経口的抗糖尿病薬の臨床的知見補遺,とくに,心・脈管障害との関連性について
スポンサーリンク
概要
- 論文の詳細を見る
1. Clinical opinion of D 860 has been evenly divided between praise and censure, however it may tentatively come to a settlement that the therapeutic value of D 860, more or less limited, has been appreciated in Japan as well as in oversea. The hypoglycemic action of D 860 was studied respecting its equipotential dosis compared with insulin which widely ranged from 0.2 to 0.5 g or more per unit of insulin largely depending upon the metabolic state of individual patient. The equi-hypoglycemic dosis of D 860 compared with insulin was apt to be found relatively small amog the group of older corpulent diabetic patients with slight or moderate severity, whereas relatively large among the group of younger meager patients with or beyond the moderate severity. Even if the metabolic disturbance of the patients is not so heavy, the combined use of insulin was almost always necessary for the treatment with D 860. It was also hardly dispensable to combine the dietary control for the treatment of D 860 even in the slight cases. 2. The treatment with D 860 did not essentially alter the mode of Staub-Traugott's effect even if the control of hyperglycemia could be achieved in favour for the long time. D 860 within the usual therapeutic dosage showed scarcely any side effect upon hepatorenal and hematological function as well as upon chemical constituents of blood, for example, serum protein or electrolytes, especially Na and K. 3. The hypoglycemic action of activated meso-oxalate investigated Prof. Kobayashi and their collaborater in the Tokyo University, School of Medicine proved far less potent than that of D 860, although no toxicity was observed with the usual therapeutic dosis, orally 3g pro die on an average. 4. It may be generally accepted that the circulation is influenced by the insulin injection, partly through the direct action of insulin, or through the hypoglycemia and lastly through the secondary hyperepinephrinemia and other changes in the chemical constituents of blood in which especially the change of K ion is possible to play an important role. In general, the subcutaneous or intravenous injection of insulin from 5 to 10 units evokes, already within 10', the initiation of hypoglycemia which becomes most remarkable at 20' or 30' thereafter in diabetic patients. The cardiovascular dynamical analysis showed the tendency of "Anspannugsregulation (Duesberg and Schroeder)" in the great circulation and of "Druckreaktion (Blumberger)" in the heart almost at the same as the initiation of hyperglycemia, though these cardiovascular changes are seemed to appear without the close relationship with the extent of the induced hypoglycemia, so far as the dosis above mentioned is concernd. These patterns of circulatory changes are used to occur independently of the level of the arterial blood pressure. Above all, it is characteristic of patterns that the cardiac output tends to be reduced and the "Umformungszeit (UFZ)" to be prolonged. Therefore in the case with coronary stenosis, an accident may take place during the sleep due to the excessive use of the retard insulin such as injected in the night before; the more inconcious of the claim the patient is, the more dangerous the accident is. As D 860 within the usual therapeutic dosis possesses hardly any unfavourable action upon the cardiovascular dynamics as well as upon the electrocardiogram, consequently it may find its merit in the use among the senile diabetic patients who are threatened with coronary disorders. Such a severe reduction as formerly performed for the treatment of diabetes mellitus becomes to be lightened and tends to be commonly accepted also in Japan, especially for the treatment of diabetic patients complicated with coronary heart diseases a certain extent of hyperglycemia as well as glycosuria are permitted under the cautions observation, therefor so far as this trend towards this therapeutic principle is adopted, the less hypoglycemic potency of D 860 can not be undervalued without reserve and qualifications for the treatment of senile corpulent diabetic patients, especially complicated with coronary disorders.
- 千葉大学の論文