Case Report: Two cases of type 2 diabetes mellitus (among which 1 case of metabolic syndrome) previously taken as type 1 diabetes mellitus in adolescents are presented and the evaluation and management are discussed. There was a family history of Diabetes mellitus in one of the adolescent. Both of them had signs of insulin resistance, they were overweight and obese respectively, poorly controlled on premix insulin. The laboratory test revealed a high HbA1C, dyslipidemia and high blood pressure (in one of them). The fasting C-peptide was within the normal range. The management plan consisted on lifestyle modification and medications made of metformin and intermediate acting insulin at 0.3UI/kg/day. 3 months after starting the treatment, we noticed a decrease of HbA1C, reduction of weight and blood pressure, and the improvement of the blood glucose. From these 2 cases, if they were T1 DM patients despite their weight, we should have expected to have a low fasting C-peptide. Both patients had acanthosis nigricans and metabolic syndrome in one of them but the C-peptide was within the normal range, meaning that their pancreas still secreting insulin, but it doesn't work properly because of resistance.
In conclusion, in the presence of signs of insulin resistance and obesity in a supposed T1DM patient, the fasting C-peptide can be useful to make the diagnosis of T2DM more probable. The management of this condition consists on lifestyle changes and medication (insulin and metformin).
Keywords: Type 1 diabetes mellitus, Type II Diabetes Mellitus, insulin resistance, metabolic syndrome, dyslipidemia, self-monitoring blood glucose, Fasting C-Peptide.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology