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Fulminant Type 1 diabetes in a pregnant woman as an initial manifestation of the insulin autoimmune syndrome
Author(s) -
Kim H. S.,
Lee T.Y.,
Kim E. Y.,
Choi J. H.,
Kim S. Y.,
Hwang Y.C.,
Kang J.H.,
Ahn K. J.,
Chung H. Y.,
Jeong I.K.
Publication year - 2012
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2012.03623.x
Subject(s) - medicine , diabetic ketoacidosis , type 1 diabetes , ketoacidosis , insulin , diabetes mellitus , fulminant , endocrinology , autoantibody , type 2 diabetes , immunology , antibody
Diabet. Med. 29, 1335–1338 (2012) Abstract Fulminant Type 1 diabetes is a subtype of Type 1 diabetes characterized by (1) abrupt onset of diabetes, (2) very short duration of hyperglycaemia with mildly elevated HbA 1c (< 69 mmol/mol, 8.5%), (3) rapid progression to diabetic ketoacidosis, (4) very low C‐peptide level, and (5) often associated with elevated serum pancreatic enzymes, and absence of diabetes‐related autoantibodies. We encountered a case of fulminant Type 1 diabetes that developed with an initial manifestation of the insulin autoimmune syndrome and rapidly progressed to diabetic ketoacidosis during pregnancy. A 31‐year‐old Korean woman presented with recurrent sudden onset of sweating and change of consciousness during sleep at 19 weeks gestation. During a 72‐h fasting test, hypoglycaemia (1.72 mmol/l) occurred at 4 h after the start of the test. At that time, there was a high insulin level (370.2 μU/ml), a paradoxically low C‐peptide level (0.01 nmol/l) and a positive insulin autoantibody test. An oral glucose tolerance test revealed postprandial hyperglycaemia. She was initially diagnosed as the insulin autoimmune syndrome. On the day 5 of admission, she developed diabetic ketoacidosis. Her HbA 1c was 62 mmol/mol (7.8%). The rapid progression of diabetic ketoacidosis altered the diagnosis to fulminant Type 1 diabetes. This case differed from typical fulminant Type 1 diabetes because it presented with hypoglycaemia, and positive insulin and anti‐phospholipid antibody tests. Her HLA typing was HLA‐DQA1*0302, 0501, HLA‐DRB1*0301 (DR3), 0901(DR9). Her glucose level was subsequently very well controlled with multiple insulin injections and she successfully delivered a healthy baby.