A 42-year-old male presented with excessive urination and fatigue over the past 8 months. Laboratory tests showed elevated fasting blood glucose, post-prandial blood glucose, HbA1c, and ketones in the urine. Further testing found low C-peptide levels and positive GAD antibodies, confirming a diagnosis of latent autoimmune diabetes in adults (LADA), a type of diabetes that shares characteristics of both type 1 and type 2 diabetes. LADA is characterized by autoimmune destruction of the pancreatic beta cells and low insulin production in adults, treated primarily with insulin therapy.

1. Case 5 History: 42 yrs male presented with c/o being exhausted for past 8 month, with increased frequency of urine at night. On further inquiring he had intense thirst but no change in appetite. Past History: No major illness in past. Family History: No evidence of family history of Diabetes

2. Personal History: Works as accountant, married with two children, non smoker, does not take alcohol, or any other medicines. O/E: Weight : 88 kg Height: 171 cm BMI : 30.1 kg/m2 Pulse: 80/min Regular BP : 136/84 mm of Hg Obesity CVS/RS/AS/CNS : Normal Peri Pulse: Normal felt Feet / Nails / Sensation : clinically Normal

3. Laboratory Ix: 1. OGTT : with 75 gm glucose FBG : 170 mg/dL, PPBG : 310 mg/dL 2 Urine R/M: Sugar ++, Acetone: +, No proteins 3. Fundoscopy : normal 4. Hba1c: 8.9 %

4. Q: 1. Based on Above History what is Provisional Diagnosis? 1. Type 1 DM 2. Type 2 DM 3. LADA 4. MODY

5. Why LADA : 1. FBG, PP2BG and Hba1c : confirms Diabetes 2. Presence of Ketone's, in urine, favors Type 1 DM 3. No family history also favors Type1 DM 4. But his age favors Type 2 DM So to confirm what is required?

6. Q : 2 To confirm what else is required? 1. GAD 65 2. C peptide 3. Both 1 and 2 4. None of the above.

7. Analysis: His C peptide was less than normal GAD 65 was positive..... Thus confirming Type 1 DM, But his Age and onset (not acute) are against... So diagnosis is .....LADA (Latent Autoimmune Diabetes in Adult)

8. What is normal value of C peptide level? 2 to 4.5 1.2 to 3.4 0.4 to 2.1 Adult 2 to 4.5 1.2 to 3.4 0.4 to 2.2 Child ( < 15 yr) PP 2 Hr level After Glucose load PP 2 Hr level After Meal Fasting level “ C” peptide level : Unit :nano gm/ml