Low hemoglobin A1c levels in a patient with diabetic ketoacidosis: Fulminant type 1 diabetes mellitus

Fulminant type 1 diabetes mellitus (FT1DM) is a clinical condition that ischaracterized by remarkably rapid and complete pancreatic β-cell destruction,rapid onset of hyperglycemic symptoms followed by ketoacidosis. In mostcases this process takes a few days. Although rare, there have been clinicalmanifestations with a prolonged progress that lasts longer than one week.This study focused on the case of a 35-monthold boy who was referred toour clinic with the diagnosis of diabetic ketoacidosis, and later had a modestelevation in hemoglobin A1c (HbA1c) levels (6.7 %) incompatible with hissignificantly elevated blood glucose levels. The autoantibodies against pancreaticβ-cells were negative. On the basis of these above mentioned findings, ourpatient was then diagnosed with fulminant type 1 diabetes mellitus.If patients with diabetic ketoacidosis have no elevation in HbA1c levels,they should be assessed for possible clinical factors that can lead to lowerdetectable levels of HbA1c. Furthermore, FT1DM which is characterizedby very rapid and potentially fatal progression should be considered as adifferential diagnosis in these patients.

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