Case #1 - What is the type of diabetes in this patient? Type 1 or 2?


#1

A 55 year old woman was referred for Mangement of uncontrolled diabetes. She was diagnosed with type 2 diabetes when she was 44 years old during a routine physical exam and initially started on metrormin. After 2 years, glibenclamide was added, and 4 years later, glargine insulin was initiated following hospitalisation for hyperglycaemia with ketosis. She was discharged home on insulin, metformin and glibenclamide. She reported that her glycemic control was still poor and she experienced wide swings in her glucose values ranging from 60 to 400mg/dl. At presentation she was on glipizide, metformin, glargine and premeal insulin. On further questioning she revealed that she had a history of hypothyroidism and pernicious anemia. Her vitamin b12 deficiency was so severe that it led to myelopathy and permanent weakness in her lower extremities. She has been on b12 and levothyroxine. She denied skin pigmentation or history of adrenal insufficiency. Her other medications include atorvastatin and losartan. She had a family history of T2D in both parents, but she denied any family history of other autoimmune diseases.

On examination she was a moderately built woman in a wheelchair and was alert and oriented. There was no vitiligo. She had a mild bilateral pitting edema and pedal pulses were intact. Her HbA1c was 12.6% and blood glucose values throughout the day ranged from 100 to 400mg/dl. Her clinical characteristics at the time of diagnosis are
Age - 44 years
BMI - 25.4 kg/m2
HbA1c - 12.6 %
Triglycerides - 118 mg/dl
HDL - 40 mg/dl
LDL - 128 mg/dl
Total Cholesterol - 192 mg/dl

What type of diabetes in this patient? Type 1 or Type 2 diabetes?


#2

The patient is having Type 2 Diabetes


#3

The final diagnosis is T2DM


#4

Because of persistant hyperglycemia despite rigorous medication… its wise to check for anti–Gad antibodies… Anti pancreatic ab an and c-peptide to take decision…


#5

Multiple endocrine neoplasia
Type 1 is a possibility


#6

T2DM. BUT needs further testing GAD Aberdeen and cpeptide.


#7

Looks like Type 2 DM