Two Cases of Diabetes Mellitus Representing Long Standing Remissions or Remission-like Periods Despite Their Abrupt Onset with Ketoacidosis

Abstract

The first case was a 20-year-old women, who was admitted complaining of thirst and general fatigue. Her blood examinations showed remarkable elevations in blood glucose and ketones as well as metabolic acidosis. C-peptide (CPR) secretion was markedly reduced. Islet cell antibody (ICA) was positive. DR4 and DR2 haplotypes of human leucocyte antigens (HLA) were positive. Diagnosed as having diabetic ketoacidosis, she was treated with insulin. Shortey thereafter, she rejected treatment but she suffered no symptoms. At age 23 years, she visited our hospital again. Serum CPR responses to glucagon had recovered markedly and no medicine was required, though ICA was still positive.
The second case was a 48 year-old man, who visited our hospital complaining of thirst and general fatigue after common cold-like symptoms. Diagnosed as having diabetic ketoacidosis, he was treated with insulin. Two years later, he did not need insulin injections. However, abrupt elevations in blood glucose with ketonuria were sometimes observed after common cold like symptoms. Eventually, by age 54 years, constant insulin treatment was again needed.
Although these two cases represent similar remission-like periods, the mechanisms of their pancreatic islet-sell destruction must be different.