Adult-Onset, Obesity and Serious Insulin Resistance are New Characteristics for T1DM

Yuan Fen1, Wu Wenbin2, Dong Hui2 and Lu Fuer2*

1Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
2Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China

^*Correspondance to: Lu Fuer 

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Abstract:

Adult-onset obese T1DM with serious insulin resistance is difficult to distinguish from Latent Autoimmune Diabetes in Adults (LADA) and T2DM. Hence, it will be ignored and misdiagnosed in the clinical activities, especially for the remote districts without well-equipped medicine. The doctors can be misled by the clinical experience. In this case, a 31-years old patient with adultonset T1DM complicated with obesity and serious insulin resistance suffering from ketoacidosis was treated as T2DM by insulin injection based on the adult-onset, high BMI and serious insulin resistance. However, the blood glucose was beyond normal level obviously even we gave her a large amount of insulin from the continuous injection pump to short-acting combining with long-acting insulin (0.95 U/kg/d). The pre-meal glucose level fluctuated at 9 mM and the post-prandial glucose concentration waved at 15 mM. This phenomenon confused us and made us doubt the diagnosis. We examined the insulin and c-peptide at fasting and 1-h postprandial points. The insulin concentrations were 185.90 μIU/mL and 133.9 μIU/mL while the c-peptide was 0.48 ng/ml and 0.65 ng/ml, respectively. After, the patient completed the related antibodies examinations which showed that glutamic acid decarboxylase was over 2000.0 IU/mL. We diagnosed the patient as adult-onset T1DM with serious insulin resistance rather than LADA or T2DM. This was the first time to report adult-onset obese T1DM with serious insulin resistance. This case indicates that it is necessary to detect the autoimmune antibodies and OGTT to identify diabetes.

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Cite the Article:

Fen Y, Wenbin W, Hui D, Fuer L. Adult- Onset, Obesity and Serious Insulin Resistance are New Characteristics for T1DM. Ann Clin Case Rep. 2022; 7: 2295..