Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • Log out
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Diabetes Care Electronic Pages

Possible Influence of Ileal Neobladder on Assessment of Urinary C-peptide

  1. Takahiro Zenda, MD1,
  2. Masaji Miyamoto, MD1,
  3. Toshimitsu Misaki, MD2 and
  4. Shuichi Kaneko, MD3
  1. 1Department of Internal Medicine, Tsurugi Municipal Hospital, Hakusan, Ishikawa, Japan
  2. 2Department of Urology, Tsurugi Municipal Hospital, Hakusan, Ishikawa, Japan
  3. 3Department of Gastroenterology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
  1. Corresponding author: Takahiro Zenda, t-zenda{at}tsurugihp.jp.
Diabetes Care 2012 Feb; 35(2): e8-e8. https://doi.org/10.2337/dc11-2073
PreviousNext
  • Article
  • Info & Metrics
  • PDF
Loading

Urinary C-peptide (UCP) is one of the most popular indicators of insulin secretion by pancreatic β-cells (1,2). However, there are no previous reports discussing the relationship between UCP and neobladder, a new, reconstructed bladder using the ileum after radical cystectomy (3,4). We report a patient with neobladder in whom, among parameters of endogenous insulin production, only the 24-h UCP level was extremely decreased.

A 61-year-old Japanese man with diabetes and atrial fibrillation was hospitalized because of left-sided hemiplegia and motor aphasia caused by thrombotic cerebral infarction. The patient had undergone bladder reconstruction with 66 cm of the ileum after radical cystectomy as the result of cancer 10 years ago. Only a lineal operation scar was found on the middle lower abdominal wall. After surgery, insulin therapy had been initiated on the basis of decreased UCP levels and hyperglycemia. However, his glycemic condition on admission was poor (hemoglobin A1C [HbA1c], 10.4%). In addition to overt glycosuria, urinalysis revealed urinary tract infection. Although insulin resistance was absent, assessment of insulin secretory capacity revealed contradictory results: good response to glucagon tolerance test (4.99 ng/mL of serum C-peptide [after 5 min], increase in serum C-peptide of 3.00 ng/mL [Δ5 min]) and normal homeostasis model assessment of β-cell function index (43.7), but extreme decrease in 24-h UCP levels (<0.1–0.2 μg/day) at five different times. Since the patient's endogenous insulin secretion was thought to be reserved, glimepiride (2 mg, o.p.d.) and sitagliptin (50 mg, o.p.d.) were administered, resulting in better glycemic control (HbA1c 7.3–8.2%).

The extreme decrease in UCP levels may be associated with the ileal neobladder. During prolonged contact with the neobladder wall, UCP might be degraded by peptidases present at the brushing boarder of the ileum constituting the neobladder or by bacteria present in the neobladder on the background of a fragile defense system after urinary tract diversion (4) or high susceptibility in diabetic patients. Unlike peptides, e.g., C-peptide that consists of 31 amino acid residues (2), protein is probably not affected by the ileal neobladder, since the patient presented proteinuria (approximately 0.4 g/day). This is because, before peptides are degraded in the small intestine, protein needs to be digested into peptides by gastric acid, trypsin, and proteases in the stomach and duodenum. With recent technical advances in urological surgery, an ileal neobladder can be archived, which leaves only operation scars on the abdominal wall instead of cutaneous urinary stoma. In addition, the patient's quality of life is highly improved (3,4). However, as shown in this case, physicians must still pay careful attention not to overlook urinary tract diversion or neobladder. To confirm degradation of C-peptides in the ileal neobladder, it is necessary to compare the peptide/amino acid composition in the urine before and after neobladder passage or to demonstrate localization and activity of peptidases in the mucosa of an ileal neobladder. The present case demonstrates that UCP evaluation alone is not a reliable parameter in patients who underwent urinary tract diversion involving the small intestine.

Acknowledgments

No potential conflicts of interest relevant to this article were reported.

T.Z. and M.M. cared for the patient and researched data. T.Z. wrote the manuscript. T.M. contributed to the urological discussion. S.K. contributed to the discussion on protein digestion in the gastrointestinal tract. T.Z. takes all responsibility for the contents of the article as a guarantor.

  • © 2012 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

References

  1. ↵
    1. McDonald TJ,
    2. Knight BA,
    3. Shields BM,
    4. Bowman P,
    5. Salzmann MB,
    6. Hattersley AT
    . Stability and reproducibility of a single-sample urinary C-peptide/creatinine ratio and its correlation with 24-h urinary C-peptide. Clin Chem 2009;55:2035–2039
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Brandenburg D
    . History and diagnostic significance of C-peptide. Exp Diabetes Res 2008;2008:576862
  3. ↵
    1. Hautmann RE,
    2. Volkmer BG,
    3. Schumacher MC,
    4. Gschwend JE,
    5. Studer UE
    . Long-term results of standard procedures in urology: the ileal neobladder. World J Urol 2006;24:305–314
    OpenUrlCrossRefPubMed
  4. ↵
    1. Hautmann RE,
    2. de Petriconi RC,
    3. Volkmer BG
    . 25 years of experience with 1,000 neobladders: long-term complications. J Urol 2011;185:2207–2212
    OpenUrlCrossRefPubMed
View Abstract
PreviousNext
Back to top
Diabetes Care: 35 (2)

In this Issue

February 2012, 35(2)
  • Table of Contents
  • About the Cover
  • Index by Author
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Possible Influence of Ileal Neobladder on Assessment of Urinary C-peptide
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Possible Influence of Ileal Neobladder on Assessment of Urinary C-peptide
Takahiro Zenda, Masaji Miyamoto, Toshimitsu Misaki, Shuichi Kaneko
Diabetes Care Feb 2012, 35 (2) e8; DOI: 10.2337/dc11-2073

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Possible Influence of Ileal Neobladder on Assessment of Urinary C-peptide
Takahiro Zenda, Masaji Miyamoto, Toshimitsu Misaki, Shuichi Kaneko
Diabetes Care Feb 2012, 35 (2) e8; DOI: 10.2337/dc11-2073
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Acknowledgments
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

Diabetes Care Electronic Pages

  • Response to Comment on: Kromhout et al. n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes. Diabetes Care 2011;34:2515–2520
  • Sulfonylurea Use During Entire Pregnancy in Diabetes Because of KCNJ11 Mutation: A Report of Two Cases
  • Response to Comment on: Hegde et al. Effect of 3-Month Yoga on Oxidative Stress in Type 2 Diabetes With or Without Complications: A Controlled Clinical Trial. Diabetes Care 2011;34: 2208–2210
Show more Diabetes Care Electronic Pages

Online Letters: Observations

  • Tyrosine Kinase Inhibitor Sunitinib Allows Insulin Independence in Long-standing Type 1 Diabetes
  • FGF23 in Type 2 Diabetic Patients: Relationship With Bone Metabolism and Vascular Disease
  • Diabetic Charcot Neuroarthropathy of the Hand: Clinical Course, Diagnosis, and Treatment Options
Show more Online Letters: Observations

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.