Male, 45 years old, 80 kg, height 1.72 m, BMI 27.11 kg/m2, with dyslipidemia, with no family history of DM.
It begins with polydipsia, polyuria, tiredness and cramps.
One month later, the patient consulted in an emergency department.
Physical examination revealed dry skin and mucous membranes, acanthosis nigricans in the neck, normotensive and weight loss of 8 kg.
Tests were performed and the patient was hospitalized with the diagnosis of diabetic ketoacidosis (DKA).
We started 0.9% saline solution 1000 cc with potassium chloride and fast insulin 8 U intravenously.
At one hour, volume (3,000 cc) and IR sc (subcutaneous) were continued every 6 h, according to capillary glycemia.
Infectious focus was ruled out.
After 8 h of treatment, when acidosis is reversed and blood glucose levels < 250 mg/dl are achieved, basal boluses of insulin are started (Neutral plus insulin receptor agonist) and IR log matrix of the surrounding setting.
Upon discharge, a regimen with 180 g of carbohydrates, 18 U of NPH insulin AD and 6 U at 22 h was indicated, with self-monitoring of capillary blood glucose.
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*HCO3 Sodium bicarbonate. **HbA1c Glycosylated hemoglobin A1c.
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At 2 weeks the patient is asymptomatic with fasting capillary glucose 70-110 mg/dl, preprandial 100-130 mg/dl and postprandial 160-180 mg/dl insulin adds to the good evolution of metformin 10 mg/dl.
Controlled one month later, she reported episodes of hypoglycemia of 60 mg/dl during the day and the tests revealed good metabolic control.
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*HbA1c Glycosylated hemoglobin A1c.
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Given the onset of DM in DKA positive anti-thyroid thyroxine 1 (DM1), in a patient with phenotypic characteristics of DM2, immunologic markers for diabetes were requested: anti-beta cell antibodies (ICA), anti-glutacid antibodies (IAA),
Fasting C-peptide was normal (3.2 ng/ml).
Under these conditions insulin was discontinued, maintaining non-pharmacological measures and metformin.
The patient remains in regular follow-up for 24 months post discharge, achieving a reduction of 10 kg of weight, fasting glucose lower than 100 mg/dl, normal HbA1c, lipid profile and blood pressure.
