Fulminating Onset Type 1 Diabetes with Positivity for Anti-GAD Antibody and Elevated Pancreatic Exocrine Enzyme Concentrations

A 52-year-old man was admitted to our hospital for diabetic ketoacidosis. On admission, Hb(A1c) was 6.5%, anti-GAD antibody 10.3 U/ml, serum amylase 144 IU/l, lipase 169 U/l and elastase-I 1,000 ng/dl. There were no abdominal symptoms, and abdominal CT showed unremarkable findings. He was treated with intensive insulin therapy. After 1 month, urinary excretion of C-peptide was 3.8 microg/day. Serum pancreatic exocrine enzyme concentrations returned to normal after 3 months. After 10 months, anti-GAD antibody had become negative, but insulin therapy was still needed for glycemic control. This report concerns a case of autoimmune fulminating onset type 1 diabetes.