A 12-year-old white girl is brought to the emergency department by her parents due to 12 hours of rapidly worsening nausea, vomiting, abdominal pain, and lethargy. Over the last week she has felt excessively thirsty and has been urinating a lot. Physical examination reveals a lean, dehydrated girl with deep rapid respirations, tachycardia, and no response to verbal commands.
The rate of beta-cell destruction varies in type 1 diabetes. In some patients, there may be a slow destruction leading to gradual onset of symptoms that is clinically indistinguishable from type 2 diabetes. There is also a slow-progressing form of autoimmune diabetes known as latent autoimmune diabetes in adults (LADA). The patient with LADA may not require insulin treatment for some years and it can therefore be mistaken for type 2 diabetes in the early stages. Based on results from a retrospective study, features that suggest the presence of LADA rather than type 2 diabetes include two or more of the following: age of onset <50 years, acute symptoms of polydipsia and/or polyuria and/or unintentional weight loss before diagnosis, body mass index less than 25 kg/m², and personal or family history of autoimmune disease.
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