Abstract
Soft drink ketosis is a subset of NIDDM characterized by an acute ketotic onset following excessive ingestion of soft drinks in obese people, predominantly seen in Japanese adolescents. Insulin dependency in the early course resembles that of IDDM, although most patients clearly show clinical features of NIDDM afterwards. A 19 year-old obese Japanese male was admitted to the hospital with marked hyperglycemia (56.1 mmol/l, HbA1c 13.6%) and ketosis. His body mass index was 32.4 two months before admission. He was treated initially with regular insulin (maximum 56 U daily), followed by NPH insulin for a total of 33 days. Fasting plasma glucose was maintained at around 4 mmol/l. Twenty-four hour urinary C-peptide excretion was 69 Eg on the 4th hospital day. He had lost nearly 20 kg (final BMI 25.0). A seventy-five gram oral glucose tolerance test on the 39 th hospital day disclosed a normal glucose profile with marked first phase insulin response (insulinogenic index at 4.13). It is likely that both preservation of intrinsic insulin secretary reserve even at onset, and intensive extrinsic insulin administration might be the keys for the exceptionally normalized first phase insulin secretion in this case.
