Endocrine Abstracts

Introduction: Ketosis-prone diabetes or Flatbush diabetes has been recognized as a clinical entity since 1984. Is characterized by diabetic ketosis or ketoacidosis occurring soon after the onset of hyperglycemic syntoms (usually poyiuria, polydipsia and weight loss are present for less than 4 weeks). Unlike the insulin dependence seen in type 1 diabetes, after a few weeks (usually 2 to 12 weeks), insulin requeriments decrease, and approximately 70% of patients achieve remission and can be managed by diet alone. Most patients are overweight or obese and is reported in African-American or western Sub-Sahara-African, Hispanic descendant, and recently in Asian.

Case report: A 24-year-old male of Assian origin was admitted to our hospital in January 2014. He presented polyuria, general fatigue and a 6 kg weight loss in the preceding three weeks. Hyperglycemia had never been detected on regular check-ups.

In the emergency room his serum glucose was 323 mg/dl. Arterial blood gas analysis showeed pH 7.22, bicarbonate 19 mEq/l and ketoneuria > 80 mg/dl. Islet-related autoantibodies, such us those against GAD, IA-2 and anti beta cell were all negative. On admission his body mass index was 28.29 kg/m². He 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. After discharge his treatment was adjusted form intensive insulin subcutaneous injection to only basal insulin and after 3 months to oral hypoglycemic drugs, and finally, after 20 weeks, he was managed with diet alone. He achieved and manteined remission during this 5 years.

In the last visit his plasma glucose was 112 mg/dl and HbA1c 5.4% with diet alone.

Conclusion: When an overweight or obese young patient debut with diabetes mellitus with negative auto-antibodies and diabetic ketoacidosis, with partially preserved beta cell functional reserve after the acute of diabetic ketosis we must thing in KPDM as a posibility.