- A Case of Concurrent Emphysematous Pyelonephritis and Emphysematous Cholecystitis in a Patient with Diabetes Mellitus.
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Se Hyung Lee, Ji Hoon Kim, Jong Young Lee, Tae Hyuck Choi, Gil Hyun Gang, Myoung Sook Shim, Jin Yub Kim
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Korean Diabetes J. 2005;29(3):262-266. Published online May 1, 2005
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- Several unusual infections such as malignant otitis externa, rhinocerebral mucormycosis, emphysematous pyelonephritis and emphysematous cholecystitis exclusively occur in diabetic patients. Each of these diseases is a rare, but potentially life-threatening infection. Therefore, prompt diagnosis and early medical and operative intervention will be necessary for these diseases. We report herein a very rare case in which emphysematous pyelonephritis and emphysematous cholecystitis were simultaneously diagnosed. A 45-year-old man, who was previously diagnosed with secondary diabetes mellitus due to chronic alcoholic pancreatitis ten years earlier, presented with fever and right upper quadrant abdominal pain for 3 days. Abdominal computed tomography showed an air-fluid level in the lumen of the gall bladder and there was gas collection within the right renal parenchyma. Broad-spectrum antibiotics therapy was initiated and cholecystectomy and right nephrectomy were performed. Escherichia coli bacteria were isolated from the culture of the blood, urine and sputum. The patient recovered and was discharged in a healthy state
- Hemichorea Associated with Type II Diabetes Mellitus.
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Ju Hee Maeng, Hee Sup Lee, Jin Gun Jang, Bae Gun Park, Kwang Deog Jo, Myoung Sook Shim, Jin Yub Kim
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Korean Diabetes J. 2003;27(4):362-366. Published online August 1, 2003
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- Hemichorea has been reported as a rare complication of nonketotic hyperglycemia. We report a diabetic patient who developed paroxysmal hemichorea. When hyperglycemia is corrected, the movement disorder resolves within a few days. The MR images showed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images in the left basal ganglia contralateral to the involuntary movement. We present a case of hemichorea in a poorly controlled diabetic patient.
- Clustering of Risk Variables in Insulin Resistance Syndrome in Jungup District, Korea.
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Sang Wook Kim, Myung Hoe Huh, Young Il Kim, Jin Yub Kim, Eun Sook Kim, Moo Song Lee, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee
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Korean Diabetes J. 1999;23(6):843-856. Published online January 1, 2001
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- BACKGROUND
Insulin resistance syndrome (IRS), a clustering of hypertension, impaired glucose tolerance, low HDL cholesterol and high triglyceride, is prevalent in Korea. We studied the correlational structure of IRS using factor analysis to evaluate whether a single process underlies in the clustering of these risk factors. METHODS: Factor analysis was performed using data from 1,018 non-diabetic subjects (388 men and 630 women) who participated in the Jungup epidemiological study. RESULTS: Factor analysis reduced 9 correlated risk factors to 4 independent factors, each reflecting a different aspect of IRS: hypertension factor (increased systolic and diastolic blood pressure), glucose intolerance factor (increased fasting and postload glucose), obesity factor (increased body mass index, waist circumference, and increased insulin), and dyslipidemia factor (increased trigly- cerides and decreased HDL cholesterol). Increased insulin was also loaded into dyslipidemia factor in men and glucose intolerance factor in women. These factors explained about 70% of the total variance in the data. Three factors such as the glucose intolerance factor, the dyslipidemia factor and the obesity factor, were linked through mutual association with hyperinsulinemia, while hypertension factor was not associated with hyperin- sulinemia. Age-adjusted mean BP by BMI tertile and fasting insulin level tertile for men and women increased progressively with increase in BMI in men and women. There was no significant elevation of mean BP according to increase in fasting insulin level. In contrast to premenopausal women in whom hyperinsulinemia show mutual association with the glucose intolerance factor, the dyslipidemia factor, and the obesity factor, hyperinsulinemia was only loaded into obesity factor in postmenopausal women. CONCLUSION: These results suggested that more than one process underlies the clustering of IRS. In sulin resistance alone did not seem to be the single underlying mechanism of IRS. Especially, hypertension was not correlated with hyperin- sulinemia.
- Lack of Effectiveness of Glomerular Hyperfiltration on Development of Microalbuminuria in Type 2 Diabetic Patients: five Year Follow-up Study.
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Eun Sook Kim, Sang Wook Kim, Jin Yub Kim, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee
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Korean Diabetes J. 1999;23(2):155-161. Published online January 1, 2001
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- BACKGROUND
Glomerular hyperfiltration (GHF) is found in 30-40% of patients with type 1 diabetes at the onset of the disease. Several lines of evidence suggest that this might be responsible for the development of diabetic nephropathy. However, it is still controversial whether GHF is a risk factor in patients with type 2 diabetes. This led us to perform a five-year-prospective study in normoalbuminuric type 2 diabetic patients. METHODS: A total of 68 patients with type 2 diabetes were studied prospectively, They were all normoalbuminuric initially. Glomerular filtration rate was determined by the 51Cr-EDTA single injection method and urinary albumin excretion rate by the radioimtnunoassay method. RESULTS: GHF was present in 19 out of 68 patients. At follow-up, l7 out of 49 patients of the normofiltration group and 3 out of 19 patients of GHF group progressed to microalbuminuria (p>0.05). Multiple logistic regression analysis revealed that the known duration of diabetes, systolic hypertension, and the presence of retinopathy were independently associated with the development of microalbuminuria. CONCLUSION: Our study suggests that GHF does not predict the subsequent development of diabetic nephropathy as indicated by the elevation of the urinary albumin excretion rate during the five year interval.
- Prevalence of Insulin Resistance Syndrome in Subjects Living in Jungup District , Korea.
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Sang Wook Kim, Jin Yub Kim, Eun Sook Kim, Young Il Kim, Moo Song Lee, Hyeong Ho Kim, Joong Yeoul Park, Sung Kwan Hong, Ki Up Lee
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Korean Diabetes J. 1999;23(1):70-78. Published online January 1, 2001
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- BACKGROUND
The clustering of hypertension, impaired glucose tolerance, low HDL cholesteml and high triglyceride is known as insulin resistance syndrome (IRS). We studied the prevalence of insulin resistance syndrome among subjects living in Jungup district, Korea. METHODS: Among a total of 151,000 subjects over 40 years of years living in Jungup district, a sample of 1,791 was selected using a random cluster sampling method. Oral glucose tolerance test revealed 1,018 subjects with normal or impaired glucose tolerance. The IRS was defined as the coexistence of two or more components of triad; hypertension, impaired glucose tolerance and dyslipidemia (triglycerides >= 200mg/dL and HDL <45 mg/dL for woman, HDL < 35 mg/dL for men). RESULTS: Twenty-one percent of men and 45% of women were obese and 50.8% and 61.9% were hypertensive. Eleven percent of men and 16 percent of women were found to have dyslipidemia. The prevalence of impaired glucose tolerance was 10.2% for men and 15.7% for women. The prevalence of IRS in the Jungup population was 12.8% for men and 19.6% for women. The prevalence of IRS increased according to the plasma level of insulin. There was a positive correlation between the number of components of IRS and the level of fasting plasma insulin. CONCLUSION: We conclude that the prevalence of IRS is high in Korean subjects. The close correlation between the IRS components and fasting insulin level suggests that cardiovascular risk is associated with insulin resistance.
- Effect of Decreased Plasma Free Fatty Acids by an Antilipolytic Agent on Plasma Glucose Level and Liver Glycogen Content in Streptozotocin - induced Diabetic Rat.
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Yun Ey Chung, Sang Wook Kim, Jin Yub Kim, Eun Sook Kim, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee
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Korean Diabetes J. 1999;23(1):46-54. Published online January 1, 2001
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- BACKGROUND
Increased availability of plasma free fatty acid (FFA) leads to an inhibition of glucose utilization in peripheral tissue and to an increase of gluconeogenesis in the liver. A previous study has shown that a decrease in plasma FFA profoundly inhitbits hepatic gluconeogenesis, but total hepatic glucose production is maintained due to a com pensatory increase in glycogenolysis. It has been suggested that this hepatic autoregulatory mechanism is defective in the diabetic state, but there has been no firm evidence to confirm this. This study was performed to see the effect of decreasing plasma FFA on plasma glucose and hepatic glucose metabolism in diabetic rats, METHODS: Eight nondiabetic and 8 streptozotocin-induced diabetic rats were used. Blood sampling for plasma glucose and free fatty acid and liver biopsy for measurement of glycogen content were done after intravenous phenobarbital ancsthesia. Acipimox (50 mg/kg in saline) was administered via gastric tube. Plasma glucose and FFA were measured at 30, 60 and 120 min. Liver biopsy was repeated at 120 min. RESULTS: Baseline plasma glucose and FFA were higher in diabetic rats than in nondiabetic rats (18.8 +1.4 mmol/L vs. 6.9+0.8 mmol/L, 720+/-36 umol/L vs. 420+40 umol/L p<0.001 respectively). Hepatic glycogen content was higer in nondiabetic rats (31.8 +1.6mg/g liver vs. 26.02.Dmg/g liver, p<0.01). After acipimox administration, plasma glucose decreased profoundly in diabetic rats (18.8+1.4 mmol/L to 9.2+1.2 mmol/L, p<0.001) but not in nondiabetic rats. Glycogen content was significantly reduced in both groups (p<0.001). However, the difference in the contents was much smaller in the diabetic group compared with the nondiabetic group (6.5+2.1 mg/g liver vs. 19.2+ l.9 mg/g liver, p<0.001). CONCLUSION: 1t is suggested that the intrahepatic autoregulatory mechanism, which maintains hepatic glucose production constant in nondiabetic rats, is defective in diabetic rats.
- The Effects of Metformin Given into the Brain on Food Intake and a Expressions of Hypothalamic Neurotransmitters in the Rats.
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Eun Sook Kim, Jin Yub Kim, Sang Wook Kim, Joong Yeol Park, Ki Up Lee, Sung Kwan Hong
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Korean Diabetes J. 1998;22(4):475-481. Published online January 1, 2001
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Metformin, a biguanide agent, is an oral hypoglycemic agent frequently prescribed to non-insulin-dependent diabetic patients. In adclition to the glucose lowering effect, it is known to suppress fol intake, but the action mechanism for food intake suppression is not known yet. Hypothalamic neuropeptide Y (NPY) is recently identified that strongly stimulates food intake and melanin concentrating hormone (MCH) is also known to be involved in the ingestion of foods. The effects of mettormin on these substances are not known yet. We tried to define the effect of metformin administered into the lateral ventricle on the amount of food intake and mRNA expressions of NPY and MCH. METHODS: Each rat was housed in a separate cage, and brain cannula was set into the lateral ventricle and proper position was checked by the response to angiotensin-II injection. Metformin l ug (1 ug/uL) or normal saline (1 uL) were injected daily into the lateral ventricle for 4 days in the Metformin group (n=7) and Control group (n=6) respectively, and the amount of food intake and weight change were recrded. Expressions of corticotropin releasing hormone mRNA in paraventricular nucleus, NPY mRNA in arcuate nucleus, and MCH mRNA in lateral hypothalamus were measured by the in situ hybridization technique. RESULTS: The amount of food intake was lower in metformin group than that in control group by 14~35% during the study period (p<0.05). Changes of body weight was -18+9 g (mean+SD) in metformin group and -2+11 g in control group. But mRNA expressions of NPY, MCH and CRH were not different between the groups (p>0.05). CONCLUSION: Metformin injected into the brain reduced the amount of food intake and body weight without the changes of NPY and MCH mRNAs. This study suggests that metformin suppress food intake by directly acting in the brain, but these effects are not through the changes of NPY and MCH mRNA expressions.
- High Serum Lipoprotein ( a ) Levels in Korean Type 2 Diabetic Patients with Proliferative Diabetic retinopathy.
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Hyung Joo Park, Chul Hee Kim, Yun Ey Chung, Sang Wook Kim, Jin Yub Kim, Eun Sook Kim, Sung Kwan Hong, Ki Up Lee
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Korean Diabetes J. 1998;22(3):338-343. Published online January 1, 2001
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To examine the possible association between serum lipoprotein(a) (Lp(a)) concentration and proliferative diabetic retinopathy(PDR) in Korean patients with type 2 diabetes mellitus. METHODS: A total of 412 Korean outpatients with type 2 diabetes were examined. Diabetic retinopathy was determined by fundoscopic examination by an ophthalmologist and/or by fluorecein angiography. Semm Lp(a) levels were measured by one step sandwich ELISA method. RESULTS: The patient with PDR had higher serum Lp(a) levels than those with no retinopathy or non-proliferative diabetic retinopathy(NPDR). Multiple logistic regression analysis showed that serum Lp(a) level and the presence of diabetic nephropathy were independent variables having a statistically significant association with PDR. CONCLUSION: Korean type 2 diabetic patients with PDR had higher serum Lp(a) levels compared with those with no retinopathy or NPDR. Although these results suggested that Lp(a) might play a role in the occlusion of retinal capillaries leading to PDR, further prospective studies are required to prove causal relationship.
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