Fulminant Type 1 diabetes in a pregnant woman as an initial manifestation of the insulin autoimmune syndrome |
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Authors: | 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 |
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Affiliation: | Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine Department of Internal Medicine, Hanmaeum General Hospital Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea. |
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Abstract: | 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. |
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