First Report of Fulminant Type 1 Diabetes Mellitus in the Philippines
Fulminant Type 1 Diabetes Mellitus is a subtype of Type 1 DM not popularly known to many. It has been well reported among Japanese population, and with only few case reports among Caucasians. Fulminant Type 1 DM is characterized by extremely rapid beta cell destruction leading to absence of insulin secretion, hyperglycemia and ketosis, which most of the time is negative for autoantibodies like anti-GAD. Clinical and laboratory tests suggestive of Fulminant Type 1 DM include: duration of hyperglycaemia is 5 days, with normal or near normal hemoglobin A1c and a negligible C-peptide value. Its diagnosis warrants extensive insulin therapy and detection of early microvascular complications.
A 43 year old female admitted due to weakness associated with polyuria, nausea and vomiting. Patient was apparently well, without known co-morbidities and previous hospitalization when she initially felt weak five days prior to admission. The severity of weakness progressed two days prior to admission and now associated with frequent urination, severe thirst, nausea and vomiting.
Initial tests ruled out presence of a systemic infection and pacreatitis, with other laboratory tests consistent with diabetic ketoacidosis: metabolic acidosis with pH of 7.22 on arterial blood gas (N.V. pH 7.35 - 7.45), random capillary blood sugar level of more than 500 mg/dL (N.V. < 200 mg/dL), and positive serum ketones.
Initially, Type 2 Diabetes Mellitus was considered, but further tests showed: hemoglobin A1c of only 6.1%, with a non-detectable fasting C-peptide of 0.01 ng/mL (N.V. 0.8 - 3.1 ng/mL) and a negative anti-GAD which led to entertain a case of Fulminant Type 1 Diabetes Mellitus.
She was managed with hydration and intravenous human short-acting insulin infusion which subsequently transitioned to subcutaneous insulin and was discharged using Glargine and Glulisine.
This is the first reported case of Fulminant Type 1 Diabetes Mellitus in the Philippines, to date. It is important to be aware of such condition because initial and long term management greatly affect patients’ morbidity and mortality.