A Case of Transient Severe Diarrhea, Urinary Retention, and Worsening of Motor Nerve Function in A Type 2 Diabetic Patient After Strict Metabolic Control with Insulin.
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Although painful sensation and paresthesia are sometimes precipitated by strict glycemic control in diabetic patients, cases that present severe autonomic neuropathy as a sign of posttreatment neuropathy are very rare. We report a patient with type 2 diabetes who showed acute exacerbation of autonomic neuropathy and motor nerve function without painful symptoms after treatment with insulin.<BR>A 63-year-old man with type 2 diabetes was admitted to our hospital for the improvement of hyperglycemia. He had been diagnosed as having diabetes mellitus at age 50, and had been treated with glibenclamide. Upon admission, his fasting plasma glucose (FPG) and HbA<SUB>1c</SUB> levels were 496 mg/d<I>l</I> and 15.8%, respectively. He already had neuropathy with muscle atrophy and delay of motor nerve conduction, preproliferative retinopathy, and microalbuminuria. Because of his poor insulin secretion and severe hyperglycemia, he was placed on insulin therapy. FPG levels decreased to 150mg/d<I>l</I> within 6 days. He had severe diarrhea with incontinence several times on the 10 th hospital day, and urinary retention on the 15th hospital day. Culture of stool revealed no bacteria except <I>E. coli</I>. After treatment with loperamide chloride (2mg t.i.d.) and intermittent self-catheterization of urine, he recovered from diarrhea and urinary retention. During the whole clinical course, the patient experienced no spontaneous pain in the extremities.<BR>This is, to the best of our knowledge, the first description of case of a type 2 diabetes with severe autonomic neuropathy without pain occurring after insulin therapy, which may be a feature of a complicated syndrome presenting as a variant of posttreatment neuropathy.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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