Type 2 diabetes mellitus in a young girl: ominous presentation and atypical course

To report a 7-year-old young girl who was found unresponsive and found to be in severe diabetic ketoacidosis (DKA). Presence of obesity, acanthosis nigricans, and strong family history of type 2 diabetes mellitus (T2DM) along with negative pancreatic autoimmune antibody evaluation suggested T2DM as the culprit.

We present clinical findings, laboratory test results, and imaging reports as well as follow-up on this unique presentation of T2DM.

A 7-year-old girl was found unresponsive at home. Initial evaluation demonstrated severe DKA and diminished neurologic status. CT-scan of the head did not demonstrate cerebral edema. Her neurologic status deteriorated dramatically on four separate occasions requiring reintubation twice. She was transitioned to intensive insulin management, requiring up to 2 units/kg/day insulin. Her insulin sensitivity improved dramatically prior to discharge. Now 18 months from diagnosis, she remains on basal insulin and metformin.

New-onset T2DM is an increasing event in youth. Reports suggest that these youth may acutely deteriorate as opposed to the typical longer duration of onset in youth with new-onset type 1 diabetes mellitus. Attention to effective screening of those at risk and increasing public awareness of T2DM in youth is important and may reduce the risk of such dreadful presentations as described in the current report. The balance between insulin deficiency and insulin resistance is variable at different phases of the condition. This highlights the need for study of the natural history of T2DM in youth.