PMC4580314_01
PMC4580314_02
PMC4580314_03
Transition of HbA1c (a) and vomiting episode frequency (b). a: Line graph linked by open circles shows the change in HbA1c; black rectangle shows the duration of continuous subcutaneous insulin infusion therapy. b: Histogram showing the episodes of vomiting attacks; white rectangle shows the duration of counseling, relaxation, cognitive behavioral therapy and psychological education by a clinical psychologist; gray rectangle shows the duration of hypnotherapy; and arrows indicate miniature garden therapy. During a total of 40 hospitalizations, nurses and doctors were committed to not only treating the patient medically but also providing emotional and social support
40200_2015_206_Fig2_HTML.jpg
PMC4580314_03_40200_2015_206_Fig2_HTML.jpg
Fig2
ACTH and ADH were observed, but they promptly improved during remission (Table 1). As a result of psychological intervention (behavioral therapy to include a combination of counseling and autogenic training, etc.) by a clinical psychologist, glycemic control showed temporary improvement (Fig. 2a). However, in December of the same year, we began CSII treatment during the vomiting phase because self-injection of insulin was interrupted and glycemic control had become more difficult with her HbA1c showing another upward trend (Fig. 2a). As a result, she no longer developed DKA during the periods of vomiting and was capable of maintaining her activities of daily living, while repeated cycles of vomiting remitted and glycemic control also showed a trend toward improvement (Fig. 2a, b). Edition [WEIS-III] score was 60 points), and a developmental disorder was inferred. Even so, the patient was able to be discharged because vomiting frequency was reduced by a combination of hypnotherapy and sandplay therapy (Fig. 2b).