A Case of Obese Type 2 Diabetes Mellitus Associated with Nonalcoholic Steatohepatitis (NASH) Treated with a Combined Therapy of Glimepiride and Insulin

Sakae Nohara, Masanori Iwase, Udai Nakamura, Kouichi Azuma, Keiichiro Iwai, Mitsuo Iida

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Abstract

A 71-year-old woman was admitted to hospital because of poor glycemic control and liver dysfunction. Although the patient's diabetes had been well-controlled with glibenclamide and pioglitazone, the pioglitazone had been discontinued because of an adverse effect on body weight gain and edema. The patient's HbA1C level subsequently rose from 7% to 11.6%. At admission, her BMI was 40.8 kg/m2 and she exhibited hypertension, hyperlipidemia, and microalbuminuria. A lacunar brain infarction was also diagnosed. The patient's fasting blood glucose level was 302 mg/dl, her serum IRI was 14.7 μU/ml, a hypoglycemic response was not obtained on an insulin tolerance test, and her fasting blood glucose was 219 mg/dl, and her postprandial blood glucose was 457 mg/dl at an insulin dosage of 1 U/kg body weight. Although she did not drink alcohol, she exhibited mild liver dysfunction: AST, 80 U/l; ALT, 70 U/l; γGTP, 102 U/l. A liver biopsy was performed, and the histological findings were compatible with a diagnosis of NASH. When 6 mg of glimepiride, a sulfonylurea with an insulin-sensitizing extrapancreatic effect, was added to the patient's insulin therapy, her blood glucose control improved markedly: fasting blood glucose, 76 mg/dl; postprandial blood glucose, 135 mg/dl; insulin dosage, 0.5 U/kg body weight. When insulin or oral hypoglycemic agents alone fail to control blood glucose in patients with type 2 diabetic associated with NASH, a combination therapy of glimepiride and insulin is recommended.

Original languageEnglish
Pages (from-to)873-879
Number of pages7
JournalJournal of the Japan Diabetes Society
Volume46
Issue number11
Publication statusPublished - 2003

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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