1. A case of type 1.5 diabetes mellitus or LATENT AUTOIMMUNE DIABETES IN ADULT
3RD MEDICAL UNIT
CHIEF PROF Dr. M. NATARAJAN MD
ASST Dr. SYED BAHAVUDEEN HUSSAINI MD DNB
ASST Dr. VALLIDEVI MD
ASST Dr.SHANMUGANATHAN MD
Presentor- YAGNESHWARARAJA

2. A 30 years old female came with presenting C/O
polyuria for 2months
polydypsia for 2months

3. History Of Presenting Illness
H/O Polyuria for 2months- >4litres /day.
H/O Polydypsia for 2months
H/O weight loss around 3-4 kgs
No H/O Burning Micturition
No H/O Polyphagia
No H/O Fever
No h/o abdominal pain
No h/o genital itching

4. No H/O Chestpain/ Palpitation/ Breathlessness
No H/O Cough with expectoration
No H/O Blurring of vision
No H/O Drug intake
No H/O Trauma to head

5. PAST HISTORY FAMILY HISTORY no family h/o diabetes mellitus .
Not a known case of DM/SHTN
No H/O PTB/CAD/Thyroid disease/Seizures.
FAMILY HISTORY
no family h/o diabetes mellitus .
PERSONAL HISTORY
Mixed diet
Normal bowel habbits.

6. MENSTRUAL HISTORY
Unmarried
Regular cycles 3/30
LMP- 30/06/2017

7. GENERAL EXAMINATION Consious, Oriented, Afebrile, No Pallor,
No Icterus,
No Cyanosis,
No Pedal Edema,
No Generalized lymphadenopathy

8. Markers of insulin resistance like
acanthosis nigricans,
skin tags
are absent
Her BMI is 23.16(Wt-60 kgs,Ht-161 cms)
normal body mass index
stigmata for autoimmune illness such as
vitilligo,goitre,arthralgia are ABSENT

9. VITALS PULSE RATE -82/min Regular BLOOD PRESSURE - 120/70mm Hg
RESPIRATORY RATE - 18/min
SpO % at room air

10. SYSTEMIC EXAMINATION CVS –S1 S2 +, no murmur, RS-BAE +,
no added sounds,
P/A-SOFT,
no organomegaly,
CNS-NO FND,
FUNDUS-normal,no e/o diabetic retinopathy or optic atrophy.

11. INVESTIGATION Hb- 13.3gms/dl RBC- 5.13 million/cu.mm. TC- 8300
DC- Neutrophils- 62.1%, Lymphocytes-31.6%,
Eosinophil-2.2%, Monocytes-3.7%,
Basophil -0.4%
ESR(Auto)- 30mm/hr.

12. PCV- 42.9%
MCV- 83.7
MCH – 25.9
MCHC-30.9
PLATELET COUNT- 2,49,000 cells/cumm.
RDW- 14.7
ABSOLUTE EOSINOPHIL COUNT- 200
RETICULOCYTE COUNT- 0.70

13. RBS- 530 mg/dl
FBS- 234 mgs/dl
PPBS- 427mgs/dl
UREA- 17 mgs/dl
CREATININE- 0.86mgs/dl

14. FASTING LIPID PROFILE:
Total Cholestrol- 196mg/dl
HDL mg/dl
LDL mg/dl
VLDL mg/dl
TGL mg/dl

15. Sr. Uric acid – 2.9 mg/dl
THYROID PROFILE : FT ng/dl( )
TSH- 1.81mIU/L( )
HbA1C %
Sr. FASTING C-PEPTIDE- 0.67ng/ml (ref range ng/ml)-after achieving glycaemic control.

16. URINE
ALBUMIN- NIL
GLUCOSE(F)- ++
DEPOSIT Occasional pus cells/hpf.
Epi cells +
No RBC/CAST/CRYSTALS.
ACETONE - positive

17. USG- ABD AND PELVIS UTERUS- Normal size, Anteverted Normal Endometrial thickness. LT OVARY- Dominant Follicle RT OVARY- Small Cystic lesion(1.6*1.4*2cm) with dense echogenic content suggestive of early dermoid. Fluid filled segment of Ascending colon and Caecum upto Hepatic Flexure- Non specific segmental colitis.

18. LIVER/GB/PANCREAS/KIDNEYS/SPLEEN/BL ADDER- NORMAL
No E/O Free fluid in peritoneum
Rpt USG after 1month to reassess size and morphology of cyst.

19. IMMUNOLOGY SERUM ANTI GAD ANTIBODIES 106.3 IU/ml.(Increased)
(<30: neg, >30: pos)
This assay is a tool in the diagnosis of type 1
DM.

20. TREATMENT She was started on insulin infusion.
Responded well, controlled sugar levels.
Now converted into subcutaneous insulin.
Sugar levels are under control.

21. DISCUSSION WITH DIABETOLOGIST
To differentiate LADA and DIDMOAD it will be useful to
1)assess urine specific gravity,urine osmolality after achieving glycaemic control
2)audiometry-if required
Fasting C-peptide-can be correlated with corresponding FBS
Subclinical preceding viral infection could have been initiated the process

22. SUMMARY
30 yrs old female patient )with h/o polyuria,polydypsia weight loss, )with negative family h/o, )normal BMI, )without any markers for insulin resistance or autoimmune illness, NO e/o diabetic retinopathy or optic atrophy
5)with elevated sugar values,high Hb A1c
6)low fasting C-peptide levels
7)acetone positive
8)anti GAD positivity,responded well to insulin infusion,now on subcutaneous insulin

23. AIM OF PRESENTATION Approach towards diabetes mellitus in third decade
TYPE 1 DM
TYPE 1.5 DM
MODY
TYPE 2 DM