A Case of Ketosis-prone Type 2 Diabetes Discovered by Diabetic Ketoacidosis

Abstract

The patient was a 69-year-old man with type 2 diabetes who was being treated at a nearby hospital. The patient developed diabetic ketoacidosis with impaired consciousness and was brought transported to our hospital for emergency treatment. His blood C-peptide level was below detectable and tests for islet-related autoantibodies were negative. His blood glucose level was 1153 mg/dL. Initially, we suspected the onset of fulminant type 1 diabetes during treatment for type 2 diabetes, but the patient was diagnosed with ketosis-prone type 2 diabetes due to the recovery of his insulin secretory capacity after the improvement of DKA and the history of temporary insulin treatment for ketosis. It is difficult to distinguish KPD from soft drink ketosis and type 1 diabetes at the onset, and it is important to conduct detailed medical examinations and re-evaluate the insulin secretory capacity after the patient's condition stabilizes. In addition, cases have been reported in which the insulin secretory capacity declines each time that DKA recurs repeatedly or over time, and it is important to understand the clinical characteristics and to educate patients about the importance of weight management and outpatient treatment. Recently, KPD has been suggested as a possible subtype of type 1 diabetes. The elucidation of pathological conditions, such as disease enlightenment, the accumulation of further cases, and the results of genetic analyses are desired.