Spontaneous and long‐term resolution of diabetes following diabetic ketoacidosis: a rare entity?

Diabetic ketoacidosis is usually characterised by absolute insulin deficiency with an essential requirement for life‐long insulin therapy. We report a case of a 40‐year‐old Ghanaian man, who presented with classical diabetic ketoacidosis, in the absence of any previous history of diabetes or intercurrent illness. After conventional treatment with insulin for one year, he submitted himself to a course of treatment with Chinese herbal medicines and accupressure. Over the following year he became normoglycaemic without the need for exogenous insulin therapy demonstrating the unusual feature of resolution of type 1 diabetes. Spontaneous resolution of hyperglycaemia following diabetic ketoacidosis challenges the traditional understanding of the pathogenesis of this condition, which is usually attributed to non‐reversible insulin deficiency. Newly diagnosed patients presenting with diabetic ketoacidosis may have ‘atypical’ diabetes, rather than life‐long insulin deficiency due to autoimmune type 1 diabetes. Literature review suggests that atypical (idiopathic or J‐type), diabetes is probably more common than is appreciated. Copyright © 2002 John Wiley & Sons, Ltd.