Abstract

A CASE SERIES ON THE MANAGEMENT OF FLATBUSH DIABETES IN A 1000 BEDDED TERTIARY CARE TEACHING HOSPITAL

Swathi Krishna K.*, Asifa Shaz A., Aparna Priya M., Ravina R. V. and Srinithi S.

Abstract

Background: Ketosis-prone diabetes or Flatbush diabetes is a widely recognized clinical entity which has become relatively common in sub-Saharan Africans, Asian and Indian populations, and Hispanic populations. Flatbush diabetes most commonly commences during middle age with no known precipitating cause. The condition is in contrast to type 1 and type 2 diabetes where the patients are insulin independent, do not have autoantibodies, and have well-functioning beta cells as evidenced by C-peptide levels. Patients initially exhibit severe hyperglycemia requiring insulin therapy along with oral hypoglycaemic agents which gets transitioned to dietary management or diet plus oral medication gradually with time. It is described as type 1.5 diabetes because patients lack auto-antibodies such as GAD, IAA, IA2 etc and have well preserved β –cell functioning. The mechanisms responsible for the development of flatbush diabetes as well its remission with time remains unknown. The study aims to emphasize the clinical presentation and importance of management of Flatbush diabetes in Indian population. Case presentation: A 59 year old female admitted with complaints of involuntary movements of right upper limb and lower limb with non-ketotic hyperglycemia associated with hemichorea with HbA₁c >18.5%. The patient was initially managed with IV fluids and insulin therapy followed by normoglycemia managed with lifestyle and healthy dietary management. A similar case was reported by a male patient of age 90 years hospital with the complaints of chest pain, breathing difficulty and vomiting. The patient also received basal bolus insulin therapy along with IV fluids with dose titrations in accordance to the blood glucose levels monitored. The patient was put off the insulin therapy/ antidiabetic agents following normoglycemia. The above two patients were advised to continue the same healthy lifestyle and dietary habits without the requirement of antidiabetic agents. Conclusion: The above case study reports provides an insight to the clinicians to predict which patients with diabetes require temporary insulin treatment versus life-long insulin therapy.

Keywords: Flatbush diabetes, ketosis, hyperglycemia, management.