Fulminant type 1 diabetes: the clinical features and treatment strategy

Abstract

Objective To enhance the understanding of fulminant type 1 diabetes (FT1DM). Methods Clinical and laboratory data of 3 patients diagnosed as FT1DM in our hospital from January 2007 to March 2008 were retrospectively analyzed. Results (1)All of 3 cases were males aged from 29 to 43 years old with body mass index ranged from 21.5 to 23.3 kg/m2. (2)They were developed to ketoacidosis rapidly after the appearance of diabetic symptoms in 2–4 days. One case had a cardiac arrest. (3) At the stage of onset, the plasma glucose level were above 38 mmol/L, glycosylated hemoglobin ranged from 6.2% to 6.3% and serum glycated albumin ranged from 15% to 24%. (4) Serum glutamic acid decarboxylase antibody and protein tyrosine phosphatase antibody were negative. (5) Their β–cell functions were extremely poor confirmed by a standard test meal and arginine stimulation test. (6) Serum hemodiastase (263–2319 U/L) and lipase (812–859 U/L) were high. Ultrasound and computed tomography showed a normal pancreas. (7) Serum creatinekinase level (1283–12 239 U/L) was extremely high. One case had rhabdomyolysis confirmed by biopsy at gastrocnemius muscle. Serum liver enzyme and myocardial enzyme pedigree were risen significantly. (8) Case 1 was treated with multiple daily insulin injections (MDI) when he was discharged. Case 2 was treated with continuous subcutaneous insulin infusion (CSII). Case 3 was treated with MDI at the beginning of the therapy and transferred to CSII later. Comparing glycemic parameters of continuous glucose monitoring, not only mean level of 24 h blood glucose and intra–day glycemic variability (mean amplitude of glycemic excursions and Schlichtkrull's M–value) but also day–to–day glycemic variability (absolute means of daily differences) were indicated case 2 < case 3 (CSII) < case 1<case 3 (MDI). Conclusions (1) FT1DM patients had clinical feathers of abrupt onset, serious metabolic disorders, serious impaired islet β–cell function, complicated with multiple organ impair, which required special attention by all medical practitioners. (2) FT1DM patients had a great glycaemia excursion and were subject to hypoglycaemia. Maybe long–term CSII regimen was needed to improve the prognosis. Key words: Hemoglobin A, glycosylated; Fulminant type 1 diabetes; Continuous glucose monitoring