A Case of Anti-GAD Antibody-positive Fulminant Type 1 Diabetes with Severe Obesity

Abstract

A 45-year-old woman was referred to our hospital because of diabetic ketoacidosis. Six days before the referral, she visited a nearby clinic because of abdominal distension and appetite loss. Tablets for gastritis were prescribed, but her symptoms did not resolve. One day before her referral, she began to feel dizzy and thirsty, and visited her local doctor again. Blood and urine tests were performed. Since the results showed high blood glucose (578 mg/dL) and ketonuria, she was transferred to our hospital. The exhaustion of intrinsic insulin secretion, slight elevation of HbA1c (6.5 %) despite high blood glucose, and the abrupt onset of diabetic ketoacidosis led to the diagnosis of fulminant type 1 diabetes mellitus (FT1D). On presentation, her BMI was >40, which is rare for FT1D. She was found to be positive for GAD antibodies, which is also unusual for FT1D. This is the first reported case of GAD antibody-positive FT1D in an individual with class 3 obesity.