lesson of the month (1)

摘要

A 38-year-old man of Malaysian origin presented via an urgent referral to the diabetes clinic with a short history of fatigue, weight loss of 20 kg, polyuria and polydipsia. A random plasma glucose was 28 mmol/1 and he had ketonuria. He was commenced immediately on insulin and his symptoms rapidly improved. Four months later, however, he presented to the emergency department with four weeks of worsening dizziness, fatigue, anorexia, weight loss, polyuria and polydipsia. He had no other past medical history of note. He had returned to the UK recently to seek a medical diagnosis after living in the Czech Republic for six years.On examination he was cachectic (weight 41 kg, body mass index 18 kg/m2), pulse rate 110 bpm regular, blood pressure 110/60 mmHg lying and 70/30 mmHg standing. Further car-diorespiratory, abdominal and neurological examination was normal, with no signs of peripheral sensorimotor neuropathy or diabetic microangiopathy.