J Korean Diabetes Assoc.  2005 May;29(3):267-270.

A Case of Diabetic Ketoacidosis in a GAD Antibody-positive Diabetes Patients who Recently Experienced Hyperglycemic Hyperosmolar State

• Son JW
• Lee SH
• Lee JA
• Kim J
• Oh YS
• Shinn SH

Abstract

The term latent autoimmune diabetes in adults(LADA) was introduced to define adult diabetic patients who initially do not require insulin, but they have the immune markers of type 1 diabetes and in a number of cases, these patients progress to insulin dependency. LADA patients have several features of classic type 1 diabetes in addition to islet cell antibody positivity, including high rates of HLA-DR3 and DR4. We describe here a case of a patient with a diagnosis of LADA who, having been diagnosed with type 2 diabetes, was affected with diabetic ketoacidosis. In April 2000, a 65-year-old man was admitted to Chung-Ang University Hospital due to his decreased cognitive ability. The patient was diagnosed with type 2 diabetes 30-years ago and he was diagnosed 6-month ago as being in a hyperglycemic hyperosmolar state. He was positive for antibodies against GAD(anti-GAD, 31U/mL). His weight was 70kg, height 167cm, BMI 25 kg/m2 and the blood pressure was 86/52mmHg. No abnormalities on the physical examination were found. His acid-base balance was pH 6.937, serum bicarbonate 2.2mmol/L and the anion gap 38; he also had a strong positive reaction for ketones in his urine and serum. During half a year, the fasting C-peptide level decreased from 0.65nmol/L to 0.13nmol/L, which means the rapid progression of beta-cell destruction. Intensive treatment of LADA with insulin may improve this type of patients' quality of life, and so potentially save the beta-cell function and perhaps lessening the risk of a hyperglycemic crisis

Keyword

Latent autoimmune diabetes of the adult; Diabetic ketoacidosis; Hyperglycemic hyperosmolar state; GAD antibody

MeSH Terms

Acid-Base Equilibrium
Adult
Aged
Antibodies
Biomarkers
Blood Pressure
C-Peptide
Diabetes Mellitus, Type 1
Diabetic Ketoacidosis*
Diagnosis
Fasting
HLA-DR3 Antigen
Humans
Hydrogen-Ion Concentration
Insulin
Islets of Langerhans
Ketones
Physical Examination
Quality of Life
Antibodies
C-Peptide
HLA-DR3 Antigen
Insulin
Ketones