Endocrine Abstracts

Introduction: Currently, type 1 diabetes (T1D) is defined by the autoimmune destruction of the pancreatic β cells that culminates in dependence on exogenous insulin, typically 1–3 years after diagnosis. This ability to maintain a residual function of pancreatic β cells is, however, heterogeneous, appearing to be worst if the disease is early diagnosed. Recently, it was demonstrated that many type 1 diabetic patients produce small amounts of insulin decades after diagnosis.

Clinical cases: Case 1: Male, 42-years-old, diagnosed with T1D 18 years before. Currently on an insulin pump, he has reasonable metabolic control and no known complications. He has controlled hypertension and dyslipidemia. He was submitted to elective laparoscopic cholecystectomy that complicated with choleperitonitis. During postoperative period, under glycosylated fluids but nil per os, he remained without exogenous insulin administration for 7 days, with controlled blood glucose levels and without ketonemia.

Case 2: Female, 32-years-old, diagnosed with diabetes at age 19. At 29-years-old, because of a chronic poor metabolic control under irregular treatment with oral antidiabetic agents, she was referred to Endocrinology consultation. The investigation showed positive anti-GAD antibodies and a history compatible with T1D. She began insulin therapy with slight improvement in metabolic control due to lack of adherence. However, in periods of good therapeutic adhesion, glycemic control was relatively easy and predictable. She was recently hospitalized with diabetic ketoacidosis (first known episode).

Conclusion: The residual insulin production, detectable by the assay of C-peptide and its functional and clinical significance have been recently discussed. According to recent evidence, these cases show us that insulin production in type 1 diabetic patients can be kept for many years after diagnosis and that the end of the ‘honey-moon phase’ does not necessarily lead to the absence of insulin production.