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ketosis prone diabetes; flatbush diabetes, type 1B diabetes, atypical diabetes
Pathology:
- episodic diabetic ketoacidosis resulting from insulin deficiency
- variable periods of insulin dependence & independence
- islet beta-cells impaired by glucose toxicity
Laboratory:
- C-peptide in serum weeks to months after episode of diabetic ketoacidosis
- islet beta-cell function confirmed by C-peptide in serum > 1 ng/mL
- serum C-peptide is a marker for endogenous insulin production & residual beta-cell function
- useful for determining whether patients with ketosis-prone diabetes require insulin [1,2]
- glutamic acid decarboxylase Ab in serum to evaluate for type 1 diabetes
Management:
- treatment of diabetic ketoacidosis (DKA)
- if islet beta-cell function confirmed & type 1 diabetes unlikely, insulin may be discontinued & metformin started
General
diabetes mellitus
References
- Medical Knowledge Self Assessment Program (MKSAP) 19
American College of Physicians, Philadelphia 2022
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Waddankeri SS, Swaraj Waddankeri M, Gurushantappa Mangshetty B.
Clinical and biochemical characteristics and treatment outcomes of
ketosis-prone diabetes: the remission prone diabetes.
Int J Endocrinol Metab. 2021;19:e106799.
PMID: 34149844