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Resident PGY 2
Henry Ford Hospital
Latent Autoimmune Diabetes in Adults (LADA), is considered a rare subset of Type 1 Diabetes Mellitus. These adults do not require insulin at diagnosis but progress to insulin dependence in a short period of time. Because of this the diagnosis is often missed and can result in potentially fatal complications such as Diabetic Ketoacidosis (DKA. Our case highlights one such example with extreme levels of hyperglycemia of 2345mg/dl and its unique therapeutic challenges. A 49-year-old male with a strong family history of diabetes and recent diagnosis of prediabetes in the outpatient setting was found unresponsive at home. He had profound hypothermia 28.4 C, hyperglycemia 2345mg/dl, corrected sodium 182mg/dl and ketoacidosis. Due to altered mental status and seizures he was intubated and fluid resuscitated. Nephrology were consulted due to high risk of cerebral edema with rapid correction, they advised lowering of glucose no more than 50mg/dl/hour. He was started on a customized DKA protocol and his mentation and all laboratory abnormalities improved over a 72 hour period. He was extubated and transferred to the floor. Further workup revealed a C-peptide level of <0.2 ng/ml, GAD antibodies > 120 IU/ml. Patient was diagnosed with Type 1 Diabetes Mellitus (LADA).Type 1 diabetes mellitus is often unrecognized until acute decompensation. This case highlights the importance of remaining vigilant outside of the typical adolescent age group. In addition, it describes complications of extreme hyperglycemia including encephalopathy, hypothermia, seizures, acute kidney injury and its careful management in order to prevent catastrophic fluid shifts.
Sharma, Shivani; Ashraf, Taha; Gandhi, Nitesh; and Cohen, Avi, "LADA presenting as hyperglycemic coma" (2020). Case Reports. 20.