Type 1 diabetes mellitus is usually believed to present acutely and it is assumed that metabolic decompensation is sudden.
We present 3 cases of asymptomatic type 1 diabetes
A 28 year old asymptomatic gentleman moved to a new surgery and glycosuria was noted as part of routine screening , no ketonuria., body mass index 21, no past medical illness or any family history of diabetes. His fasting blood glucose 8.8mmols(4 -6mmols), 2hrs postprandial 13.8. He was referred to the diabetic clinic, BP was 120/70,normal fundi, and clinical no evidence of neuropathy.His renal functions were normal .Islet cell antibodies were positive > 80 jdf ( normal <5jdf ), glutamic acid decarboxylase antibodies GAD 57.3(negative <1.6 ), insulin autoantibodies 11.94( negative <0.4) ,IA-2 182( negative<0.92). HBAIc was 9.34% (4.6-6.8%). He was on insulatard 25 units twice a day.
A 32 year old gentleman, glycosuria was seen on routine screening, no ketonuria, his body mass index 24, smoker, no past medical illness, no family history of diabetes mellitus. Fasting blood glucose 19.4(4-6mmol/l). fundi normal, no evidence of neuropathy. Islet cell antibodies negative, glutamic acid decarboxylase antibodies positive, insulin autoantibodies negative, HBAIc 11.4%,renal functions were normal. Started on glipizide but due to poor glycemic control changed to insulin.
A 47year old asymptomatic gentleman on routine screening,glycosuria without ketonuria was seen. He had a history of depression, fasting blood glucose 7.3 mmol/l(4-6mmol/l).No family history of diabetes mellitus.fasting, blood glucose of 7.3. renal functions normal ,HBAIc 8.3%. islets cell antibodies negative, glutamic acid carboxylase antibodies positive 11(0-1). Started on insulin.
Symptomatic insulin dependent diabetes mellitus is simple to diagnose as it presents acutely. Increased awareness and routine screening would undoubtedly prevent episodes of ketoacidosis and the occasional tragedy.Early detecion of metabolic abnormalities would improve the chances for success of intervention and prevent long term complications
03 - 05 Nov 2003
Society for Endocrinology