How could atypical diabetes mellitus be wrongly diagnosed as type 1 diabetes when the patient presents with diabetic ketoacidosis at the emergency department of the hospital?

Until recently, the development of diabetic ketoacidosis was equivalent to having type 1 diabetes. Diabetic ketoacidosis represents the most serious acute decompensation of blood sugar control there is. However, there are now patients that present with diabetic ketoacidosis who, later, clearly do not need insulin to maintain normal blood sugars. This form of diabetes has been more common in certain ethnic groups in the United States. I am not sure if this form of diabetes is also common in Malaysia. When diabetic ketoacidosis occurs, it usually represents an inability to make enough insulin in the pancreas. However, recent descriptions of atypical diabetes have shown that patients present with diabetic ketoacidosis, are treated in the hospital, released, and when they are studied, show that they have insulin secretion and can be subsequently treated with oral agents. What this means for physicians and patients is that it is important to treat with insulin up front after the diabetic ketoacidosis, but then when sugars are improved, retest to see how much insulin secretion is present before making a long-term assessment. The insulin treatment is still good. It may even protect the insulin-producing cells. There is no clear determination as to whether insulin might even be superior in these patients. The practical issue that they don’t need the insulin is what concerns most people.

JTL