[Fulminant type 1 diabetes in an elderly patient treated after receiving a diagnosis of type 2 diabetes].

ABSTRACT

The patient was a 76-year-old, male who was diagnosed with high blood glucose at 30 years of age. He suffered a stroke at 52 years of age. and was diagnosed with type 2 diabetes at a nearby hospital. Oral hypoglycemic medicines were administered along with diet and exercise therapy, which resulted in good glycemic control. The patient required an emergency hospital admission in December 2010 for weight loss. In addition, he suffered from frequent urination. He was diagnosed with diabetic ketoacidosis based on the following findings: blood glucose, 1,003 mg/dL; glycated hemoglobin, 7.7%; positive urine ketone bodies; and blood gas pH, 7.293. Although he had previously received medical treatment, the patient was transferred to our hospital, as he was unable to achieve stable glycemic control. At the time of admission, level of blood glucose and fasting serum C peptide were 1.002 mg/dL and 0.1 ng/mL, respectively. A glucagon loading test performed at our hospital revealed a serum C peptide level of <0.5 ng/ml. Tests for islet-cell autoantibodies were negative, and the patient's pathological conditions met the diagnostic criteria for fulminant type 1 diabetes. His human leukocyte antigen genotype was DRB1*0405 DQB1*0401, which is a disease susceptibility haplotype. In our experience, acute exacerbation of fulminant type 1 diabetes is observed in elderly patients who receive treatment following a diagnosis of type 2 diabetes. The differential diagnosis of ketoacidosis in elderly patients with type 2 diabetes should also include fulminant type 1 diabetes. Furthermore, providing an appropriate diagnosis and rapid treatment intervention is required.