A Case of Fulminant Type 1 Diabetes Patient Accompanied by Hyperinsulinemic Hypoglycemia Prior to Clinical Diagnosis of Diabetes

Abstract

A 48-year-old man presented to a local hospital with a 3-week history of low-grade fever, a 4-day history of epigastralgia and a 6-day history of diarrhea. Acute pancreatitis was initially suspected based on the patient's elevated serum amylase level. Three days before admission, the patient developed severe thirst and polydipsia. On admission to our hospital, his plasma glucose level was 494 mg/dl, his HbA1c concentration was 6.2 %, and ketoacidosis was noted. On the 35th day of hospitalization, the patient's serum C-peptide level was undetectable after intravenous glucagon loading. According to these results and the clinical course, he was diagnosed with fulminant type 1 diabetes. Intensive insulin therapy was administered with CSII. His glucose, CPR and IRI levels in preserved serum samples that were taken at the local hospital (6 days prior to his admission to our hospital) were 61 mg/dl, 1.6 ng/ml and 5.8 μU/ml, respectively. These values were considered to indicate a state of hyperinsulinemic hypoglycemia. There have been nine reports, including own of case, in which patients experienced hypoglycemia before the onset of fulminant type 1 diabetes. These cases illustrate the rapid destruction of beta-cells followed by hyperinsulinemic hypoglycemia before the onset of fulminant type 1 diabetes and may provide valuable insight into a new etiology of hypoglycemia.