Characteristics of fulminant type 1 diabetes mellitus.
BACKGROUND
Fulminant type 1 diabetes is characterized by acute onset and rapid development of ketoacidosis.


METHODS
We present three cases of fulminant type 1 diabetes we experienced at our hospital. All three patients showed extremely high levels of plasma glucose, low HbA1c levels, positivity for urinary ketone bodies, ketoacidosis, and low C-peptide excretion. Flu-like symptoms were noted a few days before hospitalization, and increases in the WBC and CRP levels were observed. Interestingly, case 1 was negative for anti-GAD antibody at the time of hospitalization but became positive 22 days later. Moreover, this patient reverted to being negative for anti-GAD antibody 93 days later. Cases 1 and 3 were positive for HLA-DR4 and HLA-DR9, and Case 2 was positive for HLA-DR4. All three individuals had flu-like symptoms and showed inflammatory markers in the blood.


CONCLUSIONS
Although autoimmune abnormalities are not usually linked with fulminant type 1 diabetes, the conclusion drawn from the present study is that patients with this disease should be monitored on several different occasions for autoimmune antibodies.
Sue
Mariko
M
Department of Internal Medicine, Saiseikai Kanagawa-ken Hospital, Yokohama, Japan.
Yoshihara
Aya
A
Otani
Takatoshi
T
Tsuchida
Yasuyo
Y
Higa
Mariko
M
Hiroi
Naoki
N
D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000276:immunology*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000276:immunology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged
D001323:Autoantibodies; D001786:Blood Glucose; D006442:Glycated Hemoglobin