Abstract
Two cases of abrupt onset type 1 diabetes associated with elevation of elastase 1 and diabetic ketoacidosis are reported. Patient 1 is a 22 year-old woman who gave a normal response to an oral glucose tolerance test 13 weeks before admission. In September 1983, in the 40th week of pregnancy, she delivered a dead fetus. Since she lost consciousness soon after delivery, she was transferred to our hospital. Patient 2 is a 20 year-old man who was admitted to our hospital because of nausea and vomiting of 2 days duration following a common cold. Both cases were diagnosed as diabetic ketoacidosis, and the patients were treated with insulin and saline. Although their glycemic levels were very high, HbA1 values were normal on admission. Furthermore they showed no intrinsic insulin secretion. They were considered to have developed type 1 diabetes recently. The levels of their elastase 1 were very high (i.e. 2500 and 1800 ng/dl), but amylase and lipase levels were normal. After insulin treatment, their amylase levels showed a slight transient elevation, while elastase 1 decreased gradually.
We compared the levels of elastase 1 in three other ketotic or ketoacidotic diabetic patients with those in case 1 and 2. We propose inflammation of the exocrine pancreatic cells around the islets associated with the insulitis as a possible mechanism of the elevation of elastase 1 in these diabetic ketoacidotic patients.
