A Case of Rapid-onset Type 1 Diabetes with Frequent Early Onset Hypoglycemia

Abstract

A 35-year-old woman was admitted due to frequent hypoglycemia. She demonstrated a marked hyperglycemia from the hypoglycemic state soon after an oral glucose tolerance test (OGTT). Accordingly, we started her on insulin therapy. The serum insulin level was very high before the OGTT examination, whereas the C-peptide level in the urine was extremely low after the examination. She was treated with an intensified insulin therapy, but control of blood glucose was difficult; i.e. a brittle type. She was suspected of having the “fulminant type 1 diabetes” because of the rapid onset and the negative findings for autoantibodies against constituents of pancreatic beta cells. We could not reach a final diagnosis since none of the pancreatic enzymes were elevated and it was possible that she might have had impaired glucose tolerance before onset. However, her clinical manifestation was drastic since she shifted from hypoglycemia to hyperglycemia after the OGTT in only one hospitalized day. It is probable that this case is a subtype of the fulminant type 1 diabetes.