Abstract
The patient was a previously healthy 54-year-old woman. There were no preceding cold-like symptoms. Ten days before being admitted to our hospital, she became aware of dry mouth, polydipsia, polyuria and weight loss and 7 days before, she had received a general health check-up at another hospital. Owing to a casual blood glucose level of 532 mg/dL and HbA1c of 6.6 %, she had been examined further at the other hospital 3 days before. Fasting blood glucose was 321 mg/dL, HbA1c 7.4 % and urinary ketone bodies 3+, and administration of vildagliptin 100 mg was started. On the day of admission to our hospital, the patient had earlier been referred to the diabetology outpatient department of the other hospital and due to the findings of a casual blood glucose level of 394 mg/dL, pH 7.314 and HCO3- of 17.4 mmol/L, fulminant type 1 diabetes with diabetic ketoacidosis (DKA) was suspected, and she was referred to our department for consultation. When she came, with a casual blood glucose level of 329 mg/dL, HbA1c of 7.9 %, a blood 3-hydroxy butyric acid level of 5,378 μmol/L, a venous blood pH of 7.335 and an HCO3- level of 17.4 mmol/L, she was considered to be developing DKA, continuous insulin infusion therapy was commenced and she was admitted. As anti-GAD antibodies, IA-2 antibodies and insulin autoantibodies were negative, the urinary C peptide level was 1.6 μg/day and in a glucagon stimulation test, the prestimulation serum C peptide level was 0.1 ng/mL and post stimulation serum C peptide level was 0.2 ng/mL, fulminant type 1 diabetes was diagnosed. Based on the present case, the chance noting of hyperglycemia symptoms in a medical interview and a low HbA1c level despite hyperglycemia should definitely bring type 1 fulminant diabetes to mind and serve as an urgent reminder of the importance of early referral to a specialist department.
