20/02/2026
Type 1 or Type 2? Look Beyond Labels—
I feel satisfied to share with you one case under unit 2 in MGM..
A 13-year-old pubertal girl presented after struggling with poor glycemic control at couple of outside hospitals, where she received high-dose basal-bolus insulin therapy (total daily dose exceeding age-appropriate requirements) without adequate response....relatives were very frustrated with poor glycemic control with trial and error of different insulin régime....
Her fasting blood glucose remained elevated at 200 mg/dL, with hyperinsulinemia (fasting insulin 43 µU/mL) yielding a HOMA-IR index of 21.23—indicative of severe insulin resistance. HbA1c was 6.8%, reflecting average glycemia but underscoring postprandial excursions typical of insulin-resistant states.i advised C Peptide and GAD ANTIBODY.. But relatives were exhausted with finances..
Key features argued strongly against type 1 diabetes mellitus: absence of diabetic ketoacidosis (DKA) or ketosis at presentation, no acidosis, marked hyperinsulinemia with preserved beta-cell function (high HOMA-IR), and pubertal insulin resistance.. Also patient severe acanthosis skin markers showing insulin resistance..
These aligned with type 2 diabetes mellitus (T2DM), increasingly prevalent in adolescents amid rising obesity.
Tablet metformin was introduced at 500 mg twice daily..
Within week, her blood glucose levels stabilized impressively—fasting and pre-meal readings normalized without hypoglycemia—demonstrating rapid response to insulin sensitization.This case exemplifies the value of recognizing insulin resistance in hyperglycemic adolescents, differentiating T2DM from type 1 through clinical surrogates and targeted therapy, and achieving glycemic remission with early metformin...
Pt got discharged happily yesterday..
Thank you for support Dr Madhuri mam,
Dr Avinash sir, Dr Jahanzeb..Dr Imtiyaz, Dr rabiya for timely management.🙏🙏.
Dr Kiran Kudlikar,Consultant Pediatric endocrinologist, MGM Hospital, Chatrapati Sambhajinagar. (Maharashtra )
