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Flatbush Diabetes Definition

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes Of Ketosis-prone Diabetes Mellitus

INTRODUCTION Since the mid-1990s, increasing attention has been focused on a heterogeneous condition characterized by presentation with diabetic ketoacidosis (DKA) in patients who do not necessarily fit the typical characteristics of autoimmune type 1 diabetes. Earlier reports used the terms "atypical diabetes," "Flatbush diabetes," "diabetes type 1B," and "ketosis-prone type 2 diabetes mellitus" to describe subsets of this condition, and it was noted that in some instances patients presented with DKA as the first manifestation of diabetes and evolved to insulin independence [1]. While initially these reports suggested that the condition, now termed ketosis-prone diabetes (KPD), might be limited to persons of non-Caucasian ethnicity, its prevalence appears to be increasing in a wide range of ethnic groups worldwide [2-5]. The classification, pathophysiology, natural history, and management of KPD will be reviewed here. Patients with islet autoantibodies who do not present with ketosis, including those termed "latent autoimmune diabetes in adults" (LADA), "type 1.5 diabetes" [6,7], and "slowly progressing type 1 diabetes" [8] are discussed elsewhere. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) CLASSIFICATION OF KPD The goal of new classification schemes is to enable clinicians to predict which patients with diabetic ketoacidosis (DKA) require temporary insulin treatment versus life-long insulin therapy. They also highlight subgroups for genetic and pathogenetic studies. Ketosis-prone diabetes (KPD) comprises a group of diabetes syndromes characterized by severe beta cell dysfunction (manifested by presentation with DKA or unprovoked ketosis) and a variable clinical course. These syndromes do not fit the traditional categories of diabetes d Continue reading >>

Flatbush Diabetes - Ny Daily News

Flatbush Diabetes - Ny Daily News

Doctors used to divide diabetes cases into two neat camps: Types 1 and 2. But the disease is not quite that simple. Flatbush diabetes, one of several variations of the disease, was identified in 1994 at SUNY Downstate Medical Center in the East Flatbush section of Brooklyn.The first symptom of Flatbush diabetes is usually diabetic ketoacidosis (DKA) a potentially fatal buildup in the blood of chemicals known as ketones, which results when the body stops producing insulin and burns an excessive amount of stored fats. (Sometimes the first symptom of Flatbush diabetes is severe hyperglycemia, or high blood sugar.)It was once thought that DKA only occurred in Type 1 patients. When middle-aged African-Americans in Flatbush were diagnosed with it, doctors assumed they were Type 1 also, even though they didnt fit the age or weight criteria.But those patients actually represented a previously unidentified subtype of Type 2. Many of them are able to manage their disease through diet, exercise, pills and some insulin. Though initially they all required insulin, they werent the brittle Type 1s who have to have insulin otherwise theyre dead the next day, said Dr. Mary Ann Banerji, clinical assistant professor of medicine at Downstate. Up to three-quarters of the Flatbush patients also had family histories of Type 2, and they all lacked the auto-immune markers that distinguish Type 1 cases. Basically, these are Type 2 diabetics who look like Type 1, said Banerji. Downstate sees about 150 cases a year of Flatbush diabetes, most of them in African-Americans. The disease also occurs in Hispanics but is rare in non-Hispanic whites.Note: THE SILENT EPIDEMIC THE SPECIAL REPORT Continue reading >>

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes of Ketosis-Prone Diabetes Mellitus Ashok Balasubramanyam , Ramaswami Nalini , Christiane S. Hampe , and Mario Maldonado Translational Metabolism Unit (A.B., R.N., M.M.), Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas 77030; Endocrine Service (A.B., R.N.), Ben Taub General Hospital, Houston, Texas 77030; Robert H. Williams Laboratory (C.S.H.), University of Washington, Seattle, Washington 98195; and Novartis, Inc. (M.M.), CH-4002 Basel, Switzerland Address all correspondence and requests for reprints to: Ashok Balasubramanyam, M.D., Translational Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Room 700B, One Baylor Plaza, Houston, Texas 77030. E-mail: [email protected] Received 2007 Aug 13; Accepted 2008 Jan 9. Copyright 2008 by The Endocrine Society This article has been cited by other articles in PMC. Ketosis-prone diabetes (KPD) is a widespread, emerging, heterogeneous syndrome characterized by patients who present with diabetic ketoacidosis or unprovoked ketosis but do not necessarily have the typical phenotype of autoimmune type 1 diabetes. Multiple, severe forms of -cell dysfunction appear to underlie the pathophysiology of KPD. Until recently, the syndrome has lacked an accurate, clinically relevant and etiologically useful classification scheme. We have utilized a large, longitudinally followed, heterogeneous, multiethnic cohort of KPD patients to identify four clinically and pathophysiologically distinct subgroups that are separable by the presence or absence of -cell autoimmunity and the presence or absence of -cell functional reserve. The resulting A classification system of KPD has proven to be highly accurate and predictive of such clinically importan Continue reading >>

Atypical Ketosis-prone Diabetes

Atypical Ketosis-prone Diabetes

S. Ali Imran , MB BS FRCP FRCPC and Ehud Ur , MB BS FRCP Dr Imran is an Associate Professor and Dr Ur is a Professor in the Division of Endocrinology and Metabolism at Dalhousie University in Halifax, NS Correspondence: Dr S.A. Imran, Division of Endocrinology and Metabolism, Dalhousie University, 7th Floor, North Victoria Building, VG Site, 1278 Tower Rd, Halifax, NS B3H 2Y9; telephone 902 473-8277; fax 902 473-3726; e-mail [email protected] Copyright the College of Family Physicians of Canada This article has been cited by other articles in PMC. Atypical diabetes is a rare form of diabetes mellitus (DM) that presents with diabetic ketoacidosis (DKA). However, in contrast to type 1 DM, patients with atypical DM undergo spontaneous remission and maintain long-term insulin independence. Family physicians must maintain a high index of suspicion to diagnose and manage such cases. A 44-year-old, previously healthy South Asian woman presented to her family physician with progressively worsening dry mouth, polyuria, and polydipsia for 6 weeks. She had also lost 7 kg in weight over the past 3 months. At the time of initial presentation, her fasting glucose was 18.1 mmol/L and her hemoglobin A1c was 13.4% (normal 4.5% to 6.5%). Results of the urinalysis were positive for glucose (> 55 mmol/L) and ketones (> 7.8 mmol/L). The family physician made a clinical diagnosis of type 1 DM and referred her to the local diabetes management centre. She was seen the same day at the diabetes centre and started on intensive insulin therapy, with multiple daily injections, after consultation with the endocrinologist. Upon presentation her weight was 63 kg with a calculated body mass index of 23.4 kg/m2. She had no family history of DM, and test results were negative for anti-islet cel Continue reading >>

Diabetes In African Americans: Unique Pathophysiologic Features

Diabetes In African Americans: Unique Pathophysiologic Features

, Volume 4, Issue3 , pp 219223 | Cite as Diabetes in African Americans: Unique pathophysiologic features Type 2 diabetes is an increasing public health problem among African Americans, especially children. Several features make type 2 diabetes among African Americans unique. First, African-American adults with type 2 diabetes, or Flatbush diabetes, present with diabetic ketoacidosis. Patients are insulin resistant with acute, severe defects in insulin secretion and no islet cell autoantibodies. Following treatment, some insulin secretory capacity is recovered and ketoacidosis generally does not recur. The second is remission in African Americans with type 2 diabetes. Recovery of glucose homeostasis, accompanied by recovery of -cell function, follows intensive glycemic regulation. Finally, among African Americans with diabetes who are not obese, normal insulin sensitivity is not uncommon. Such individuals do not have the increased cardiovascular risk of insulin-resistant individuals. Differences in visceral, not subcutaneous, adipose tissue volume appear to determine insulin sensitivity. Understanding the unique physiologic and clinical features of African Americans is critical in designing appropriate treatment strategies. Metabolic SyndromeVisceral Adipose TissueRepaglinideDiabetic KetoacidosisGlipizide These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Harris MI, Flegal KM, Cowie CC, et al.: Prevalence of diabetes, impaired fasting glucose and impaired glucose tolerance in US adults. Diabetes Care 1998, 21:518524. CrossRef PubMed Google Scholar Bran Continue reading >>

Flatbush Diabetes

Flatbush Diabetes

Most of us who have had diabetes for at least a few years are likely to be familiar with the main types of diabetes: type 1, which is autoimmune, and type 2, which involves insulin resistance. We may also be aware of some minor types like LADA (latent autoimmune diabetes of adults), a slower-onset form of autoimmune diabetes that appears in adults. Another type is MODY (maturity-onset diabetes of the young), which often, but not always, appears in children or young people. It is monogenic, meaning a mutation in only one gene causes the disease, and the affected gene is dominant, meaning that you can inherit only one copy of the gene from one parent and a normal gene from the other parent and you’ll get MODY. Type 2 diabetes is polygenic, meaning a lot of genes are usually involved. Other forms of diabetes include gestational diabetes, a usually temporary form of diabetes that occurs in late pregnancy and then goes away after the baby is born, although having gestational diabetes greatly increases your risk of getting type 2 diabetes later. And there are various rare forms of diabetes as well as diabetes induced by taking drugs, including steroids. But there’s another form of diabetes that seems to becoming more and more common, especially in Africa, and that’s Flatbush diabetes, named after the New York area where it was described some years ago. It’s also been called a lot of other things, including atypical diabetes, type 1B diabetes, idiopathic [meaning the cause is unknown) type 1 diabetes, and ketosis-prone type 2 diabetes. I’ll use the term Flatbush diabetes because I find it easier to rememember colorful nicknames, and also because it doesn’t require one to decide if this form of diabetes is really type 1 or type 2. In fact, it seems to be somewhat in Continue reading >>

Ketosis-prone Diabetesa New Subgroup Of Patients With Atypical Type 1 And Type 2 Diabetes?

Ketosis-prone Diabetesa New Subgroup Of Patients With Atypical Type 1 And Type 2 Diabetes?

Ketosis-Prone DiabetesA New Subgroup of Patients with Atypical Type 1 and Type 2 Diabetes? Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University of Tennessee College of Medicine Memphis, Tennessee 38163 Address all correspondence and requests for reprints to: Abbas E. Kitabchi, Ph.D., M.D., Division of Endocrinology, University of Tennessee College of Medicine, 951 Court Avenue, Room 335M, Memphis, Tennessee 38163. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 11, 1 November 2003, Pages 50875089, Abbas E. Kitabchi; Ketosis-Prone DiabetesA New Subgroup of Patients with Atypical Type 1 and Type 2 Diabetes?, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 11, 1 November 2003, Pages 50875089, One objective for classification of a disease is the opportunity to study its epidemiology, etiology, and pathogenesis to provide various effective interventions for its prevention and treatment. The paper of Maldonado et al. ( 1 ) in this issue of JCEM reports on the classification of four groups of diabetic patients who presented with diabetic ketoacidosis (DKA). Of the two most common types of hyperglycemic crises, DKA most often occurs in type 1 diabetes (DM-1), and hyperglycemic hyperosmolar state most frequently arises in type 2 diabetes (DM-2). However, the occurrence of these acute metabolic emergencies is not specific to one type of diabetes or the other ( 2 ). Maldonado et al. ( 1 ) have carefully and meticulously studied a well-defined multiethnic group of patients with diabetes who presented with DKA. The study cohort was divided into four groups based on positive or negative -cell insulin function (B+ or B, respectively), as well as positive or negative au Continue reading >>

Diabetes Classification

Diabetes Classification

Diabetes is defined as an elevated blood glucose of >=126 mg/dl or a hemoglobin A1c >=6.5% or a random blood glucose >=200 mg/dl with signs and symptoms of hyperglycemia. Diabetes is commonly associated with signs and symptoms of acute or chronic microvascular and macrovascular complications. Classically, symptoms due to acute hyperglycemia include polyuria, polydipsia, polyphagia, weight loss, fatigue, increased infections, and blurred vision. Early in diabetes, there may also be an absence of symptoms during which time complications may develop. Signs are related to the effects of dehydration, catabolism, and metabolic changes including hypotension, weight loss, dehydration, and diabetic ketoacidosis (DKA). Symptoms and signs related to the complications of diabetes are due to tissue effects of long-term hyperglycemia (often in the context of hypertension, hyperlipidemia, obesity, and other coexisting metabolic abnormalities) and are related to specific organ damage commonly including eye, kidney, and nerve damage, as well as cardiovascular disease, and extending to nearly all tissues. Diabetes is a very heterogeneous disorder marked by relative or absolute deficiency in insulin secretion and most often by decreased insulin action. Some forms of diabetes are autoimmune and may be associated with other autoimmune endocrine diseases others clearly linked to genetic (MODY) and syndromic disorders (Turner's, Wolfram's), while other forms have no known etiology. There are several traditional classifications based on our understanding of the cause of hyperglycemia. Although in many instances, individual patients do not neatly fit these classifications, appropriate classification may be important for identifying the pathogenesis, predicting treatment outcomes and potential Continue reading >>

Flatbush Diabetes - General Practice Notebook

Flatbush Diabetes - General Practice Notebook

Ketosis prone type 2 diabetes/atypical diabetes/flatbush diabetes is a widespread, emerging, heterogeneous syndrome characterised by patients who present with diabetic ketoacidosis (DKA) or unprovoked ketosis with hyperglycaemia but do not necessarily have the typical phenotype of autoimmune type 1 diabetes is an uncommon form of diabetes characterized by severe reversible insulin deficiency atypical diabetes was originally described by Banerji et al as a unique form of diabetes among African-American patients who presented with DKA as their initial manifestation of diabetes (1) ketosis prone type 2 diabetes, though first described and mostly observed in males of African-American descent, has been identified in Asian populations, including Japanese and Chinese there is an increased male preponderance in this condition in a South African study, half the presentations of DKA were due to type 2 diabetes (2) at initial presentation, the patients with type 2 diabetes and DKA cannot be reliably separated from those with type 1 diabetes; however, they tend to be middle-aged, obese, hypertensive and may have markers of insulin resistance such as acanthosis nigricans (2) often a positive family history of type 2 diabetes mechanism underlying their presentation seems to be the combination of insensitivity to insulin and transient loss of ability to release adequate amounts of insulin in contrast to type 1 diabetes, patients with atypical diabetes undergo spontaneous remission and maintain long-term insulin independence (1,3) during admission the patients with type 2 diabetes gradually lose their insulin resistance patients with ketosis prone type 2 diabetes do not have the autoantibodies associated with type 1 diabetes and they have recovery of insulin secretion as evidenced by Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

Approach To The Patient With Atypical Diabetes

Approach To The Patient With Atypical Diabetes

Approach to the patient with atypical diabetes Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, and Boston University School of Medicine, Boston, Mass. Correspondence to: Devin W. Steenkamp, [email protected] Copyright 1995-2014, Canadian Medical Association This article has been cited by other articles in PMC. The overarching term diabetes mellitus represents a heterogeneous group of metabolic conditions characterized by hyperglycemia. All of these conditions are underpinned by a combination of various insulin secretory defects and impaired insulin action. According to the American Diabetes Association, 1 diabetes can be broadly classified into four clinical classes: type 1 diabetes, characterized by immune-mediated destruction of the insulin-secreting cells, which usually leads to absolute insulin deficiency and dependence on exogenous insulin; type 2 diabetes, an undefined polygenic disorder with various degrees of insulin resistance preceding progressive insulin secretory defects; gestational diabetes, diagnosed for the first time during pregnancy; and diabetes due to specific causes other than those noted above. This fourth group remains poorly defined, and atypical forms of diabetes often fall into this catch-all category. Type 2 diabetes accounts for over 90% of cases seen in primary care, 1 and type 1 diabetes accounts for the majority of the rest (between 5%10% of all cases). 1 However, physicians occasionally encounter individuals with impaired glucose metabolism who are lean, lack markers of insulin resistance or the typical type 2 diabetic dyslipidemic profile, are without hypertension or other typical cardiovascular risk factors, and who are not completely insulin dependent. These patients present a diagnostic challenge. Diagn Continue reading >>

Ketosis-proned Diabetes

Ketosis-proned Diabetes

Patient Case discussion: Ketosis-proned Diabetes A SERMO Endocrinologist presented a patient case for discussion focusing on Ketosis-proned Diabetes, that started an interesting dialogue about treating patients with diabetes. Today, were offering a look into SERMO by sharing the original case presentation (with some clinical pearls!) and subsequent insights from another Endocrinologist about 1) how they advise residents and fellows to discard the Type 1 & 2 labels and 2) it would relate to the case. Join the discussion now on SERMO ! A 31-year-old African-American male patient is found to have a blood glucose of 267 on a chem panel done as an outpatient. There is an anion gap of 17. Noting this, the PCP calls the patient. He advises the patient to go to the ER for further evaluation. The patient presents to the ER in diabetic ketoacidosis (DKA). He is started on insulin, and while its too early to tell for this particular individual, many patients like him can usually come off insulin rapidly, and be well-controlled on PO agents only. Does presenting with diabetic ketoacidosis (DKA) mandate indefinite insulin treatment? Not necessarily. Weve increasingly recognized since the mid-1990s that some patients defy classification into either type 1 diabetes (T1DM) or T2DM. Ketosis-prone type 2 diabetes mellitus (KPDM) is at once underrecognized and distinctive. Winter and colleagues first described this condition in 1987. Twelve African-American patients initially presented with DKA, but their disease course unfolded similarly to an individual with T2DM.1 KPDM was initially thought to be a variant of maturity onset diabetes of the young (MODY). Other names you may have seen or heard for this include Flatbush diabetes (named for the part of Brooklyn, NY where young African-Ame Continue reading >>

Ketosis-prone Type 2 Diabetes

Ketosis-prone Type 2 Diabetes

Time to revise the classification of diabetes Diabetic ketoacidosis (DKA) is the most serious hyperglycemic emergency in patients with diabetes. DKA is reported to be responsible for >100,000 hospital admissions per year in the U.S. (1) and is present in 25–40% of children and adolescents with newly diagnosed diabetes (2) and in 4–9% of all hospital discharge summaries among adult patients with diabetes (3,4). DKA has long been considered a key clinical feature of type 1 diabetes, an autoimmune disorder characterized by severe and irreversible insulin deficiency. In recent years, however, an increasing number of ketoacidosis cases without precipitating cause have also been reported in children, adolescents, and adult subjects with type 2 diabetes (5–7). These subjects are usually obese and have a strong family history of diabetes and a low prevalence of autoimmune markers. At presentation, they have impairment of both insulin secretion and insulin action, but aggressive diabetes management results in significant improvement in β-cell function and insulin sensitivity sufficient to allow discontinuation of insulin therapy within a few months of treatment (7–9). Upon discontinuation of insulin, the period of near-normoglycemic remission may last for a few months to several years (10–13). This clinical presentation has been reported primarily in Africans and African Americans (6,7,14–16) and also in other minority ethnic groups (12,17,18). This variant of type 2 diabetes has been referred to in the literature as idiopathic type 1 diabetes, atypical diabetes, Flatbush diabetes, diabetes type 1 (1/2) (somewhere between type 1 and type 2 diabetes), and more recently as ketosis-prone type 2 diabetes (9). In this issue of Diabetes Care, Balasubramayam et al. (19) co Continue reading >>

Barker's Type 2 Ketosis Prone Diabetes / Atypical Diabetes T1b/ Flatbush Diabetes

Barker's Type 2 Ketosis Prone Diabetes / Atypical Diabetes T1b/ Flatbush Diabetes

Barker's Type 2 Ketosis Prone Diabetes / Atypical Diabetes T1b/ Flatbush Diabetes The accepted knowledge is that Diabetes destroys gradually over years. Ketosis Prone Type 2 diabetes is an acute form of type 2. This type 2 can reach fasting blood sugars of 300 or higher in months. This blog brings together all the documentation that I could find in the world and my speculation of what it means for KPDs in specific and diabetics in general. I ask you to leave your stories about what happened to you so that we can all gain a better understanding of what we are dealing with. Type 2 diabetes is a chronic disease. The excepted knowledge is that it erodes the bodys systems gradually over years. If you are reading this then you know different. Ketosis Prone Type 2 diabetes is an acute form of type 2. Rather than taking years to reach fasting blood sugars of 300 or much much higher, it can do so in less than a year. A few will even go DKA, a diabetic emergency from high blood sugars that can lead to coma and death. DKA is the only known way to identify KPD but it should be recognized that DKA is KPD at its worst. Measuring its prevalence by that is the same as using pneumonia as the best indicator of the prevalence of flu. This is all made even stranger by the fact that, if treated properly, it can go into a type of remission. People we need to be noticed. We must tell our stories to save others from what we have experienced and to give researchers an idea of who we are. This is your chance. Please leave as much of your story as you can in the comments section. Continue reading >>

Flatbush Diabetes: A Report Of Two Cases And A Review Of The Literature - Review

Flatbush Diabetes: A Report Of Two Cases And A Review Of The Literature - Review

Flatbush Diabetes: A Report of Two Cases and a Review of the Literature - Review Type 2 diabetes is an endocrine and metabolic disorder appearing with insulin resistance and impaired beta cell secretory function. Type 1 diabetes is characterized by the autoimmune destruction of pancreatic beta cells, which leads to absolute insulin deficiency. Diabetic ketoacidosis is considered a cardinal feature of type 1 diabetes. A number of studies have demonstrated that diabetic ketoacidosis also occurs in subjects with type 2 diabetes. Such patients are classified as idiopathic type 1 diabetes, type 1B diabetes, Flatbush diabetes or ketosis-prone type 2 diabetes. The aim of our study was to present two patients, who were diagnosed with ketosis-prone type 2 DM, as well as to discuss the subject in the light of the extant literature and to be able to make general recommendations. Turk Jem 2009; 13: 56-9 Key words: Flatbush diabetes, prone to ketosis, classification of diabetes mellitus Tip 2 diyabet, inslin rezistans ve beta hcre sekresyon bozukluunun birlikte grld endokrin ve metabolik bir hastalktr. Tip 1 diyabet ise pankreatik beta hcrelerinin otoimmun dekstrksiyonu sonucu inslin eksiklii ile karakterizedir. Diyabetik ketoasidoz tip 1 diyabeti belirleyici en nemli zelliklerden birisidir. Baz almalarda diyabetik ketoasidozun tip 2 diyabetik hastalarda da grld saptanmtr. Ketoz veya ketoasidoz tablosu ile bavuran baz hastalarda hem tip 1 hem de tip 2 diyabete zg klinik zelliklerin bir arada bulunduu ve bu hastalarda tan karmaas yaanabilecei bildirilmektedir. Bu hastalar idiyopatik tip 1 diyabet veya tip 1B diyabet veya Flatbush diyabet veya ketozis eilimli tip 2 diyabet olarak snflandrlmtr. Biz de bu almamzda ketozis eilimli tip 2 diyabet olduunu belirlediimiz 2 olgumuzu sunmay, k Continue reading >>

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