Ketosis-prone diabetes mellitus in an obese adolescent: A case report.

Abstract

RATIONALE:

In recent years, there are more new insights into the clinical susceptibility, pathophysiological mechanism, and progression of classification and treatment of ketosis-prone diabetes mellitus (KPDM), which was once described as Idiopathic Type 1 Diabetes, Type 1B Diabetes or Flatbush Diabetes. ketosis-prone diabetes mellitus is still a heterogeneous syndrome reported in African-American or western Sub-Sahara-African, Hispanic descendant, and recently in Asian.

PATIENT CONCERNS:

An obese 17-year-old student was admitted to a tertiary referral hospital (teaching hospital), presenting with thirst, polyuria fatigue, and a 9 kg weight loss in the preceding two weeks.

DIAGNOSES:

Physical examination showed body mass index (BMI) was 32.77 kg/m, arterial blood gas revealed a pH of 7.31. Serum glucose was 27.8 mmol/L with strong positive uric ketones (++++). Hemoglobin A1c (HbA1c) was 13.6%. The glucose disposal ratio (GDR) during the steady-state of euglycemic clamp test was 5.62 mg/kg/min and M value was 2.87 mg/kg/min during hyperglycemic clamp test. Those findings were sufficient to establish a diagnosis of ketosis-prone diabetes mellitus.

INTERVENTIONS:

This obese patient with KPDM received intensive insulin therapy and fluids infusion, and during the remainder of hospitalization his insulin requirement was approximately 1.5 U per kilogram of body weight per day. Blood glucose monitoring was rigorous until the diabetic ketoacidosis under control.

OUTCOMES:

He achieved the near-nomalglycemic remission uneventfully. At 12-month follow-up, his treatment was adjusted from insulin subcutaneous injection to oral hypoglycemic drugs.

LESSON:

The present study of this obese adolescent with negative auto-antibodies but unprovoked diabetic ketoacidosis and partially preserved beta cell functional reserve after the acute of diabetic ketosis suggested that he has the phenotype of "A-β" KPDM. Further study of this syndrome will help illustrate the inadequacy of current classification and targeted therapies.

• Authors: Huiwen Tan, Chun Wang, Yerong Yu
• Journal: Medicine (Medicine (Baltimore)) Vol. 98 Issue 25 Pg. e16076 (Jun 2019) ISSN: 1536-5964 [Electronic] United States
• PMID: 31232947 (Publication Type: Case Reports, Journal Article)

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• hemoglobin A1c protein, human
• Glucose

Topics

• Adolescent
• Body Mass Index
• China
• Diabetes Mellitus, Type 1 (complications, metabolism)
• Diabetic Ketoacidosis (etiology, metabolism)
• Glucose (analysis)
• Glycated Hemoglobin (analysis)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Male
• Obesity (complications)
• Thirst