Fulminant type 1 diabetes mellitus: Two case reports

Area of Science:

• Endocrinology and Metabolism
• Diabetology

Background:

• Fulminant type 1 diabetes mellitus (FT1DM) is a distinct subtype of type 1 diabetes characterized by abrupt onset and rapid beta-cell destruction.
• First proposed in 2000, FT1DM presents with initial gastrointestinal symptoms and markedly elevated blood glucose levels, despite normal or near-normal HbA1c.

Observation:

• Two male patients, aged 37 and 48, presented with acute gastrointestinal distress (emesis, diarrhea, stomachache) preceding hyperglycemia and ketoacidosis.
• Neither patient had a prior history of hypertension, coronary heart disease, or hyperglycemia, highlighting the sudden and unexpected nature of the disease onset.

Findings:

• Both patients exhibited acute hyperglycemia, ketoacidosis, and severe beta-cell function deficiency (HbA1c <8.5%) upon admission.
• Initial interventions included fluid resuscitation, intravenous insulin, and correction of electrolyte and acid-base imbalances, leading to stabilization.
• Long-term management involved a regimen of insulin aspart and insulin glargine.

Implications:

• FT1DM requires timely and accurate diagnosis due to its rapid progression and nonspecific initial symptoms.
• Prompt and aggressive treatment is essential to manage severe metabolic disturbances and mitigate the high risk of mortality associated with FT1DM.
• Understanding FT1DM's unique presentation is vital for effective clinical management and improved patient outcomes.