The subject was a 26-year-old Japanese woman of 148 cm height, 96.2 kg of
body weight (BW) (body mass index (BMI) of 43.8 kg/m(2)). She was referred to our hospital on May 1, 2000 for the evaluation of marked
hyperglycemia with clinical symptom of general malaise,
polydipsia, and
ketonuria (3+). She did not
smoke, or drink alcohol. But, she tended to eat lots of sweet food every day before the onset of this symptom. Her father was diagnosed
type 2 diabetes mellitus. Her fasting plasma
glucose and HbA(1c), and serum
C-peptide were 398 mg/dl, 7.8% and less than 0.05 ng/ml [normal range: 0.94-2.8], respectively. She tested negative for anti-
glutamic acid decarboxylase (GAD)
antibodies and islet-cell
antibodies.
C-peptide level in her urine was as low as 3.4 microg/day. We immediately started
insulin treatment under the diagnosis of abrupt onset of
diabetes mellitus with
diabetic ketoacidosis on the day of her admission, and the
insulin treatment was continued after her being discharged. She showed continuous BW reduction until her BW reached approximately 60 kg, followed by her BW being plateau. During the period, intra-abdominal visceral fat (VF) and subcutaneous fat (SF) volume assessed by helical computerized tomography (CT) showed a substantial reduction [3.9-0.5 l for VF, 19-3.2 l for SF volume]. Pre-
heparin plasma
lipoprotein lipase (LPL) mass showed a considerably lower value when she had continuous BW reduction than did it when her BW reduction discontinued. These findings suggest that in this subject, continuous BW reduction after the abrupt onset of diabetes is closely associated with intra-abdominal fat mass reduction, which may be related to decreased production of LPL.