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Ketosis Prone Type 2 Diabetes Symptoms

Ketosis-prone Type 2 Diabetes In Patients Of Sub-saharan African Origin: Clinical Pathophysiology And Natural History Of Beta-cell Dysfunction And Insulin Resistance.

Ketosis-prone Type 2 Diabetes In Patients Of Sub-saharan African Origin: Clinical Pathophysiology And Natural History Of Beta-cell Dysfunction And Insulin Resistance.

Department of Endocrinology & Diabetes, Saint-Louis Hospital and University of Paris VII School of Medicine, Paris, France. [email protected] Nonautoimmune ketosis-prone diabetic syndromes are increasingly frequent in nonwhite populations. We have characterized a cohort of patients of sub-Saharan African origin who had ketosis-prone type 2 diabetes (n = 111), type 1 diabetes (n = 21), and type 2 diabetes (n = 88) and were admitted to a hospital for management of uncontrolled diabetes. We compared epidemiological, clinical, and metabolic features at diabetes onset and measured insulin secretion (glucagon-stimulated C-peptide) and insulin action (short intravenous insulin tolerance test) during a 10-year follow-up. Ketosis-prone type 2 diabetes shows a strong male predominance, stronger family history, higher age and BMI, and more severe metabolic decompensation than type 1 diabetes. In ketosis-prone type 2 diabetes, discontinuation of insulin therapy with development of remission of insulin dependence is achieved in 76% of patients (non-insulin dependent), whereas only 24% of patients remain insulin dependent. During evolution, ketosis-prone type 2 diabetes exhibit specific beta-cell dysfunction features that distinguish it from type 1 and type 2 diabetes. The clinical course of non-insulin-dependent ketosis-prone type 2 diabetes is characterized by ketotic relapses followed or not by a new remission. Progressive hyperglycemia precedes and is a strong risk factor for ketotic relapses (hazard ratio 38). The probability for non-insulin-dependent ketosis-prone type 2 diabetes to relapse is 90% within 10 years, of whom approximately 50% will become definitively insulin dependent. Insulin sensitivity is decreased in equal proportion in both ketosis-prone type 2 diabetes a 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 >>

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. If you are reading this then you probably have already recognized that you have a problem. You are probably experiencing an unslackable thirst, blurred vision, possibly chills. If you are seeing blood sugar numbers north of 300 then you really need to get medical help. If you are under medical care and have been given medications but still can't get your numbers down. You must drastically reduce your carbohydrates.The very first thing you need to know is that, unless you are extremely lucky, your medical providers will know next to nothing about KPT2 diabetes. In this case, almost everything you will be told to do will be bad for you. I know of no oral diabetes med that will successfully intervene in this situation and they may cause more harm than good. This will especially be the case if you follow the advice of a certified diabetes educator. They will tell you that you must take in at least 100 to 150 grams of carbs a day. You won't be able to do it without insulin and the amount of insulin you'll be taking will be huge and very hard to control. This is because high blood sugars will give you even more high blood sugars. You will be chasing your tail while your blood sugars go higher and higher. Th Continue reading >>

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 >>

Ketosis-prone Diabetes

Ketosis-prone Diabetes

Ketosis-prone diabetes or KPD is an intermediate form of diabetes that has some characteristics of type 1 and some of type 2 diabetes. However, it is distinct from latent autoimmune diabetes , a form of type 1 sometimes referred to as type 1.5. [1] KPD is readily diagnosible because it presents a single characteristic, ketoacidosis, which if present, confirms it as ketosis-prone diabetes. [2] KPD comes in four forms depending upon the presence or absence of -cell autoantibodies (A+ or A) and -cell functional reserve (+ or ). [3] ^ There is clearly a spectrum of clinical phenotypes among patients with islet autoantibodies who do not present with ketosis, including those termed latent autoimmune diabetes in adults (LADA) (30), type 1.5 diabetes (31,32,33), and slowly progressing type 1 diabetes (34). A similar spectrum exists in KPD that includes the very different phenotypes of A+ and A++ KPD. A+ KPD is synonymous with classic, early onset autoimmune type 1 diabetes; A++ KPD may overlap with LADA. However, there are differences between LADA, as recently defined by the Immunology of Diabetes Society, and A++ KPD patients; most importantly, the definition of LADA excludes patients who require insulin within the first 6 months after diagnosis, whereas the majority (90%) of A++ KPD patients present with DKA as the first manifestation of diabetes and therefore require insulin at the start. 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 >>

Ketosis-prone Type 2 Diabetesclinical Presentation

Ketosis-prone Type 2 Diabetesclinical Presentation

Ketosis-Prone Type 2 DiabetesClinical Presentation Author: Richard S Krause, MD; Chief Editor: George T Griffing, MD more... The presentation of DKA does not differ markedly according to the A phenotype. Typical features of polydipsia, polyuria, and fatigue are seen. In patients who already require insulin, the onset of DKA can be rapid when, for example, insulin is abruptly discontinued or a major stressor such as acute myocardial infarction occurs. Patients with previously undiagnosed ketosis-prone type 2 diabetes may have a less abrupt onset of symptoms. Symptoms related to an underlying precipitating event, such as myocardial infarction or infection (eg, pneumonia, urinary tract infection) may be noted. Abdominal pain is also a common complaint associated with DKA, especially in children. The cause of abdominal pain in DKA is not well understood but appears to relate to the severity of the acidosis. Failure of abdominal pain to resolve with treatment of DKA or marked abdominal tenderness should lead to consideration of other causes. Shortness of breath in spite of normal pulse oximetry and clear lungs is common. Physical signs in DKA are associated with the severity of the metabolic derangement and dehydration and may include the following: Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med. Mar 7 2006. 144(5):350-7. [Medline] . Maldonado M, Hampe CS, Gaur LK, et al. Ketosis-prone diabetes: dissection of a heterogeneous syndrome using an immunogenetic and beta-cell functional classification, prospective analysis, and clinical outcomes. J Clin Endocrinol Metab. Nov 2003. 88(11):5090-8. [Medline] . Umpierrez GE, Woo W, Hagopian WA, Isaacs SD, Palmer JP, Gaur LK, et al. Immunogenetic analysis suggests differen Continue reading >>

Ketosis-prone Type 2 Diabetes

Ketosis-prone Type 2 Diabetes

The original schema for classifying diabetes mellitus (DM) consisted of 2 categories known as type 1 diabetes mellitus and type 2 diabetes mellitus . Type 1 diabetes was also known as insulin-dependent diabetes. Patients with this type of diabetes were considered prone to develop diabetic ketoacidosis (DKA) . Patients with type 1 diabetes were found to have an absolute insulin deficiency due to autoimmune destruction of pancreatic beta cells. Patients with type 2 diabetics, or noninsulin-dependent diabetes, were not considered to be at risk for DKA. Type 2 diabetes is strongly associated with obesity and a family history of diabetes. These patients have peripheral insulin resistance with initially normal or elevated circulating levels of endogenous insulin. Since the mid-1990s, the number of patients who presented with DKA but did not require long-term insulin therapy has increased. Many such patients had conditions that resembled traditionally defined type 2 diabetes, in that they were obese and often had a family history of diabetes. Subsequent to these observations, new ways to classify diabetes were devised. The system of classification that most accurately predicts the need for insulin treatment 12 months after presentation with DKA is known as the A system. This system classifies diabetics into 4 groups as follows: A+- - Autoantibodies present, cell function absent A++ - Autoantibodies present, cell function present A-- - Autoantibodies absent, cell function absent A-+ - Autoantibodies absent, cell function present The commonest ketosis-prone diabetes (KPD) subgroup in a longitudinal study was A-+ (54%), followed by A-- (20%) A+- (18%) and A++ (8%). [ 1 ] As noted above, in the A-+ subgroup of patients with KPD cell antibodies are absent and cell function is pres Continue reading >>

Diabetic Ketoacidosis In Type 1 And Type 2 Diabetes Mellitusclinical And Biochemical Differences

Diabetic Ketoacidosis In Type 1 And Type 2 Diabetes Mellitusclinical And Biochemical Differences

Background Diabetic ketoacidosis (DKA), once thought to typify type 1 diabetes mellitus, has been reported to affect individuals with type 2 diabetes mellitus. An analysis and overview of the different clinical and biochemical characteristics of DKA that might be predicted between patients with type 1 and type 2 diabetes is needed. Methods We reviewed 176 admissions of patients with moderate-to-severe DKA. Patients were classified as having type 1 or type 2 diabetes based on treatment history and/or autoantibody status. Groups were compared for differences in symptoms, precipitants, vital statistics, biochemical profiles at presentation, and response to therapy. Results Of 138 patients admitted for moderate-to-severe DKA, 30 had type 2 diabetes. A greater proportion of the type 2 diabetes group was Latino American or African American (P<.001). Thirty-five admissions (19.9%) were for newly diagnosed diabetes. A total of 85% of all admissions involved discontinuation of medication use, 69.2% in the type 2 group. Infections were present in 21.6% of the type 1 and 48.4% of the type 2 diabetes admissions. A total of 21% of patients with type 1 diabetes and 70% with type 2 diabetes had a body mass index greater than 27. Although the type 1 diabetes group was more acidotic (arterial pH, 7.21 ± 0.12 vs 7.27 ± 0.08; P<.001), type 2 diabetes patients required longer treatment periods (36.0 ± 11.6 vs 28.9 ± 8.9 hours, P = .01) to achieve ketone-free urine. Complications from therapy were uncommon. Conclusions A significant proportion of DKA occurs in patients with type 2 diabetes. The time-tested therapy for DKA of intravenous insulin with concomitant glucose as the plasma level decreases, sufficient fluid and electrolyte replacement, and attention to associated problems remai 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 >>

Diabetic Ketoacidosis In African Americans Acts Like Type 1 Diabetes

Diabetic Ketoacidosis In African Americans Acts Like Type 1 Diabetes

In African Americans, men, and other minorities, ketosis-prone diabetes appears more consistent with type 2 diabetes but responds to insulin as if type 1 diabetes. While diabetic ketoacidosis (DKA) appears most often in people with type 1 diabetes, in African Americans, more than 50% of newly diagnosed cases feature metabolic characteristics more closely aligned with type 2 diabetes (T2D), according to a study in Endocrine Practice.1 This subtype of diabetes, ketosis-prone diabetes (KPD), arises in an estimated one-third of African Americans with T2D, in the United States.2 “We don’t know why it is seen particularly in African Americans and males. We also don’t know the antecedent of hyperglycemia in duration and extent that affects hemoglobin A1c (HbA1c), and we don’t know how long these patients have had diabetes before presentation of DKA,” senior author Priyathama Vellanki, MD, assistant professor in the division of endocrinology, metabolism, and lipids at Emory University School of Medicine in Atlanta, Georgia, told EndocrineWeb. Given this, Dr. Vellanki said, “I am now researching the sex differences and genetics that are affecting this presentation.” Clinical Presentation of Diabetic Ketoacidosis Primary ketosis-prone diabetes in patients with T2D may be provoked or unprovoked; and, stressors such as trauma or infection may precipitate the onset of DKA, while the etiology of unprovoked ketosis remains uncertain.3 However, severe hyperglycemia and ketosis are symptoms that appear to reflect unprovoked DKA as a clinical presentation of T2D.3 Characteristics of most patients with KPD include: Obese or overweight Acute, short-term (<4 weeks) hyperglycemic symptom - Polyuria - Polydipsia - Weight loss Highly elevated glucose (>500 mg/dL0 Mean hemoglobin Continue reading >>

Hba1c As A Screening Tool For Ketosis In Patients With Type 2 Diabetes Mellitus

Hba1c As A Screening Tool For Ketosis In Patients With Type 2 Diabetes Mellitus

HbA1c as a Screening tool for Ketosis in Patients with Type 2 Diabetes Mellitus Scientific Reports volume 6, Articlenumber:39687 (2016) Ketosis in patients with type 2 diabetes mellitus (T2DM) is overlooked due to atypical symptoms. The objective of this study is to evaluate the value of hemoglobin A1c (HbA1c) as a screening tool for ketosis in T2DM patients. This retrospective study consisted of 253 T2DM patients with ketosis at Shanghai 10th Peoples Hospital during a period from January 1, 2011 to June 30, 2015. A control group consisted of 221 T2DM patients without ketosis randomly selected from inpatients during the same period. Receiver operating characteristic curve (ROC) analysis was used to examine the sensitivity and specificity of HbA1c as an indicator for ketosis. Higher HbA1c levels were correlated with ketosis. In patients with newly diagnosed T2DM, the area under the curve (AUC) was 0.832, with 95% confidence interval (CI) 0.7540.911. The optimal threshold was 10.1% (87 mmol/mol). In patients with previously diagnosed T2DM, the AUC was 0.811 (95% CI: 0.7670.856), with an optimal threshold of 8.6% (70 mmol/mol). HbA1c is a potential screening tool for ketosis in patients with T2DM. Ketosis is much more likely with HbA1c values at 10.1% in patients with newly diagnosed T2DM and HbA1c values at 8.6% in patients with previously diagnosed T2DM. Ketosis-prone type 2 diabetes is defined as the A-+ ketosis-prone diabetes (KPD) subgroup 1 . This subgroup is a major factor driving the increasing prevalence of KPD 2 , 3 , 4 , 5 , 6 , 7 . The term ketosis-prone type 2 diabetes (T2DM) is often used to describe the A-+ patients who present with new onset diabetes, unprovoked diabetic ketoacidosis (DKA) 8 , 9 and acidosis 10 , 11 , 12 . As a result, the prevalence of ke 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 >>

Ketoacidosis In A Patient With Type 2 Diabetes – Flatbush Diabetes

Ketoacidosis In A Patient With Type 2 Diabetes – Flatbush Diabetes

There is increasing recognition of a group of patients with type 2 diabetes who can present with ketoacidosis. Most reports have been of patients of African descent; however, the condition has been reported in other groups. This is a case of a Caucasian patient who has had three presentations with ketoacidosis and whose diabetes is not usually insulin-dependent. A patient, aged 48 years, presented with diabetic ketoacidosis (DKA) in a semi-comatose condition. She had a 3-day history of vomiting and loss of appetite. In the previous weeks she had undergone radiotherapy for metastatic squamous cell carcinoma (skin primary). The patient had two similar episodes of DKA, one 20 months and another 3 months earlier. Two of the patient’s brothers had type 2 diabetes. The patient was not abusing alcohol and did not have a history of pancreatitis. Three years prior to this admission the patient had been diagnosed elsewhere with type 2 diabetes, for which she had been on metformin and a small dose of insulin glargine. Two months after stopping her insulin glargine she developed her first episode of DKA while visiting our town. DKA, was diagnosed on the basis of arterial pH 7.03, blood glucose level 25.9 mmol/L, bicarbonate level of 5 mmol/L and positive urinary ketones. It was felt that infected skin lesions may have precipitated the DKA. Eleven days later, she was discharged on metformin 250 mg twice daily and a falling dose of insulin glargine (26 units a day). She was then lost to follow-up in our centre, but apparently soon after did not require insulin and maintained adequate gylcaemic control for 18 months until just prior to her next admission solely on metformin 1 g twice daily. The next admission for DKA occurred while living in a city. She was discharged on insulin but Continue reading >>

Diabetes Mellitus, Ketosis-prone

Diabetes Mellitus, Ketosis-prone

OMIM : 53 In addition to classic type 1 (see 222100) and type 2 (see 125853) diabetes mellitus, atypical presentations are seen, particularly in populations of African ancestry. Ketosis-prone diabetes, the most common atypical form, is characterized by an acute initial presentation with severe hyperglycemia and ketosis, as seen in classic type 1 diabetes, but after initiation of insulin therapy, prolonged remission is often possible with cessation of insulin therapy and maintenance of appropriate metabolic control. Metabolic studies show a markedly blunted insulin secretory response to glucose, partially reversible with the improvement of blood glucose control. Variable levels of insulin resistance are observed, especially in obese patients. Pancreatic beta-cell autoimmunity is a rare finding, and association with type 1 susceptibility HLA alleles is variable (Sobngwi et al., 2002). (612227) MalaCards based summary :Diabetes Mellitus, Ketosis-Prone, also known as diabetic ketoacidosis, is related to diabetes mellitus and cerebritis , and has symptoms including diabetes mellitus, insulin resistance and ketoacidosis. An important gene associated with Diabetes Mellitus, Ketosis-Prone is PAX4 (Paired Box 4), and among its related pathways/superpathways are Glucose / Energy Metabolism and Butanoate metabolism . The drugs Metformin and Dipeptidyl-Peptidase IV Inhibitors have been mentioned in the context of this disorder. Related phenotype is growth/size/body region . UniProtKB/Swiss-Prot : 71 Diabetes mellitus, ketosis-prone: An atypical form of diabetes mellitus characterized by an acute initial presentation with severe hyperglycemia and ketosis, as seen in classic type 1 diabetes, but after initiation of insulin therapy, prolonged remission is often possible with cessatio Continue reading >>

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