Abstract
A 41-year-old woman hospitalized for general malaise and thirst on January 28, 2000, had glycemia at 437 mg/dl, positive urinary ketone bodies, and blood gas analysis of p H7.288, HCO313.2mmol/l, compatible with diabetic ketoacidosis. Her Hb A1cwas near normal (6.3%). Serum concentrations of amylase, elastase 1, and lipase were elevated, but she had no symptoms of acute pancreatitis. Because tests for anti-GAD and IA-2 antibodies and ICA were negative, her disease was diagnosed as fulminant type 1 diabetes mellitus. Urinary C-peptide on admission was low (9.5μg/day), but recovered to normal, 32.0-34.6μg/day. The results of the arginine loading test showed improved insulin secretion. Her HLA typing was A 24, DRB 1*0405, 0901, DQB 1*0401, and *0303. We believe this case is instructive because improved insulin secretion in fulminant type 1 diabetes is considered relatively rare.
