J Korean Diabetes.  2015 Sep;16(3):225-229. 10.4093/jkd.2015.16.3.225.

A Case of Fulminant Type 1 Diabetes Mellitus in an Elderly Patient

• Woo SM
• Hong SH
• Lee SY
• Lee SH
• Lee DK
• Yang SJ

• KMID: 2149294
• DOI: http://doi.org/10.4093/jkd.2015.16.3.225

Abstract

Insulin deficiency due to destruction of pancreatic beta-cells is a typical characteristic of type 1 diabetes mellitus (DM). In 2000 Imagawa proposed a novel diagnostic model defining "fulminant type 1 DM" as developing rapidly without any evidence of autoimmunity, and ever since there have been many reports regarding the matter in Japan. In 2004, the first fulminant type 1 diabetes case was reported in Korea; however, there have been few reports since then. We present a case of a 60-year-old man who suffered from excessive thirst and polyuria after myalgia. Laboratory findings revealed a high blood glucose level and evidence of diabetic ketoacidosis, but the HbA1c level was within the normal range. The serum C-peptide level was very low and antibodies to glutamic acid decarboxylase were negative. These findings suggested fulminant type 1 diabetes. This patient has shown improvement in symptoms and examination results without complications after being treated with insulin therapy with hydration, throughout 6-months follow-up period.

Keyword

Diabetes mellitus; Diabetic ketoacidosis; Type 1

MeSH Terms

Aged*
Antibodies
Autoimmunity
Blood Glucose
C-Peptide
Diabetes Mellitus
Diabetes Mellitus, Type 1*
Diabetic Ketoacidosis
Follow-Up Studies
Glutamate Decarboxylase
Humans
Insulin
Japan
Korea
Middle Aged
Myalgia
Polyuria
Reference Values
Thirst
Antibodies
Blood Glucose
C-Peptide
Glutamate Decarboxylase
Insulin

Reference

References

1. Imagawa A, Hanafusa T, Miyagawa J, Matsuzawa Y. Osaka IDDM Study Group. A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. N Engl J Med. 2000; 342:301–7.

2. Imagawa A, Hanafusa T, Uchigata Y, Kanatsuka A, Kawasaki E, Kobayashi T, Shimada A, Shimizu I, Toyoda T, Maruyama T, Makino H. Fulminant type 1 diabetes: a nationwide survey in Japan. Diabetes Care. 2003; 26:2345–52.

3. Bottazzo GF, Florin-Christensen A, Doniach D. Islet-cell antibodies in diabetes mellitus with autoimmune polyendocrine deficiencies. Lancet. 1974; 2:1279–83.

4. Jung TS, Chung SI, Kim MA, Kim SJ, Park MH, Kim DR, Kang MY, Hahm JR. A Korean patient with fulminant autoantibody-negative type 1 diabetes. Diabetes Care. 2004; 27:3023–4.

5. Jung JH, Hahm JR, Kim MA, Park MH, Kim DR, Jung TS, Chung SI. Fulminant autoantibody-negative and type 1A diabetes phenotypes in a Korean HLA identical dizygotic twin. Diabetes Care. 2005; 28:2330–1.

6. Cho YM, Kim JT, Ko KS, Koo BK, Yang SW, Park MH, Lee HK, Park KS. Fulminant type 1 diabetes in Korea: high prevalence among patients with adult-onset type 1 diabetes. Diabetologia. 2007; 50:2276–9.

7. Kim MS, Kim CJ, Ko CW, Hwang PH, Lee DY. Fulminant type 1 diabetes mellitus in Korean adolescents. J Pediatr Endocrinol Metab. 2011; 24:679–81.

8. Kim HS, Lee TY, Kim EY, Choi JH, Kim SY, Hwang YC, Kang JH, Ahn KJ, Chung HY, Jeong IK. Fulminant Type 1 diabetes in a pregnant woman as an initial manifestation of the insulin autoimmune syndrome. Diabet Med. 2012; 29:1335–8.

9. Tan F, Loh WK. Fulminant type 1 diabetes associated with pregnancy: a report of 2 cases from Malaysia. Diabetes Res Clin Pract. 2010; 90:e30–2.

10. Kim HJ, Kim HS, Hahm JR, Jung JH, Kim SK, Lee SM, Kim S, Chung SI, Jung TS. The first Vietnamese patient with fulminant type 1 diabetes mellitus. Intern Med. 2012; 51:2361–3.

11. Napartivaumnuay N, Suthornthepvarakul T, Deerochanawong C, Sarinnapakorn V, Niramitmahapanya S. Fulminant type I diabetes: the first case report in Thailand. J Med Assoc Thai. 2013; 96(Suppl 3):S114–7.

12. Taniyama M, Katsumata R, Aoki K, Suzuki S. A Filipino patient with fulminant type 1 diabetes. Diabetes Care. 2004; 27:842–3.

13. Pozzilli P, Visalli N, Leslie D. No evidence of rapid onset (Japanese) Type I diabetes in Caucasian patients. IMDIAB Group. Diabetologia. 2000; 43:1332.

14. Vreugdenhil GR, Schloot NC, Hoorens A, Rongen C, Pipeleers DG, Melchers WJ, Roep BO, Galama JM. Acute onset of type I diabetes mellitus after severe echovirus 9 infection: putative pathogenic pathways. Clin Infect Dis. 2000; 31:1025–31.

15. Moreau C, Drui D, Arnault-Ouary G, Charbonnel B, Chaillous L, Cariou B. Fulminant type 1 diabetes in Caucasians: a report of three cases. Diabetes Metab. 2008; 34:529–32.

16. Imagawa A, Hanafusa T, Uchigata Y, Kanatsuka A, Kawasaki E, Kobayashi T, Shimada A, Shimizu I, Maruyama T, Makino H. Different contribution of class II HLA in fulminant and typical autoimmune type 1 diabetes mellitus. Diabetologia. 2005; 48:294–300.

17. Jung TS, Hahm JR, Jung JH, Chung SI. The classification of diabetic patients presenting diabetic ketoacidosis: the characteristics of fulminant type 1 diabetes. Korean Diabetes J. 2008; 32:534–6.

18. Kim NH, Kim HY, Seo JA, Kim NH, Choi KM, Baik SH, Choi DS, Kim SG. A pooled analysis of 29 patients with fulminant type 1 diabetes in Korea: a comparison with a nationwide survey in Japan. Diabetes Res Clin Pract. 2009; 86:e43–5.

19. Kawasaki E, Matsuura N, Eguchi K. Type 1 diabetes in Japan. Diabetologia. 2006; 49:828–36.

20. Lim CY, Kim HJ, Min KW, Kim HJ, Park KS, Kim EJ, Han KA. A case of fulminant type 1 diabetes with diabetic ketoacidosis and acute renal failure. J Korean Diabetes. 2006; 7:374–7.

21. Murase Y, Imagawa A, Hanafusa T, Iwahashi H, Uchigata Y, Kanatsuka A, Kawasaki E, Kobayashi T, Shimada A, Shimizu I, Maruyama T, Makino H. Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy–a nationwide 5-year-study in Japan. Diabetologia. 2007; 50:531–7.