Fulminant type 1 diabetes: the clinical features and treatment strategy

Objective To enhance the understanding of fulminant type 1 diabetes (FT1DM). Methods Clinical and laboratory data of 3 patients diagnosed as FT1DM in our hospital from January 2007 to March 2008 were retrospectively analyzed. Results (1)All of 3 cases were males aged from 29 to 43 years old with body mass index ranged from 21.5 to 23.3 kg/m2. (2)They were developed to ketoacidosis rapidly after the appearance of diabetic symptoms in 2–4 days. One case had a cardiac arrest. (3) At the stage of onset, the plasma glucose level were above 38 mmol/L, glycosylated hemoglobin ranged from 6.2% to 6.3% and serum glycated albumin ranged from 15% to 24%. (4) Serum glutamic acid decarboxylase antibody and protein tyrosine phosphatase antibody were negative. (5) Their β–cell functions were extremely poor confirmed by a standard test meal and arginine stimulation test. (6) Serum hemodiastase (263–2319 U/L) and lipase (812–859 U/L) were high. Ultrasound and computed tomography showed a normal pancreas. (7) Serum creatinekinase level (1283–12 239 U/L) was extremely high. One case had rhabdomyolysis confirmed by biopsy at gastrocnemius muscle. Serum liver enzyme and myocardial enzyme pedigree were risen significantly. (8) Case 1 was treated with multiple daily insulin injections (MDI) when he was discharged. Case 2 was treated with continuous subcutaneous insulin infusion (CSII). Case 3 was treated with MDI at the beginning of the therapy and transferred to CSII later. Comparing glycemic parameters of continuous glucose monitoring, not only mean level of 24 h blood glucose and intra–day glycemic variability (mean amplitude of glycemic excursions and Schlichtkrull's M–value) but also day–to–day glycemic variability (absolute means of daily differences) were indicated case 2 < case 3 (CSII) < case 1