A 29 year old man from Somalia was transferred to our out-patient clinic from the Department of Infectious Diseases after hyperglycemia and ketosis had unexpectedly been found during a negative tuberculosis work up. His family history was positive in that his mother and two uncles had T2D-like diabetes.
His medications consisted of human insulin isophane 16 + 10 U (thus a daily insulin dose of 26 U [0.42 U/kg b.w.]).
Upon his first visit at our out-patient clinic, physical examination showed a BMI of 21.1 kg/m2 and was otherwise unremarkable. He had a B-HbA1c of 82 mmol/mol (9.9%) and fS-LDL-cholesterol concentration 3.4 mmol/l. He was negative for autoantibodies against GAD-65 and IA-2 and his C-peptide concentration rose from 0.483 to 1.17 nmol/l upon meal stimulation, indicative of non-autoimmune non-insulinopenic diabetes.
All insulin therapy was discontinued and replaced with sitagliptin (100 mg q.d.) and atorvastatin (40 mg q.d.).
Upon revisiting the diabetes nurse 6 months later, his fP-glucose was usually around 5 mmol/l, prandial P-glucose usually below 7 mmol/l, B-HbA1c 44 mmol/mol (6.3%) and fS-LDL-cholesterol was 1.8 mmol/l. The patient was referred to a primary care health center.