75NEVER TOO LATE FOR DIABETIC KETOACIDOSIS (DKA)

Abstract

Background: An extensive review of the literature yielded limited reports of new onset Type 1 diabetes in elderly patients. We present one such case in a 77-year-old female. Case history: A 77-year-old Caucasian female presented with acute delirium. History from husband revealed that the patient had been lethargic for 2 weeks, had developed polydipsia and polyuria over 2 days and became drowsy on the day of admission. There was no history of significant comorbidities and no regular medications. Patient did not drink alcohol but had been a heavy smoker. On examination, the patient was confused, dehydrated and in hypovolemic shock. The rest of the examination was unremarkable with no signs of sepsis. Investigations revealed blood glucose of 47.7mmol/l, pH 6.98, pCO2 2.4kpa, HCO3 4.7mmol/l, base excess of -27mmol/l, blood ketones 10.5mmol/l and serum osmolality 373mmol/kg. The patient was diagnosed with diabetic ketoacidosis (DKA) and treatment was started without delay. She improved clinically and insulin was stopped, but the patient reverted back to DKA. She was then commenced on a twice daily insulin regime. Further investigation revealed anti-glutamic acid decarboxylase antibodies of>2,000U/ml. Discussion: New onset diabetes in the elderly is usually classified as Type 2 diabetes. However, this patient with ketoacidosis, insulin dependence and antibody positivity makes Type 1 diabetes more likely. The differential diagnosis includes latent autoimmune diabetes in adults. This is unlikely in view of the rapid progression to insulin dependence. Conclusion: Clinicians should be aware of the possibility of late-onset Type 1 diabetes in elderly patients.