Case 5 History: 42 yrs male presented with c/o being exhausted for past 8 month, with increased frequency of urine at night. On further inquiring he had intense thirst but no change in appetite. Past History: No major illness in past. Family History: No evidence of family history of Diabetes
Personal History: Works as accountant, married with two children, non smoker, does not take alcohol, or any other medicines. O/E: Weight : 88 kg Height: 171 cm BMI : 30.1 kg/m2 Pulse: 80/min Regular BP : 136/84 mm of Hg Obesity CVS/RS/AS/CNS : Normal Peri Pulse: Normal felt Feet / Nails / Sensation : clinically Normal
Q: 1. Based on Above History what is Provisional Diagnosis? 1. Type 1 DM 2. Type 2 DM 3. LADA 4. MODY
Why LADA : 1. FBG, PP2BG and Hba1c : confirms Diabetes 2. Presence of Ketone's, in urine, favors Type 1 DM 3. No family history also favors Type1 DM 4. But his age favors Type 2 DM So to confirm what is required?
Q : 2 To confirm what else is required? 1. GAD 65 2. C peptide 3. Both 1 and 2 4. None of the above.
Analysis: His C peptide was less than normal GAD 65 was positive..... Thus confirming Type 1 DM, But his Age and onset (not acute) are against... So diagnosis is .....LADA (Latent Autoimmune Diabetes in Adult)
What is normal value of C peptide level? 2 to 4.5 1.2 to 3.4 0.4 to 2.1 Adult 2 to 4.5 1.2 to 3.4 0.4 to 2.2 Child ( < 15 yr) PP 2 Hr level After Glucose load PP 2 Hr level After Meal Fasting level “ C” peptide level : Unit :nano gm/ml
<ul><li>LADA take home message: </li></ul><ul><li>Suspect LADA in any adult patient of DM with ketosis </li></ul><ul><li>LADA is ketosis prone </li></ul><ul><li>LADA shows autoimmune destruction of B cells of Pancreas </li></ul><ul><li>LADA is differs Type 2 DM by low “C” peptide and positive for auto antibody. </li></ul><ul><li>Insulin is the treatment of choice as in Type 1 DM </li></ul>