2022 Volume 65 Issue 6 Pages 319-326
A 23-year-old man was admitted to our hospital with a medical history of body weight reduction and hyperglycemic symptoms. His laboratory findings showed that his blood glucose level was 496 mg/dL, HbA1c 15.8 %, urine ketone bodies (3+), venous blood pH 7.15, and BMI 29.0 kg/m2. He was diagnosed with diabetic ketoacidosis (DKA) in June X. He neither consumed a lot of soft drinks nor had any virus infections. Islet-related autoantibodies were all negative, but his endogenous insulin secretion was remarkably low, and his serum C peptide level was 0.37 ng/mL. Tentatively, we diagnosed him with type 1B diabetes. His endogenous insulin secretion recovered rapidly after five months with insulin therapy, which allowed him to avoid insulin treatment for the following 10 months. However, he was hospitalized again with a diagnosis of diabetic ketosis (DK) with body weight gain in September X+1. Based on his clinical course, he was diagnosed with ketosis-prone diabetes. The results of glucagon and arginine load tests revealed that his endogenous insulin secretion was severely depressed at the onset of DKA and DK but recovered clearly after six months with the increase in endogenous glucagon secretion.
