Useful meal tolerance test (MTT) for carbohydrate amount and post-prandial blood glucose

Background: Low carbohydrate diet (LCD) has been effective for type 2 diabetes mellitus (T2DM), because of less post-prandial increase of blood glucose. Case presentation: The case is 62-year-old male with T2DM, who had experience of LCD a few years ago. He developed diabetic exacerbation as HbA1c 10.7% in autumn 2021. Results: He began super-LCD with 12% of carbohydrate in calorie ratio, and recorded the pictures of detail food intake every day and 45-minunte post-prandial blood glucose for long. His HbA1c decreased to 7.1% for 9 weeks. For breakfast, carbohydrate amount varies from 19.7 g to 51.1g, and 45-min post-prandial blood glucose distribute 121mg/dL to 226mg/dL. The relationship between carbohydrate amount in breakfast and 45-min post-prandial blood glucose was investigated. As a result, significant correlation was observed between them (R2=0.46, p<0.05). Regression curve revealed y=2.5897x+73.226, in which the slope of the straight line is 2.6. Discussion and Conclusion: Obtained data may suggest that carbohydrate 1g can increase post-prandial glucose 2.6mg/dL. As to the standard fact of carbohydrate metabolism in the textbook, 3.0mg/dL glucose increase per carbohydrate 1g has been observed. Restricted carbohydrate intake would be beneficial for improving glucose variability in T2DM

Satisfactory Control for Glucose Profile by Combined Agents of Xultophy with A Small Dose

The patient was a 74-year-old female with type 2 diabetes mellitus (T2DM) treated on Humalog mix 25 twice a day. As social history, she has worked long years for growing and harvesting lotus roots. It gives physically heavy loading, which brings unstable glycemic daily control. She had to titrate minute regulation every time. For stable glucose variability, the treatment was changed to Xultophy, which is a specific combined agent of Insulin Degludec and Liraglutide (IDeg/Lira) once a day. Then, detailed glucose monitoring showed a better daily profile of blood glucose, irrespective of heavy or light work. It showed the bio-psycho-social benefit of Xultophy

Improved Insulin Resistance and Glucose Variability by Super-Low Carbohydrate Diet

Background Diabetes mellitus (DM) has been more prevalent. American Diabetes Association (ADA) proposed the Standards of Medical Care in Diabetes-2022. For nutritional therapy, low carbohydrate diet (LCD) has been recognized for its benefits. Authors have continued diabetic research concerning LCD and meal tolerance test (MTT). Case Presentation The case is 61-year-old male with type 2 diabetes mellitus (T2DM) for years. His hemoglobin A1c (HbA1c) increased to 7.8% in autumn 2021, and further evaluation and treatment was conducted including LCD, daily check of meal and carbohydrate amount, 75 g OGTT, glucagon stimulation test (GST) and others. Results He was on super-LCD method including 12% of carbohydrate. His carbohydrate intake amount and 45-minutes post-prandial blood glucose showed significant correlation. The results of 75 g OGTT twice in May 2020 and December 2021 showed that similar pattern of glucose and insulin responses and insulinogenic index (IGI). In contrast, they showed decreased fasting immuno-reactive insulin (IRI) and Homeostasis model assessment insulin resistance (HOMA-R). For GST, C-peptide showed normal response. Discussion and Conclusion Judging from the results of MTT, OGTT, GST and IGI, he seems to show rather decreased insulin resistance by LCD associated with preserved insulin secretion ability to some degree. Further investigation would be required from pathophysiological point of view

The importance of continuing adequate lifestyle including exercise, daily activity and low carbohydrate diet (LCD) for type 2 diabetes mellitus (T2DM)

The case was 71-year-old male patient with type 2 diabetes mellitus (T2DM). He was diagnosed T2DM at the age of 61 associated with thirsty, polydipsia and fatigue. HbA1c value was 12.5% and blood glucose profile was 150-300 mg/dL. Just after starting low carbohydrate diet (LCD), his blood glucose kept under 150 mg/dL all day long. He continued good diabetic control as HbA1c 5.8-6.8% for 10 years. Some beneficial points are found: i) keeping LCD with the feeling not stressful but pleasant for observing the normal glucose level, ii) walking daily for 2 hours, iii) continuing educational activity in the walking association for DM and health care. iv) writing the diary for years every day, including exercise, meal, medicine, activities and so on, v) checking post-prandial hyperglycemia by meal tolerance test (MTT). For details of v), HbA1c was 6.5% in May 2021 and fasting glucose was 107mg/dL. Glucose values 45-min and 60-min after 3 meals showed 210-201-177mg/dL and 195-213-172mg/dL, respectively. His various continuing behaviors contributed satisfactory glycemic control. This article becomes reference in the diabetic practice and research

Detail Investigation of Frequent Nocturia and its Improvement by the Administration of Diuretic

Background: For elderly people, nocturia has been often found associated with other diseases. Case presentation: The case is 88-year-old male with hypertension, Cardiovascular Disease (CVD), Diabetes, Chronic Kidney Disease (CKD). He developed nocturia and insomnia, and then checked daily water balance by himself. Results: Basic situation showed water intake/urine volume were 750mL/1030mL/day, in which urine ratio of day/night was 27%/73% with waking up twice during night. He was given furosemide 20mg, per os at 1500h. Same study showed 960mL/1090 mL, and urine ratio as 77%/23% with no waking up. Discussion and Conclusion: From some reports, Odds Ratio (OR) for combination of nocturia shows 1.25 for hypertension, 1.23/1.74 for CVD (mild/severe). Consequently, current treatment would contribute adequate managements for nocturia problem

Ketone Bodies in the Fetus and Newborn During Gestational Diabetes and Normal Delivery

Background: Authors successfully treated gestational diabetes by a very low carbohydrate diet without insulin and other drugs. Increased ketone bodies seemed to play an essential role in energy metabolism, and the fetus and newborn also showed hyperketosis. It is necessary to clarify how much ketone bodies were present in the placenta and umbilical cord in the fetus and newborn and the pregnant mother with or without gestational diabetes. Subjects and Methods: All cases were patients of Muneta OB/GYN Clinic in Chiba, where about 700 deliveries were done every year, 90% normal and 10% gestational diabetic. Blood of 313 mothers and babies at health check-up postpartum, 192 samples of placenta and cord blood at the delivery, and 122 cases were obtained at the time of miscarriage. Abbott's kit measured βHB, and 101 samples obtained at the post partem health check-up were biochemically analyzed for both βHB and glucose. The IBM-SPSS did the statistical analysis. Results: βHB in Mothers' and newborns' blood at four days postpartum was 0.062 and 0.244 mmole/L (median), respectively, and glucose was 4.55±0.81 mmole/L. βHB was high throughout the pregnancy; In the placenta, βHB in the first-, second-and-third trimester was 1.95±0.9 mmole/L, 2.82±0.49 mmole/L, 1.87±0,65 mM/L, respectively. In the cord blood, it was 2.3±1.13 mmole/L, 1.36±0.76 mmole/L, and 0.69±0.6 mmole/L, respectively. Placental βHB at the delivery was 1.99±0.78 mmole/L, and that of the umbilical cord was 0.75±0.36 mmole/L. In the first trimester miscarriage, βHB in spontaneous abortion was 1.84±0.85 mmole/L, while it was 2.09±0.94 mmole/L in artificial abortion. Aborted cases in the second trimester showed 1.96±0.38 mmole/L βHB and 3.74±0.75 mmole/L glucose in the cerebrospinal fluid. Discussion: Our data showed βHB and glucose concentration in the human fetus and newborn under the normal physiological condition. βHB was present in the placenta and umbilical cord blood throughout fetal life and after birth. Different concentrations between the placenta and umbilical cord blood suggested the fetus's uptake for energy and intrauterine growth. High βHB in the cerebrospinal fluid suggested the effects on neuronal development

An actual condition survey on “career development regarding cancer nursing”

本研究の目的は，看護職者のキャリアディベロップメント支援のための継続教育プログラムの構築の基礎資料を得るために，A県下の看護職者のがん看護に関する学習状況やキャリア志向の実態を明らかにすることである．A県下病床数１００床以上の外・内科を併設する病院１７施設の看護職者１０１７名中６８６名（回収率６７．５％）を分析対象とした．結果，がん看護に関する学習項目全てにおいて学習ニードが高かった．また，がん看護の学習機会を持つ者や学習の阻害要因はないと回答した者が多かった．職業的満足感では“看護の仕事にやりがいを感じている”“仕事上での目標がある”と回答した者が多く，“今の看護の仕事に満足している”とした者は約半数であった．がんに関する資格取得希望者は少なかった．がん看護に関する学習ニードと対象者の背景および学習機会，阻害要因，キャリア志向との関係については，学習機会があると回答した方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．また，阻害要因があると回答した方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．職業的満足感では“看護の仕事にやりがいを感じている”で〈そう思う群〉の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．“仕事上での目標がある”では〈そう思う群〉の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．“今の看護の仕事に満足している”では〈思わない群〉の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．資格取得希望者の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．以上より，がん看護に関する学習ニードの高さが示された．がん看護に関するキャリアディベロップにおいて，施設側と教育側の連携と学習ニードを充実させていくことが鍵となることが示唆された．The objective of this study was to elucidate the actual conditions of learning needs for cancer nursing and career-intended mind among nursing staff in Prefecture A in order to obtain basic information for establishing a continuing educational programs as support for developing a career of nursing staff. A survey was conducted on １０１７ nurses working at one of １７ hospitals with ≥１００ beds in Prefecture A that have both a department of surgery and a department of internal medicine. Answers from ６８６ nurses （response rate, ６７．５％）were analyzed. The results indicated that there was a high level of learning needs in all learning items regarding cancer nursing. In addition, many nurses answered that they had opportunities to learn cancer nursing or that they had no obstacles to learn. Regarding job satisfaction, many nurses answered that they “feel worthwhile in nursing work” and “have objectives in their jobs” and approximately half of them answered that they “are satisfied with current nursing work”. Few nurses had a desire to acquire qualifications for being engaged in a high level of cancer care. In comparison of average scores of learning needs, nurses who answered there was a learning opportunities have higher scores than total average scores（P＜０．０５）. In addition, learning need was high the one where had a hindrances to learning（P＜０．０５）. As for the learning needs regarding cancer nursing and the relations of the career intention, learning need was higher Agree group in “find nursing work rewarding” （P＜０．０５） and “have career objectives” （P＜０．０５）. Furthermore, learning need was higher Disagree group in “are satisfied with current nursing work” （P＜ ０．０５）. Learning need was higher a qualification applicant （P＜０．０５）. These findings indicate a high level of learning needs regarding cancer nursing. It is necessary for “career development regarding cancer nursing” to be filled up in cooperation and learning need

Learning of the students who have undertaken the patients necessitating rehabilitation

運動機能障害や意識レベルの障害があり，リハビリテーション看護の必要な患者を受け持った学生の実習終了後のレポートより，学生の学びを抽出し，内容分析を行った．その結果，２０３コードが抽出でき，３９サブカテゴリー，１０カテゴリーに分類できた．その内容は『リハビリテーション看護の方法の理解と必要性の自覚』，『患者の状況・把握の重要性と判断の難しさ』，『リハビリテーションの必要な患者の思い』，『看護師としての役割の自覚』，『看護のやりがいの実感』，『医療者の連携の重要性』，『家族への援助の必要性』，『コミュニケーションの重要性と難しさ』，『安全確保の重要性と難しさ』，『説明・指導・教育の重要性と難しさ』であった．この中で『リハビリテーションの必要な患者の思い』，『看護のやりがいの実感』，『安全確保の重要性と難しさ』，の３つが，リハビリテーション看護の必要な，運動機能障害や意識レベルの障害がある患者についての特徴的な学びであることがわかった．The learning of the students who experienced rehabilitation nursing of patients having disturbance of motility and/or impairment of consciousness was analyzed from their reports after the clinical practice. As the result, ２０３ codes were extracted and classified into ３９ sub categories and １１ categories. The categories were “understanding of the method of the rehabilitation nursing and consciousness of its necessity”, “importance of the grasp and difficulty of the judgment of the patient situation”, “thought of the patients who need rehabilitation”, “consciousness of the role as a nurse”, “necessity of the assist to the family”, “actual feeling of worth doing of the nursing”, “importance of the cooperation of the medical person”, “importance and difficulty of the communication”, “importance and difficulty of safety ensuring”, “importance and difficulty of explanation, guidance and education”, and “others”. It was found that the knowledge obtained through the rehabilitation nursing was mainly characterized with “importance of safety ensuring”, “thought of the patients”, and “actual feeling of worth doing of the nursing”

Ketone Bodies Elevation in Placenta, Umbilical Cord, Newborn and Mother

Background: Low carbohydrate diets (LCD) have been recently prevalent in the medical and health field, especially in diabetes mellitus. We have applied LCD on thousands of patients with metabolic diseases and reported the clinical effect of LCD so far. Through our experience and research concerning LCD, the physiological role of glucose and ketone bodies during the pre- and post-partum period was investigated in this study. Subjects and methods: Subjects were 60 normal pregnant woman who had a normal delivery in full-term, without an abnormal glucose intolerance. Methods included the measurement of the value of ketone bodies in the umbilical cord blood, placental tissue fluid and maternal blood, associated with the value of blood glucose. As ketone bodies, the value of 3-hydroxybutyric acid (3-OHBA, beta-hydroxybutyric acid) was measured. 3-OHBA and glucose values were measured by the electrode method using Precision Exceed Kit (Abbott) and the conventional enzymatic cycling method, with comparison investigation of the data from two kits. Results: The average 3-OHBA levels were as follows: 2,235.0 μmol/L in the placenta, 779.2 μmol/L in the umbilical cord blood, in which the former is significantly higher than the latter (p < 0.001), 240.4μmol/L in the newborn after four days, and 366.7μmol/L after 30 days. The standard 3-OHBA level in a healthy man is less than 85 μmol/L. Glucose levels in the umbilical cord and placenta were 78.6 mg/dL vs 74.9 mg/dL, with no significant difference, and was the same as that of the pregnant woman. Accuracy management of the two kits revealed a significant correlation (r = 0.94, p < 0.001). 3-OHBA values of the maternal blood and umbilical cord blood were extremely elevated from the standard level, with a mutual significant correlation (r = 0.724, p < 0.001, n = 416). Conclusion: This clinical study concerning ketone bodies during pre- and post-partum period was investigated, and revealed that 1) a clinically rapid useful kit for ketone bodies had high reliability and validity compared with conventional kit, 2) elevated values of 3-OHBA were shown in the placental tissue fluid, umbilical cord, newborn and maternal blood, 3) 3-OHBA would be a physiologically indispensable element in nutrition metabolism for fetus and newborn at least until 30 days, with further development of investigation for ketone bodies

トクシマシ イシカイ ノ ジョセイ イシ シエン ジギョウ

In recent years, an increase in the ratio of female physicians in Tokushima Prefecture, with a particularly notable rise among younger generations that has exceeded the national average, has been observed. However, these physicians continue to face severe working environments, and support measures are required for female physicians during childbirth and in the early stages of parenthood. To this end, the Tokushima City Medical Association has been involved in initiatives to support female physicians since ２００８. First, we developed “Net Joy,” a website that provides the information necessary for female physicians to continue their clinical work through a bulletin board system that offers information on topics such as employment and childcare. Furthermore, we have administered questionnaire surveys related to working environments and support systems in clinical training hospitals and compiled a booklet entitled Support Notebook for Female Physicians that is available on the Net Joy website. Since ２０１１, as post-residency training in ultrasound techniques, we have held six separate practical training seminars at the Tokushima University Hospital Ultrasound Examination Center and the Tokushima City Medical Association Hall. Since ２０１４, we have been involved in efforts to enhance its training content and develop it into a long-term program