either insulin or an oral hypoglycemic agent is discontinued. In contrast, diabetic ketoacidosis results from relative or absolute insulin deficiency. Although about 40% of diabetic patients who inject human insulin have insulin antibodies, these antibodies seldom significantly affect the glycemic control. It has not been reported in the literature that insulin antibody in the setting of human insulin therapy is associated with diabetic ketoacidosis and subsequent hypoglycemia. We describe here a rare case of spontaneous hypoglycemia due to insulin antibody after the improvement of diabetic ketoacidosis in a patient with type 2 diabetes mellitus and who had been treated with human insulin.
Antibodies ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Glucose ; Humans ; Hypoglycemia ; Insulin ; Insulin Antibodies

BACKGROUND: Although the majority of diabetes mellitus (DM) patients diagnosed as adults have non-autoimmune forms of the disease, islet autoimmunity is encountered in some patients initially thought to have type 2 DM. The phenotype of DM patients with glutamic acid decarboxylase (GAD) antibodies is different from that of patients with GAD antibody-negative type 2 DM, with features such as relative leanness and hyperglycemia which may influence the development of complications. We sought to compare the prevalence of chronic complications in patients with and without the GAD antibody. METHODS: We recruited 427 patients (M: 218, F: 209) that were clinically diagnosed with type 2 DM after the age of 35 years. We measured GAD antibody and assessed the factors associated with chronic microvascular and macrovascular complications. RESULTS: Of these patients, 26 were GAD antibody-positive. The patients with GAD antibody had lower systolic blood pressure, higher high-density lipoprotein cholesterol value, and lower level of fasting and stimulated C-peptide than patients without GAD antibody (P < 0.05). Also, the patients with GAD antibody had lower prevalence of retinopathy compared with the patients without GAD antibody (19.2 vs. 47.9%; P < 0.05). The prevalence of nephropathy, peripheral neuropathy and cardiovascular autonomic neuropathy did not differ between the groups. In addition, the prevalence of coronary heart disease, cerebrovascular disease and peripheral arterial disease did not differ between the two groups. CONCLUSION: This study suggests that diabetic patients with GAD antibody have a lower risk for the development of retinopathy compared with patients without GAD antibody.
Adult ; Antibodies ; Autoimmunity ; C-Peptide ; Cholesterol ; Coronary Disease ; Diabetes Complications ; Diabetes Mellitus ; Fasting ; Glutamate Decarboxylase ; Humans ; Hyperglycemia ; Hypertension ; Lipoproteins ; Peripheral Arterial Disease ; Peripheral Nervous System Diseases ; Phenotype ; Prevalence ; Thinness

BACKGROUND: Diabetes mellitus is a major independent risk factor for cardiovascular disease (CVD), but high cardiovascular risk in diabetes mellitus patients is not completely explained by clustering traditional risk factors. Recently, associations between diabetic polyneuropathy (DPN) and macrovasculopathy have been suggested. We aimed to assess associations between DPN and cardiovascular complications in type 2 diabetic patients. METHODS: Microvascular and cardiovascular complications were evaluated in 1,041 type 2 diabetic patients. RESULTS: In patients with DPN, the age, prevalence of hypertension, diabetes duration, systolic blood pressure, pulse pressure, and hemoglobin glycation (HbA1c) levels were significantly higher, while the high density lipoprotein cholesterol (HDL-C) levels were lower than in those without DPN. The prevalence of CVD was higher in patients with DPN. In multivariate analysis, DPN was independently associated with CVD (odds ratio, 1.801; 95% confidence interval, 1.009 to 3.214). CONCLUSION: Our results showed that DPN was associated with a high prevalence of cardiovascular disease in type 2 diabetic patients, but further studies are needed to investigate the causative nature of associations between DPN and CVD.
Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diabetic Neuropathies ; Hemoglobins ; Humans ; Hypertension ; Lipoproteins ; Multivariate Analysis ; NAD ; Prevalence ; Risk Factors

BACKGROUND: The initial insulin dose is often determined by clinical experience or with a formula using the body weight. However, it may be difficult to determine the initial insulin dose because various factors such as insulin sensitivity and the glycemic status can influence the insulin requirement. The purpose of this study was to assess the factors that influence the initial insulin requirement in insulin naive patients with type 2 diabetes mellitus. METHODS: A total 128 patients who were admitted for glycemic control were investigated. The patients were managed with long-acting insulin glargine and rapid-acting insulin lispro. RESULTS: The basal insulin requirement was positively correlated with waist circumference, body mass index (BMI), the HbA1C, AST, ALT, fasting plasma glucose and 2-hour postprandial glucose levels and the homeostasis model assessment of insulin resistance (HOMA-IR), but it was negatively correlated with age and the stimulated C-peptide level. The daily insulin requirement was positively correlated with waist circumference, BMI, the HbA1C, AST, ALT, triglyceride, fasting plasma glucose and 2-hour postprandial glucose level and HOMA-IR, but it was negatively correlated with age. On the multiple linear regression analysis, the basal insulin requirement was independently associated with BMI (beta = 0.507, p < 0.001), the 2-hour postprandial glucose level (beta = 0.307, p < 0.001), the ALT level (beta = 0.214, P = 0.015) and the meal-stimulated C-peptide level (beta = -0.209, P = 0.010). The daily insulin requirement was independently associated with BMI (beta = 0.508, p < 0.001) and the 2-hour postprandial glucose level (beta = 0.404, p < 0.001). CONCLUSION: Our results show that the BMI and 2-hour postprandial glucose level are useful predictors of the initial insulin requirement in insulin naive type 2 diabetic patients. It may be prudent to consider the other various factors that influence the insulin requirement together when insulin therapy is required.
Body Mass Index ; Body Weight ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Lispro ; Insulin Resistance ; Insulin, Long-Acting ; Insulin, Short-Acting ; Linear Models ; Plasma ; Waist Circumference ; Insulin Glargine

BACKGROUND: Cardiovascular risk is higher among people with diabetic nephropathy than among those with normal renal function. Carotid intima-media thickness (IMT) is an independent predictor of cardiovascular mortality in type 2 diabetic patients. However, the relationship between carotid IMT and diabetic nephropathy is not well known. The aim of our study was to elucidate whether carotid IMT is associated with progression of diabetic nephropathy in type 2 diabetic patients. METHODS: We recruited a total of 354 type 2 diabetic patients with diabetic nephropathy. Renal function was evaluated by serum creatinine levels, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR). Carotid IMT was assessed using B-mode ultrasound by measuring generally used parameters. Baseline-to-study end changes in eGFR were calculated, and the yearly change of eGFR (mL/min/yr) was computed. RESULTS: Age, diabetes duration, ACR, and eGFR were significantly correlated with mean or maximal carotid IMT; however, lipid profiles, HbA1c, and blood pressure were not correlated. The mean yearly eGFR change was -4.9 +/- 5.3 mL/min/yr. The yearly eGFR change was negatively correlated with mean and maximal carotid IMT. After adjusting for age and diabetes duration, the mean IMT is an independent predictor of yearly eGFR change. CONCLUSION: Carotid IMT may be a predictor of diabetic nephropathy progression in patients with type 2 diabetes.
Blood Pressure ; Carotid Intima-Media Thickness ; Creatinine ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Glomerular Filtration Rate ; Humans

No abstract available.
Diabetic Neuropathies ; Humans

BACKGROUND/AIMS: We investigated the associations among body mass index (BMI), insulin resistance, and beta-cell function in Korean patients newly presenting with type 2 diabetes. METHODS: In total, 132 patients with new-onset type 2 diabetes mellitus were investigated. A standard 75-g oral glucose tolerance test was performed, and the indices of insulin secretion and insulin resistance were calculated. RESULTS: A higher BMI was associated with higher homeostasis model assessment values for insulin resistance (HOMA-IR), homeostasis model assessment of beta-cell function (HOMA-beta), and insulinogenic index as well as lower levels of insulin sensitivity index composite (ISIcomp) and disposition index (DI). In multiple regression models, BMI had independent positive associations with HOMA-IR, ISIcomp, and HOMA-beta and inverse associations with the DI. CONCLUSIONS: Our results showed that BMI had independent positive associations with indices of insulin resistance and an inverse association with beta-cell function adjusted for insulin resistance in Korean patients newly presenting with type 2 diabetes.
*Asian Continental Ancestry Group ; Biological Markers/blood ; Blood Glucose/metabolism ; *Body Mass Index ; Diabetes Mellitus, Type 2/blood/diagnosis/*ethnology/physiopathology ; Female ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated/metabolism ; Humans ; Insulin/blood ; Insulin Resistance/*ethnology ; Insulin-Secreting Cells/*metabolism ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors

BACKGROUND/AIMS: Many studies have demonstrated an association between hemoglobin levels and cardiovascular disease in diabetic patients. The aim of this study was to determine whether there is an association between hemoglobin concentrations and various clinical parameters, including metabolic factors, plasma C-peptide response after a meal tolerance test, and microvascular complications, in Korean patients with type 2 diabetes. METHODS: In total, 337 male patients with type 2 diabetes were recruited. All subjects were subjected to a meal tolerance test and underwent assessment of hemoglobin levels, fasting and postprandial beta-cell responsiveness, and microvascular complications. RESULTS: Patients with lower hemoglobin concentrations had a longer duration of diabetes, a lower body mass index, and lower concentrations of total cholesterol, triglycerides, and low-density lipoprotein cholesterol. They also had lower levels of postprandial C-peptide, Delta C-peptide, and postprandial beta-cell responsiveness. They had a higher prevalence of retinopathy and nephropathy. In multivariate analyses, there was a significant association between nephropathy and hemoglobin concentration. Also, hemoglobin concentrations were independently associated with Delta C-peptide levels and postprandial beta-cell responsiveness. CONCLUSIONS: Hemoglobin concentrations are associated with postprandial C-peptide responses and diabetic nephropathy in patients with type 2 diabetes.
Aged ; Biological Markers/blood ; Blood Glucose/metabolism ; C-Peptide/blood ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/*blood/diagnosis/epidemiology ; Diabetic Nephropathies/*blood/diagnosis/epidemiology ; Diabetic Retinopathy/*blood/diagnosis/epidemiology ; Hemoglobins/*metabolism ; Humans ; Insulin-Secreting Cells/metabolism ; Linear Models ; Lipids/blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postprandial Period ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors

BACKGROUND/AIMS: To characterize ultrasonographic findings in papillary thyroid carcinoma (PTC) combined with Graves' disease. METHODS: Medical records and ultrasonographic findings of 1,013 patients with Graves' disease and 3,380 patients without Graves' disease were analyzed retrospectively. A diagnosis of PTC was based on a pathologic examination. RESULTS: The frequency of hypoechogenicity was lower in patients with PTC and Graves' disease than in patients with PTC alone (p < 0.05). The frequency of perinodular blood flow in patients with PTC and Graves' disease was significantly higher than in those with PTC alone (p < 0.05). PTC combined with Graves' disease was characterized by more ill-defined borders and less frequency of overall calcification, punctate calcification, and heterogeneous echogenicity, although the difference was not statistically significant. CONCLUSIONS: Our results suggest that patients with Graves' disease more frequently have atypical PTC findings on ultrasonography.
Adult ; Carcinoma, Papillary/*ultrasonography ; Female ; Graves Disease/*ultrasonography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Gland/*ultrasonography ; Thyroid Neoplasms/*ultrasonography ; Ultrasonography/*methods

It is becoming increasingly evident that adults with Turner's syndrome are susceptible to endocrine autoimmunity. An increased prevalence of thyroid autoantibodies and hypothyroidism in patients with Turner's syndrome has been reported, but the involvement of Graves' disease in these patients is relatively rare. We describe a case of Graves' disease associated with Turner's syndrome. A 28-year-old woman was referred for diffuse anterior neck swelling and palpitation. She had been diagnosed with Turner's syndrome with monosomy 45,X before the age of 9 years and she took estrogen together with progesterone. The physical examination revealed a firm, non-tender goiter. The T3 level was 632 ng/dL, the free T4 level was 5.68 ng/dL, the TSH level was 0.02 microIU/mL, the % of TSH-binding inhibiting immunoglobulin was 24% and the anti-thyroid autoantibodies were positive. The radioactive iodine uptake was increased. Therefore, she was diagnosed as having Graves' disease.
Adult ; Autoantibodies ; Autoimmunity ; Estrogens ; Female ; Goiter ; Graves Disease ; Humans ; Hypothyroidism ; Immunoglobulins ; Iodine ; Monosomy ; Neck ; Physical Examination ; Prevalence ; Progesterone ; Thyroid Gland ; Turner Syndrome