A Case of Fulminant Type 1 Diabetes Developed During Treatment for Nephrotic Syndrome

Abstract

The patient was a 43-year-old woman. She developed minimal change nephrotic syndrome at 41 years of age, and was being managed with oral prednisolone as an outpatient of our hospital. She developed malaise 7 days prior to admission, and thirst and polyuria occurred from 3 days prior to admission. On the day of admission, she began vomiting and visited our hospital. At that time, her blood glucose level was 399 mg/dL, a urinary ketone body test was positive, her blood level of ketone bodies was increased, and an arterial blood gas analysis showed metabolic acidosis. She was therefore diagnosed with diabetic ketoacidosis and was admitted to our hospital. Investigations performed after admission revealed the following findings: HbA1c, 6.9 %; urinary C-peptide, <3.2 μg/day; and fasting blood C-peptide, 0.08 ng/mL. Accordingly, she was diagnosed with fulminant type 1 diabetes. Good glycemic control was achieved by the administration of insulin (28 units/day). The association of minimal change nephrotic syndrome with fulminant type 1 diabetes has rarely been reported. We believe that our patient could be important for investigating the pathogenic mechanisms of these two diseases.