Adult diabetic ketoacidosis and ketosis-prone type 2 diabetes mellitus

Diabetic ketoacidosis (DKA) was regarded as an initial presentation of type 1 diabetes mellitus. However, a subgroup of patients with DKA shows clinical presentation similar to type 2 diabetes. These patients are obese and have strong family history of diabetes. No autoantibodies related to type 1 diabetes mellitus nor common HLA gene change is noted in these patients. They are now known as "Ketosis-prone type 2 diabetes". Acute onset of polydipsia, polyuria, and body weight loss without obvious predisposing factor are typical presentations. During onset of DKA, decreasing secretion of insulin and insulin resistance were noted. β-cell function improves after insulin therapy. Thus, these patients can maintain normo-glycemia without insulin injection after insulin therapy for a few months. The duration can last for weeks to months. Absence of autoantibodies and measurable insulin level can predict the probability of cessation of insulin injection in the future. Although glucose desentization was proposed, the mechanism of the transient dysfunction of β-cell is still unclear.