Fulminant type I diabetes: the first case report in Thailand

Type 1 diabetes is classified as either autoimmune (type IA) or idiopathic (type IB) diabetes. Fulminant type 1 diabetes is a recently-discovered subtype of idiopathic type 1 diabetes. It is defined as diabetes with complete abrupt onset of beta cell destruction and progression to hyperglycemia and ketoacidosis within a short period of time, but with a near-normal HbA1c level. The patients often have flu-like or abdominal symptoms at onset and elevated levels of pancreatic exocrine enzymes. Their diabetes-related autoantibodies are usually negative. In the present report, the authors present a case of fulminant type 1 diabetes in a 43-year-old Thai woman who presented with sudden onset of flu-like symptoms and abdominal pain. Findings on admission included a high blood glucose level and ketoacidosis, but a prediabetes range ofHbA1c level. Autoantibodies to glutamic acid decarboxylase (GAD) were negative. This subtype of type 1 diabetes was first identified in 2000 and there have been case reports from Japan, Korea, the Philippines and the Netherlands. Nonetheless, no case had been reported in Thailand until the present study. Here the authors report the first case of fulminant type 1 diabetes in Bangkok, Thailand.