Synopsis
Recognise adult autoimmune diabetes and ketosis-prone phenotypes, treat acute insulin deficiency safely, and revisit long-term classification using antibodies and beta-cell reserve.
- Latent autoimmune diabetes in adults describes slower autoimmune beta-cell loss that initially resembles type 2 diabetes but progresses towards insulin dependence.
- GAD antibodies are commonly detected; local panels may include IA-2 or ZnT8, and testing is most informative close to diagnosis when clinical classification is uncertain.
- Rapid deterioration, catabolic weight loss, ketosis, personal autoimmunity or failure of non-insulin therapy should prompt reassessment for autoimmune diabetes.
Investigation priorities
Identify autoimmune beta-cell disease in an adult whose diabetes type is uncertain.
Management branches
An adult with any prior diabetes label has ketonaemia, acidosis and compatible illness.
- Start the current adult DKA protocol with fluid, fixed-rate insulin, potassium monitoring and precipitant treatment, regardless of body habitus or presumed type.
- Continue or establish background insulin according to the pathway and involve the inpatient diabetes team early for transition and education.
A person is clinically stable after DKA and insulin requirements fall as glucose toxicity resolves.
Key medicines
Basal-bolus insulinUse an individual specialist-led basal and mealtime regimen, titrated from glucose patterns, carbohydrate intake, renal function and hypoglycaemia risk; continue basal insulin during illness.
Intravenous insulin for DKAFollow the current JBDS-aligned fixed-rate infusion and local protocol alongside fluid, potassium and glucose-containing solutions until biochemical resolution criteria are met.