부산대학교 도서관

Fulminant type 1 diabetes (FT1D) is characterized by the acute onset of insulin-deficient hyperglycemia and ketoacidosis due to the sudden destruction of pancreatic beta-cells within a few days. We report the case of a patient with FT1D in whom the blood glucose level was measured incidentally at 3 weeks prior to the diagnosis. A 63-year-old Japanese man presented to our hospital with a 14-day history of thirst, polyuria, and fatigue. The laboratory tests revealed severe hyperglycemia (651 mg/dL) with metabolic acidosis (arterial blood pH of 7.11) and ketonuria, indicating a diagnosis of diabetic ketoacidosis. Annual health checks had not detected hyperglycemia in the past. His ketoacidosis was controlled within 24 hours by an intravenous infusion of fluid and insulin. Although he had a 2-week history of thirst and polyuria, the clinical features were generally consistent with FT1D. The fasting blood glucose level was measured during his most recent annual health check, which was performed 3 weeks prior to the diagnosis of FT1D, and which was reported to be 183 mg/dL. This is the first reported case of FT1D in which hyperglycemia was detected 1 week before the onset of symptoms. Our findings seem to support the concept that there is variation in the rapidity of pancreatic beta-cell destruction during the development of FT1D.