Case history
Case history
A 12-year-old white girl is brought to the emergency department by her parents due to 12 hours of rapidly worsening nausea, vomiting, abdominal pain, and lethargy. Over the last week she has felt excessively thirsty and has been urinating a lot. Physical examination reveals a lean, dehydrated girl with deep rapid respirations, tachycardia, and no response to verbal commands.
Other presentations
The rate of beta-cell destruction varies in type 1 diabetes. In some patients, there may be a slow destruction leading to gradual onset of symptoms that is clinically indistinguishable from type 2 diabetes. When the initial presentation of type 1 diabetes occurs in adulthood, some refer to it as latent autoimmune diabetes in adults (LADA). It is useful to distinguish LADA from type 2 diabetes, because patients with LADA usually require insulin therapy. Features that suggest the presence of LADA rather than type 2 diabetes include: age of onset less than 35 years, acute symptoms of polydipsia, polyuria, and/or ketosis at the time of diagnosis and/or unintentional weight loss before diagnosis, body mass index less than 25 kg/m², and personal or family history of autoimmune disease.[5][6] However, due to the broad heterogeneity of LADA, measurement of islet cell antibodies remains essential in order to decrease the number of misdiagnoses of diabetes.[7]
Adults ages 60 years and over presenting with weight loss and new-onset diabetes should be assessed for pancreatic cancer.[8] See Pancreatic cancer.
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