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Why Are Type 1 Diabetics Prone To Ketosis?

Omim Entry - # 612227 - Diabetes Mellitus, Ketosis-prone; Kpd

Omim Entry - # 612227 - Diabetes Mellitus, Ketosis-prone; Kpd

A number sign (#) is used with this entry because of evidence that susceptibility to ketosis-prone diabetes mellitus is conferred by homozygous mutation in the PAX4 gene ( 167413 ) on chromosome 7q32. One patient has been found to be heterozygous for mutation in PAX4. 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 ). Maldonado et al. (2003) studied 103 patients with diabetic ketoacidosis (DKA), classifying them into 4 groups according to the presence or absence of autoimmune markers for type 1 diabetes (A+ or A-) and the presence or absence of beta-cell functional reserve (beta+ or beta-). There were 18 patients in the A+beta- group, 23 in the A-beta- group, 11 in the A+beta+ group, and 51 in the A-beta+ group. Collectively, the 2 beta- groups differed from the 2 beta+ groups in earlier onset and longer duration of diabetes, lower body mass index (BMI), less glycemic improvement, and persistent insulin requirement. HLA class II genotyping showed 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 >>

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 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 >>

66 Ketosis-prone Type 2 Diabetes Mellitus. | Journal Of Investigative Medicine

66 Ketosis-prone Type 2 Diabetes Mellitus. | Journal Of Investigative Medicine

66 KETOSIS-PRONE TYPE 2 DIABETES MELLITUS. Southern Abstracts: Endocrinology and Metabolism Joint Poster Session 5:00 PM: Friday, March 3, 2006 66 KETOSIS-PRONE TYPE 2 DIABETES MELLITUS. Emory University School of Medicine, Atlanta, GA Many newly diagnosed African Americans with diabetic ketoacidosis (DKA) display clinical, metabolic, and immunological features of type 2 diabetes during follow-up. Their initial presentation is acute and without precipitating cause. Most patients are able to discontinue insulin therapy within a few weeks/months of follow-up. This clinical presentation is common, affecting 20-50% of newly diagnosed black and Hispanic patients with DKA. This subtype of diabetes is referred to as diabetes type 1B, idiopathic type 1 diabetes, atypical diabetes, Flatbush diabetes, type 1.5 diabetes, and, more recently, ketosis-prone type 2 diabetes (KPDM). We reviewed current knowledge regarding the clinical presentation, metabolic, and immunologic features of subjects with this "atypical " form of diabetes. We performed a computerized search of biomedical journal literature from Medline, PubMed, and Ovid from 1/1966 to 10/2005. English-language original articles found under the subject headings "ketosis-prone type 2 diabetes " and "atypical diabetes " were reviewed. In this analysis we included 484 cases (429 blacks, 39 Hispanics, 8 Asians, 8 Caucasians) from 7 series reported from America, Europe, Africa, and Asia. Clinical characteristic include a mean age of 40 6 3 years, male gender 67% 6 9, new-onset diabetes: 83%, % family history: 80 6 5, % positive antibodies: 7.1 6 7, % patients who attained remission: 59 6 15, A1C at presentation: 13.2 6 0.6%, and A1C at remission: 7.0 6 1.2%. At presentation, they have markedly impaired insulin secretion and insu Continue reading >>

Diabetic Ketoacidosis: Not Always Due To Type 1 Diabetes

Diabetic Ketoacidosis: Not Always Due To Type 1 Diabetes

Diabetic ketoacidosis: not always due to type 1 diabetes Diabetic ketoacidosis: not always due to type 1 diabetes BMJ 2013; 346 doi: (Published 10 June 2013) Cite this as: BMJ 2013;346:f3501 S Misra, specialty registrar metabolic medicine 1 , 1Department of Metabolic Medicine and Clinical Biochemistry, Imperial Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK 2Department of Diabetes and Endocrinology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK Correspondence to: S Misra smisra{at}imperial.ac.uk This article discusses how to diagnose and manage patients with ketosis prone type 2 diabetes Patients presenting with diabetic ketoacidosis may have type 1 or type 2 diabetes Diabetic ketoacidosis should be treated with insulin in accordance with nationally agreed guidance After treatment of diabetic ketoacidosis, patients found to have type 2 diabetes may not require lifelong insulin treatment Consider ketosis prone type 2 diabetes in older, overweight, non-white patients who present with diabetic ketoacidosis at their first presentation of diabetes; this diagnosis is also a possibility in patients with any features that are atypical for type 1 diabetes Discharge all patients on insulin and arrange for specialist follow-up Under specialist supervision consider whether insulin can be down-titrated on the basis of clinical progress and, where possible, C peptide and antibody measurements Diabetic ketoacidosis (DKA) is not just the hallmark of absolute insulin deficiency in type 1 diabetesit is increasingly being seen in people presenting with type 2 diabetes. 1 2 This is at odds with traditional physiological teachingthat clinically significant ketosis does not occur in the presence of insulin concentrations associated with type 2 diabetes b Continue reading >>

Ketosis

Ketosis

Tweet Ketosis is a state the body may find itself in either as a result of raised blood glucose levels or as a part of low carb dieting. Low levels of ketosis is perfectly normal. However, high levels of ketosis in the short term can be serious and the long term effects of regular moderate ketosis are only partially known at the moment. What is ketosis? Ketosis is a state the body goes into if it needs to break down body fat for energy. The state is marked by raised levels of ketones in the blood which can be used by the body as fuel. Ketones which are not used for fuel are excreted out of the body via the kidneys and the urine. Is ketosis the same as ketoacidosis? There is often confusion as to the difference between ketosis and ketoacidosis. Ketosis is the state whereby the body is producing ketones. In ketosis, the level of ketones in the blood can be anything between normal to very high. Diabetic ketoacidosis, also known as DKA, only describes the state in which the level of ketones is either high or very high. In ketoacidosis, the amount of ketones in the blood is sufficient to turn the blood acidic, which is a dangerous medical state. When does ketosis occur? Ketosis will take place when the body needs energy and there is not sufficient glucose available for the body. This can typically happen when the body is lacking insulin and blood glucose levels become high. Other causes can be the result of being on a low carb diet. A low level of carbohydrate will lead to low levels of insulin, and therefore the body will produce ketones which do not rely on insulin to get into and fuel the body’s cells. A further cause of ketosis, less relevant to people with diabetes, is a result of excessive alcohol consumption. Is ketosis dangerous? The NHS describes ketosis as a pote 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 >>

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 >>

The Ketogenic Diet And Type 1 Diabetes

The Ketogenic Diet And Type 1 Diabetes

What is type 1 diabetes? How is it different than type 2? Type 2 diabetes is a condition where the body becomes resistant to insulin, forcing the pancreas to produce ever more insulin, and leading to a downward spiral of metabolic illness. It’s also called “Adult Onset Diabetes”, because the vast majority of people who develop it do so in adulthood, after years of eating a high-carb diet. Type 1 diabetes, also known as “Juvenile Diabetes”, is a disorder where the body’s immune system attacks the cells of the pancreas responsible for producing insulin. Only the pancreas can produce insulin, and insulin is the hormone primarily responsible for shuttling molecules out of the blood and into cells for energy or storage. That means, if the pancreas isn’t producing insulin, a person will starve to death from the inside. Their cells, literally, cannot get any food. They can eat and eat and eat, but there’s no mechanism to transport that food energy into the cells. That’s why they need regular insulin shots. On a regular-carb diet, those insulin shots might be several times per day. On a high-carb diet, those shots will be even more frequent. Type 1 diabetics must keep injecting themselves with insulin in order to deal with all the glucose in their blood stream. They have to keep insulin levels high, if they eat high carbs, because they have a high level of glucose to deal with. Being ketogenic means insulin levels don’t have to be high, because there isn’t a high level of glucose that needs to be shuttled around. And, because there isn’t a big requirement for insulin, the type 1 diabetic can reduce the amount of insulin needed on a daily basis (many reduce this requirement by 80%). The important thing to remember is that someone suffering from type 1 dia 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 >>

Ketosis-prone Diabetes

Ketosis-prone Diabetes

Does presenting with diabetic ketoacidosis (DKA) mandate indefinite insulin treatment? Not always. Since the mid-1990s, weve increasingly observed and recognized patients that dont neatly fit into either type 1 diabetes (T1DM) or T2DM. Ketosis-prone type 2 diabetes mellitus (KPDM) is underrecognized and distinctive. First described by Winter and colleagues in 1987, 12 African-American patients initially presented with DKA, but their disease course unfolded more like that of an individual with T2DM.1 KPDM was initially thought to be a variant of maturity onset diabetes of the young (MODY). Other names include Flatbush diabetes (named for the part of Brooklyn, NY where young African-Americans were described to have these clinical features of KPDM), type 1.5 diabetes, and atypical diabetes. 1. A large number of KPDM patients present without a previous diagnosis of DM and without a known precipitating cause for the DKA. >75% of KPDM patients fit this description. Most patients are African-American or Hispanic, overweight or obese, male (theres a two- to three-fold greater prevalence in men compared with women), in their 40s or 50s at the time of diagnosis. 2. If the patients insulin requirements rapidly decline in the first several weeks after presenting, think of possible KPDM. i. Patients test pre-meal glucose at least 2 times/day, and check in with their health care professional team every 2 weeks for the first 2 months after being discharged from the hospital to titrate insulin, and subsequently every 2 or 3 months, as extent of control warrants. ii.Clinicians begin tapering insulin by 25% at each visit, once fasting glucose declines below 130 mg/dL for 2 weeks, or if the patient develops hypoglycemia. 3. Many patients with KPDM will spontaneously remit. Most patients Continue reading >>

Ketosis-onset Diabetes And Ketosis-prone Diabetes: Same Or Not?

Ketosis-onset Diabetes And Ketosis-prone Diabetes: Same Or Not?

Ketosis-Onset Diabetes and Ketosis-Prone Diabetes: Same or Not? Endocrinology and Metabolism Department of the Second Hospital Affiliated to Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang Province 150086, China Received 1 March 2013; Revised 3 April 2013; Accepted 3 April 2013 Copyright 2013 Beiyan Liu et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To compare clinical characteristics, immunological markers, and -cell functions of 4 subgroups (A classification system) of ketosis-onset diabetes and ketosis prone diabetes patients without known diabetes, presenting with ketosis or diabetic ketoacidosis (DKA) and admitted to our department from March 2011 to December 2011 in China, with 50 healthy persons as control group. Results. -cell functional reserve was preserved in 63.52% of patients. In almost each subgroup (except A subgroup of ketosis prone group), male patients were more than female ones. The age of the majority of patients in ketosis prone group was older than that of ketosis-onset group, except A subgroup of ketosis prone group. The durations from the patient first time ketosis or DKA onset to admitting to the hospital have significant difference, which were much longer for the ketosis prone group except the A+ + subgroup. BMI has no significant difference among subgroups. FPG of ketosis prone group was lower than that of A + subgroup and A+ + subgroup in ketosis-onset group. A subgroup and A+ + subgroup of ketosis prone group have lower HbA1c than ketosis-onset group. Conclusions. Ketosis-onset diabetes and ketosis prone diabetes do not absolutely 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 >>

Ketosis Prone Type 2 Diabetes - General Practice Notebook

Ketosis Prone Type 2 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 >>

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