Endocrine Abstracts

Introduction

In clinical practice, differentiating between the types of diabetes is not always possible. In recent years, there has been an increase in the cases of Type 2 diabetes triggered by diabetic ketoacidosis in young-adult age individuals, and this condition is known as ketosis-prone diabetes (KPD). In this report, we present a case of autoantibody-positive KPD who had an adequate pancreatic reserve and an atypical phenotype due to having a normal body weight, in whom the presence of ketosis could not be confirmed by laboratory tests.

Case presentation

A 33-year-old female patient presented to an Internal Diseases clinic with complaints of frequent urination, increased water consumption, and weight loss. In that clinic, the patient was diagnosed with diabetes mellitus (DM) due to increased blood glucose (413 mg/dl) and HbA1c (9.5%) levels, and the patient was initiated on an intensive insulin therapy although no blood gas or urine test was performed. After one month, the patient presented to our Endocrinology clinic. Her body height was 152 cm, weight was 56 kg, and body mass index was 24 kg/m². Her sister and niece had been previously diagnosed with Type 1 DM. The C-peptide level, which was measured due to the lack of insulin resistance findings, uncontrolled weight loss, and the young age of the patient, was sufficient (6.02 µg/l). Moreover, the islet cell antibody and the anti-glutamic acid decarboxylase antibody, which were assessed twice, were positive with a high titer ( b 250.00 IU/ml). Basal insulin and metformin treatment was initiated, considering that the patient might need insulin due to autoantibody positivity. Throughout the follow-up, no decrease has been detected in her C-peptide level. Additionally, the patient is still being followed up, with her blood sugar regulated and her HbA1c level being at the target range.

Conclusion

Ketosis-prone diabetes (KPD) is an atypical form of diabetes whose frequency has increased in recent years. There are four variants of KPD defined in the literature. In one of these, the beta-cell reserve is preserved but the islet cell antibody is positive. In such patients, the progressive beta-cell loss may develop, which may require lifelong insulin therapy. More over autoantibody positivity is a strong determinant of subsequent insulin need, and in such cases, patients should be re-evaluated with clinical and laboratory findings and treatment revisions should be performed as needed.

Key words

Ketosis-prone diabetes, insulin autoantibodies