Diabetic Ketoacidosis as the First Manifestation of New Onset Juvenile Type 2 Diabetes

以糖尿病酮酸血症為初表現的青少年第2型糖尿病

10.6558/MTJM.2006.11(4).9

王子源(Tzu-Yuan Wang)；張淳堆(Chwen-Tzuei Chang)；陳清助(Ching-Chu Chen)；陳榮興(Rong-Hsing Chen)；黃偉倫(Wei-Lun Huang)

糖尿病酮酸血症 ； 青少年第2型糖尿病 ； 初發的糖尿病 ； diabetic ketoacidosis ； juvenile type 2 diabetes ； new-onset diabetes

Mid-Taiwan Journal of Medicine

11卷4期（2006 / 12 / 01）

267 - 270

英文

糖尿病酮酸血症被認為是第1型糖尿病的主要特徵，然而，幾篇報告指出肥胖非裔美國成年人、青少年及肥胖日本年輕第2型糖尿病患者，會自發性的出現酮酸血症。本文提出一例罕見的病例報告，一位15歲非肥胖新發生的第2型糖尿病女孩，以糖尿病酮酸血症為初表現，而且沒有任何造成酮酸血症的誘發原因，以致最初被誤診斷為第1型糖尿病。因此，我們強調以糖尿病酮酸血症為表現的非月即半青少年糖尿病患，並非一定是第1型糖尿病，也必須考慮第2型糖尿病的可能。

Diabetic ketoacidosis (DKA) is considered a cardinal feature of type 1 DM. However, several reports have indicated that ketosis can occur spontaneously in type 2 diabetes patients. We report a rare case of new-onset non-obese juvenile type 2 diabetes presenting as DKA without a precipitating event. The patient was first misdiagnosed as having type 1 diabetes. A previously healthy 15-year-old girl was sent to the emergency room in a drowsy state of consciouness. Laboratory data revealed marked hyperglycemia, ketonemia and metabolic acidosis. DKA was the preliminary diagnosis, and she was treated with intravenous saline and continuous insulin infusion. Eight days later, she was discharged on a regimen of subcutaneous insulin injections twice daily. Two months following acute presentation, the insulin dose was decreased to once daily. Fasting C-peptide was 2.6ng/mL (normal range 0.9 to 4ng/mL). Insulin was discontinued and good glycemic control was achieved with gliclazide and metformin therapy. DKA in nonobese juvenile patients with new-onset diabetes does not necessarily imply the presence of type 1 diabetes. Type 2 diabetes should also be considered in non-obese juvenile patients presenting with DKA.