scholarly journals Diabetic Ketoacidosis as First Presentation of Latent Autoimmune Diabetes in Adult

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Omar Nadhem ◽  
Essam Nakhla ◽  
Roger D. Smalligan
Keyword(s):  
Diabetic Ketoacidosis ◽  
Age Of Onset ◽  
Autoimmune Diabetes ◽  
Case Reports ◽  
White Female ◽  
Acid Decarboxylase ◽  
Insulin Independence ◽  
Adult Age ◽  
Latent Autoimmune Diabetes ◽  
Diabetic Education

A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months. The importance of this case is the unlikely presentation of LADA. We believe that more research is needed to determine the exact proportion of LADA patients who first present with DKA, since similar cases have only been seen in case reports. Adult patients who are obese and have high blood sugar may deserve screening for LADA, especially in the presence of other autoimmune diseases. Those patients once diagnosed with LADA need extensive diabetic education including potentially serious events such as diabetic ketoacidosis.

A Case Report of Latent Autoimmune Diabetes Arising After Isotretinoin Treatment: Real Association or Coincidence? A Hypothesis on Pathophysiology

2021 ◽  
Vol 21 ◽  
Author(s):  
Yusuf Bozkuş
Keyword(s):  
Hba1c Level ◽  
Autoimmune Diabetes ◽  
Case Reports ◽  
Fasting Blood Glucose ◽  
Acid Decarboxylase ◽  
Case Presentation ◽  
Severe Acne ◽  
Latent Autoimmune Diabetes ◽  
The Relationship

Background: Latent autoimmune diabetes in adults (LADA) is the most common form of adult-onset autoimmune diabetes. Isotretinoin is a very effective treatment for severe acne. There are various reports on the effect of isotretinoin on autoimmunity. We present a case of LADA, probably related to isotretinoin treatment. To the best of our knowledge, this case was the second case of LADA that occurred after isotretinoin treatment. In this study, we discuss a hypothesis on the pathophysiology of how isotretinoin can induce LADA. Case Presentation: A 55-year-old female was diagnosed with type 2 diabetes mellitus (T2DM) one month after the end of a nine-month isotretinoin treatment period. At the time of diagnosis, the patient’s fasting blood glucose level was 257 mg/dL, and HbA1c level was 10.3%. After that, she was followed up for T2DM for two years. Since the patient did not comply with classical T2DM characteristics and the C-peptide level was 0.4 ng/ml (0.78-5.18), an autoantibody test was performed. The patient was found positive for anti-glutamic acid decarboxylase antibody (>2000 IU/mL). Her oral antidiabetic drug treatment was discontinued, and insulin degludec and insulin aspart therapy were started. Three months after this adjustment HbA1c level decreased to 7.2%. Except for 25-hydroxycholecalciferol, which was low (10.9 ng/mL), all other laboratory parameters were within the normal range. Conclusion: Isotretinoin is known to have some immunomodulating effects. There are some case reports on the relationship between isotretinoin and autoimmune diseases. The negative immune environment that developed due to the long-standing moderate-severe VitD deficiency may have taken a turn toward autoimmunity upon isotretinoin treatment. This hypothesis on how isotretinoin can cause autoimmune diabetes needs to be validated.

scholarly journals Latent autoimmune diabetes in adults: increased awareness will aid diagnosis

2007 ◽  
Vol 44 (4) ◽  
pp. 321-323 ◽  
Author(s):  
Andrew M Fielding ◽  
Sinead Brophy ◽  
Helen Davies ◽  
Rhys Williams
Keyword(s):  
Insulin Treatment ◽  
Autoimmune Diabetes ◽  
Acid Decarboxylase ◽  
Diabetic Patients ◽  
Pancreatic Β Cell ◽  
Β Cell ◽  
Gad Antibodies ◽  
Adult Age ◽  
Latent Autoimmune Diabetes ◽  
Insulin Dependent

Latent autoimmune diabetes iln adults (LADA) is the term used for patients with non-insulin dependent diabetes who progress to insulin dependency as their pancreatic secretion of insulin fails. Diagnosis is based on adult age at the time of diabetes, the presence of serum autoantibodies to pancreatic antigens and the absence of a requirement for insulin at diagnosis. High titres of serum glutamic acid decarboxylase (GAD) antibodies act as a marker for LADA. Serum C-peptide concentrations are also lower in autoimmune diabetic patients. The best treatment for patients with LADA is not clear, but early insulin treatment may prevent pancreatic β-cell failure.

scholarly journals An Unusual Case of Latent Autoimmune Diabetes in Adult and Pancreatic Neuroendocrine Tumor in a Patient Presenting With Diabetes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A367-A367
Author(s):  
Neelam Baral ◽  
Sriram Gubbi ◽  
Ghadah Al-Naqeeb ◽  
Joseph G Verbalis
Keyword(s):  
Age Of Onset ◽  
Autoimmune Diabetes ◽  
Pancreatic Head ◽  
Whole Body ◽  
Proliferation Index ◽  
Acid Decarboxylase ◽  
Latent Autoimmune Diabetes ◽  
Pancreatic Net ◽  
Well Differentiated ◽  
Grade One

Abstract Introduction: Latent autoimmune diabetes in adults (LADA) and pancreatic neuroendocrine tumors (PNETs) are rare causes of adult-onset diabetes mellitus (DM). The existence of both LADA and a PNET in a single patient has not been previously reported. Clinical Case: A 65-year-old female with history of type 2 DM diagnosed 15 months ago, on metformin 500mg twice a day presented with fatigue, dry mouth, polyuria, and blurry vision for one week and weight loss of 12 pounds over 3 months. Plasma glucose was 599 (nl 65–144 mg/dL) with an elevated anion gap (17; nl 5–15 mmol/L), low bicarbonate (19; nl 21–32 mmol/L) and elevated beta hydroxybutyrate (4.79; nl 0.02–0.27 mmol/L). Diabetic ketoacidosis was diagnosed, and intravenous fluids and insulin were administered. Work up revealed HbA1C of 14% (nl 4.2%-5.6%) which had increased from 7% noted three months ago. glutamic acid decarboxylase antibodies (GAD65 Ab) was >250 (0.0–0.5 IU/mL) and C peptide was 0.42 (0.81–3.85 ng/mL). A computed tomogram of the abdomen performed to evaluate the acute worsening of her HbA1C revealed a 1.4 x 1.3 cm poorly defined hypoenhancing pancreatic head lesion, which on magnetic resonance imaging was 1.6 x 1.2 cm. Further evaluation showed normal levels of glucagon (127; nl <=208 ng/L), somatostatin (26; nl <=30ppg/mL) and vasoactive intestinal peptide (<13; nl 0–60 pg/mL), and an elevated chromogranin A (155; nl 0-95ng/mL). An endoscopic ultrasound guided fine needle aspiration of pancreatic head mass revealed a well differentiated NET with Ki-67 proliferation index of <1%. She underwent pylorus preserving pancreaticoduodenectomy and histopathology showed a 2 cm grade one NET on pancreatic head with no involvement of the 23 tested lymph nodes. Immunohistochemistry was positive for chromogranin and synaptophysin and negative for insulin, somatostatin and gastrin, confirming diagnosis of well-differentiated pancreatic NET Stage Ib (T2N0M0). Whole body PET CT scan done 2 months following surgery did not reveal any focal radiotracer uptake to suggest metastasis. Given the presence of GAD65 Ab, age of onset of DM, and an initial non-requirement of insulin, the patient was diagnosed with LADA and insulin therapy was initiated. Conclusion: We report a unique case of a patient with LADA who was incidentally found to have a non-functioning pancreatic NET. Although functional PNETs such as glucagonoma and somatostatinoma cause hyperglycemia, DM associated with non-functioning NETs is rare, but has been reported with gastrointestinal NETs (1). Our patient likely developed uncontrolled hyperglycemia from LADA but was incidentally found to have a PNET which may have contributed to the worsening of hyperglycemia. This highlights the importance of thorough evaluation for the causes for acute worsening of hyperglycemia.

Type 1 Diabetes-related Autoantibodies in Different Forms of Diabetes

2019 ◽  
Vol 15 (3) ◽  
pp. 199-204 ◽  
Author(s):  
Elin Pettersen Sørgjerd
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Autoimmune Diabetes ◽  
Acid Decarboxylase ◽  
Adult Onset ◽  
Latent Autoimmune Diabetes ◽  
Childhood Type 1 Diabetes ◽  
Childhood Type

Autoantibodies against Glutamic Acid Decarboxylase (GADA), insulinoma antigen-2 (IA- 2A), insulin (IAA) and the most recently Zinc Transporter 8 (ZnT8A) are one of the most reliable biomarkers for autoimmune diabetes in both children and adults. They are today the only biomarkers that can distinguish Latent Autoimmune Diabetes in Adults (LADA) from phenotypically type 2 diabetes. As the frequency of autoantibodies at diagnosis in childhood type 1 diabetes depends on age, GADA is by far the most common in adult onset autoimmune diabetes, especially LADA. Being multiple autoantibody positive have also shown to be more common in childhood diabetes compared to adult onset diabetes, and multiple autoantibody positivity have a high predictive value of childhood type 1 diabetes. Autoantibodies have shown inconsistent results to predict diabetes in adults. Levels of autoantibodies are reported to cause heterogeneity in LADA. Reports indicate that individuals with high levels of autoantibodies have a more type 1 diabetes like phenotype and individuals with low levels of autoantibody positivity have a more type 2 diabetes like phenotype. It is also well known that autoantibody levels can fluctuate and transient autoantibody positivity in adult onset autoimmune diabetes have been reported to affect the phenotype.

CLINICAL AND IMMUNOLOGICAL ASPECTS OF VERIFICATION OF LATENT AUTOIMMUNE DIABETES IN ADULTS AT EARLY STAGES OF DISEASE MANIFESTATION

2021 ◽  
Vol 74 (7) ◽  
pp. 1707-1712
Author(s):  
Tetiana М. Tykhonova ◽  
Igor V. Belozоrov ◽  
Nadiya Ye. Barabash ◽  
Larysa O. Martymianova
Keyword(s):  
Autoimmune Diabetes ◽  
Tyrosine Phosphatase ◽  
Disease Onset ◽  
Acid Decarboxylase ◽  
Excess Body Weight ◽  
Disease Manifestation ◽  
Latent Autoimmune Diabetes ◽  
Immunological Examination ◽  
High Level

The aim: To establish diagnostic markers of LADA at the stage of manifestation based on the analysis of clinical and anamnestic data, the results of immunological examination of patients with different types of DM. Materials and methods: Study included 121 patients with LADA (1st (main) group), 60 patients with type 1 DM (2nd group), 81 patients with type 2 DM (3d group). The examination included analysis of complaints, medical history, determination of anthropometric data, studies of the level of antibodies to glutamic acid decarboxylase (GAD ab), cytoplasmic antigen (ICA ab), tyrosine phosphatase (IA-2 ab). Results: Criteria of LADA diagnosis included slow nature of DM course, the average age of the disease onset (45,02±9,96) years, combination of diabetic complaints with gradual weight loss, frequent detection of DM (64,46%) on request, fairly high level of glycemia at diagnosis ((14,12±4,57) mmol/l)), the possibility of ketonuria episodes in a certain amount (23,14%) of cases in the absence of acute ketoacidotic states. The presence of excess body weight and even obesity is not a criterion for excluding LADA. Conclusions: To verify the diagnosis of LADA it is necessary to study of at least two types of antibodies. The most conclusive is the determination of GAD ab and IA-2 ab.

Sign in / Sign up

Export Citation Format

Share Document