Clinical features and treatment strategy of patients with fulminant type 1 diabetes

Objective To discuss the clinical features and treatment strategy of patients with fulminant type 1 diabetes mellitus (FT1DM). Methods Clinical and laboratory data of 4 patients diagnosed as FT1DM in our hospital from January 2008 to February 2016 were retrospectively analyzed. Results 2 females and 2 males aged from 22 to 68 years old were included.They were developed to ketoacidosis rapidly after the appearance of diabetic symptoms in 2-6 days.Some cases complicated with shock, acute renal insufficiency and rhabdomyolysis.One case with late pregnancy had a stillbirth.The plasma glucose level was ranged from 35.6 to 67.8 mmol/L, HbA1c ranged from 5.8 % to 6.7%, fasting C peptide ranged from lower than 0.01 to 0.11 ng/mL and 2-hour postprandial C peptide ranged from lower than 0.01 to 0.12 ng/mL.No improvement in C peptide levels were followed up for 9-43 months.After acute phase, intensive insulin therapy was used to control blood glucose.The patients had a great glycaemia excursion and were subjected to hypoglycaemia. Conclusion FTlDM is a special type of diabetes developed rapidly with dangerous prognosis.It is often shown as ketoacidosis and the HbA1c level is normal or mildly elevated.Serious cases are associated with other organ damage, pregnancy fetal death rate is very high.Because the serious impaired islet B-cell function, FTlDM patients has a great glycaemia excursion, continuous subcutaneous insulin infusion is the first choice to control plasma glycemia. Key words: Diabetes mellitus, type 1; Fulminans; Diabetic ketoacidosis; Glycesylated hemoglobin