Article Text


Failure to develop diabetic ketoacidosis in a newly presenting type 1 diabetic patient

Statistics from

Q1: What test may be used to confirm a diagnosis of type 1 (as opposed to type 2) diabetes mellitus?

The intravenous glucagon stimulated C-terminal peptide test is considered the gold standard in confirming that a patient has type 1 (insulin dependent) diabetes mellitus. The insulin precursor proinsulin is released from the pancreas and then broken down into insulin and C-peptide. One milligram of glucagon is given intravenously, the subsequent rise in blood glucose stimulates the pancreas to release proinsulin, and thus pancreatic reserve can be measured by assaying C-peptide levels. In this patient type 1 diabetes was confirmed by a maximal response of 127 pmol/l at five minutes (adequate insulin reserve: >500 pmol/l, borderline insulin reserve: 200–500 pmol/l).

Q2: Given this patient's history before this admission; what other condition are the urea and electrolytes results in box 1 (see p 734) consistent with and how is the diagnosis confirmed?

Addison's disease is a deficiency in both glucocorticoids and mineralcorticoids. Glucocorticoid deficiency may lead to hypoglycaemia, while mineralcorticoid deficiency leads to …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.