Usefulness of artificial pancreas. Diagnosis and treatments of unstable diabetes mellitus accompanying digestive organ deseases

• Published in: Jinko Zoki Vol. 18; no. 3; pp. 1303 - 1306
• Main Authors: 原口義座 原口義座, 星野 正己, 石原 哲
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本人工臓器学会 1989; JAPANESE SOCIETY FOR ARTIFICIAL ORGANS
• Subjects: Artificial pancreas; Brittle diabetes; Diabetes mellitus; Insulin therapy; Unstable diabetes
• ISSN: 0300-0818; 1883-6097
• DOI: 10.11392/jsao1972.18.1303

Unstable or brittle diabetes still remains a condition for which sufficient nutrition is difficult to be given, especially accompanied with serious conditions such as sepsis, hepatic failure, etc. In this report we tried to determine the new criteria of nustable diabetes, with the use of artificial pancreas. In order to avoid iatrogenic factors, energy was adminis tered via a central vein, by constant infusion rate. Determination of the admninstered energy was based on resting energy expenditure. The parameters, used are as follows: 1) Energy Intake/Given Insulin Ratio (daily), 2) Difference between Mean Blood Sugar (BS) and BS, Aimed by Artificial Pancreas (daily), 3) Standard Deviation of BS (daily), 4) Maximum Daily Difference of BS. When more than 3 parameters were positive, it was diagnosed to be unstable. A total of 23 days (13.9%) fulfilled the criteria. Among the accompanied lesions, liver failure and sepsis existed more frequently in this condition. [CONCLUSION] Brittle or unstable diabetes are believed to be caused by the absolute defect of pancreatic β cell function. This condition is also thought to be influenced with the disturbance of liver function and fat tissue, which will have a role as a buffer of stabilizing blood sugar. Our results supported this hypo thesis. 不安定型糖尿病の評価には, 治療条件を一定とする必要があるが, 必ずしも容易ではなく, 医原性因子も多いとされる。今回, 人工膵施行例で, 医原性因子を除外した上で, 評価を試みた。栄養は中心静脈よりconstant rateで投与した。また我々の不安定型糖尿病の基準を作成した。1)1日毎Energy摂取量/投与インスリン比, 2)平均血糖値(BS)と人工膵の目標BSとの差(ズレ), 3)1日BSの標準偏差, 4)最大日内変動幅, の4項目の内, 3項目以上をみたしたものを不安定型とした。のべ23日, 13.9%で陽性であった。関連する病態としては, 高度感染と肝不全で高頻度であった。この型の糖尿病の主な原因は, 膵β細胞予備能の激減とされるが, また血糖調節機構における緩衝的役割を担う肝臓等の組織の障害も推定される。今回の検討で, 肝不全, 敗血症等の重篤な代謝障害例が多くみられたことは, これを示唆すると考えられた。