Acute-onset type 1 diabetes mellitus can occur in older patients and may present with life-threatening complications, such as severe diabetic ketoacidosis (DKA) and hypothermia. Traumatic events, such as hemothorax from blunt chest trauma, can precipitate DKA even in patients with previously mild glucose intolerance. Intensive supportive care, including rewarming, insulin infusion, fluid resuscitation, vasopressors, and bicarbonate, can lead to recovery without the need for invasive interventions, such as CHDF or ECLS. Markedly elevated CA19-9 levels in the absence of malignancy may result from non-neoplastic conditions, such as lung injury and hepatic cysts, emphasizing the importance of thorough differential diagnosis. Positive islet autoantibodies and depleted C-peptide levels confirmed the diagnosis of acute-onset type 1 diabetes, reinforcing the need to consider autoimmune diabetes even in older patients with new-onset hyperglycemia.
Kawashima et al. (Thu,) studied this question.