Extreme hyperglycemia and diabetic ketoacidosis occurring in a patient on chronic dialysis

Department of Urology, North medical center, Kyoto prefectural university of medicine, Kyoto, Japan.Department of Nephrology and Urology, Nishijin Hospital, Kyoto, Japan.Department of Internal medicine, Nishijin Hospital, Kyoto, Japan.Diabetic ketoacidosis (DKA) is a complication that is rarely reported in patients on chronic dialysis. Herein, we describe the case of a patient on chronic hemodialysis who presented to us with acute onset diabetic ketoacidosis. A 50-year-old man with insulin-dependent diabetes mellitus, who was on hemodialysis for 2 years, presented to us with altered consciousness. Laboratory data revealed the following results: blood sugar, 110.1 mmol/L (1984 mg/dL); serum sodium, 107 mmol/L; β -hydroxybutyric acid, 1991 μ M; pH, 7.048. A diagnosis of diabetic ketoacidosis was made, and insulin therapy and hemodialysis were initiated, following which his parameters including blood glucose, and serum potassium and sodium improved. High osmotic dehydration was not observed in our patient owing to his renal dysfunction. The patient’s consciousness normalized following the correction of hyperglycemia and DKA. This case report highlights the importance of early diagnosis of DKA, and prompt initiation of insulin therapy and hemodialysis in patients on chronic dialysis. Therefore, in patients with end stage renal disease, the blood glucose correction should be followed by the restoration of sodium and osmolality, guided by corrected sodium concentration and effective osmolality, and by the appropriate adjustment of insulin and dialysis

Insulin signaling in adipocytes differentiated from mouse stromal MC3T3-G2/PA6 cells

金沢大学医学部附属病院薬剤部The stromal MC3T3-G2/PA6 (PA6) cells from mouse clavaria did not require insulin for differentiation into mature adipose cells, although insulin is well known to play a key role in adipocyte differentiation. Large lipid droplets were observed in the cytoplasm of PA6 cells, and mRNA expression of the adipose specific proteins (aP2, PPARγ, C/EBPα, FAS, GLUT4, leptin, and adiponectin) as differentiation markers appeared or increased clearly in the cells at 8 d after stimulation without insulin. In addition, the glycerol released from the cells (lipolysis) was increased in a concentration-dependent manner by isoproterenol. However, the isoproterenol-induced lipolysis in the cells was not influenced by treatment with insulin, although that was observed in extramedullary adipocytes, 3T3-L1 cells. On the other hand, the 2-deoxy-D-[1-3H]glucose uptake in differentiated PA6 cells also increased by insulin, as shown in other adipose cells. In the cells, insulin induced the phosphorylation of extracellular signal-regulated kinases (Erks), Akt at Ser 473 and ribosomal p70 S6 protein kinase (p70 S6K) at Thr 389, and the insulin-induced 2-deoxy-D-[1-3H]glucose uptake was inhibited by pre-treatment with wortmannin, an inhibitor of phosphatidylinositol 3-kinase (PI3K), or ML-9, an Akt inhibitor. These results suggest that the insulin signal for adipogenesis (lipogenesis) and lipolysis in bone marrow stroma PA6 cells differs from extramedullary adipocytes, such as 3T3-L1 cells. © 2005 Pharmaceutical Society of Japan

Attributing Historical Changes in Probabilities of Record-Breaking Daily Temperature and Precipitation Extreme Events

© 2016, the Meteorological Society of Japan. We describe two unprecedented large (100-member), longterm (61-year) ensembles based on MRI-AGCM3.2, which were driven by historical and non-warming climate forcing. These ensembles comprise the "Database for Policy Decision making for Future climate change (d4PDF)". We compare these ensembles to large ensembles based on another climate model, as well as to observed data, to investigate the influence of anthropogenic activities on historical changes in the numbers of record-breaking events, including: the annual coldest daily minimum temperature (TNn), the annual warmest daily maximum temperature (TXx) and the annual most intense daily precipitation event (Rx1day). These two climate model ensembles indicate that human activity has already had statistically significant impacts on the number of record-breaking extreme events worldwide mainly in the Northern Hemisphere land. Specifically, human activities have altered the likelihood that a wider area globally would suffer record-breaking TNn, TXx and Rx1day events than that observed over the 2001- 2010 period by a factor of at least 0.6, 5.4 and 1.3, respectively. However, we also find that the estimated spatial patterns and amplitudes of anthropogenic impacts on the probabilities of record-breaking events are sensitive to the climate model and/or natural-world boundary conditions used in the attribution studies