Endocrine Abstracts

Introduction: Type 1 diabetes mellitus (T1DM) is the most common form of diabetes in children and young adults. Though T1DM often presents in an acute manner, it may be preceded by a prodromal period, often extending over years.

Case report: A 19-year-old male, diagnosed with T1DM at the age of 15, with no insulin treatment, was admitted to our department for high glycemic value (G) of 365 mg/dl on a routine exam at his GP. At diagnosis the patient was asymptomatic, with a jeun G=149–159 mg/dl, 2 h-OGTT=386 mg/dl, A1c=5.2%, high GAD antibodies, C peptide and insulin levels in the normal lower range. The lack of family history and the normal G of his parents excluded a MODY form and the absence of obesity or overweight excluded T2DM. His past medical history was consistent with: left popliteal deep vein thrombosis in the context of a moderate (27%) deficit of S protein, moderate thinness, mild dyslipidemia and mild normocytic, normochromic anemia. Six months after the diabetes diagnosis and on a diet the A1c=7.28%. In our department, labs exams revealed: G=285 mg/dl, mild hypokalemia, mild dyslipidemia, ketonuria (150 mg/dl), significant glycosuria (1 g/dl) and the A1c >14% was consistent with a sever glycemic imbalance in the last 3 months. A basal bolus regimen with glargine and lispro insulin was started, adjusted according to the glycemic values and carbs ingestion. The screening for other autoimmune diseases was performed revealing only slightly elevated circulating immune complexes.

Discussions: This case illustrates the complexity of diagnosis in a case of slow onset T1DM. The clinical judgment and immunological labs exams are essential for a correct diagnosis. From our knowledge, this case presents the largest period from the diagnosis of T1DM and initiation of the insulin therapy.