Abstract
We report a rare case of slowly progressive insulin-dependent diabetes mellitus acutely exacerbated by excessive soft-drink consumption providing novel insights into differential diabetic ketoacidosis diagnosis. A healthy 62-year-old woman with no diabetes, obesity, or infection history admitted for severe hyperglycemia-plasma glucose: 998 mg/dl; hemoglobin A1c [HbA1c]: 13.9%, and ketoacidosis-reported drinking 1 l of tangerine juice daily for 3 weeks before admission. She lacked insulin secretion and tested positive for antiglutamic acid decarboxylase antibody (titer: 8.1 U/ml) , yielding an initial diagnosis of acute type-1 diabetes mellitus onset. Diabetic retinopathy was also detected, suggesting prolonged hyperglycemia. Intravenous fluid repletion and continuous insulin infusion attenuated the hyperglycemia and ketoacidosis, restoring insulin secretion and obviating the need for insulin. Oral α-glucosidase inhibitor and metformin therapy was initiated and the woman discharged. She maintained good glycemic control and adequate insulin secretion in the next 2 years.
