MODY or T2DM

MODY OR T2DM ?? Chief Complaints A 35 year old female presented to OPD with uncontrolled sugars Her present complaints are decreased appetite, occasional increase in urine frequency and sudden onset paresthesia in different parts of body History K/C/O T2DM from last 12 years, so she was diabetic at the age of 23 Investigations RBS - 218 HbA1C - 8.3 FBS in range of 200 TSH - has increased from 5.19 to 6.19 from september to December on 100 mcg Lipid profile is deranged and mixed Dyslipidemia BP 144/92mmHg Management Her current medications on which she was from elsewhere - Ajaduo 25/5 morning Glimestar PM2 OD morning Thyronorm 100mcg I have put her on - Tab Gluconorm Z XR 1 tab morning and half tablet night Tab Voglibose 0.2mg with lunch Gemcal XT I am suspecting she could be a case of MODY considering age of onset? I am not willing to put burden of C peptide fasting

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In this case it is very important to know whether it is LADA. Latent autoimmune diabetes in adults (LADA), is a condition that shares characteristics of both type 1 and type 2 Those who have LADA essentially needs treatment with insulin Fasting C peptide level and Autoantibodies - islet cell antibodies ( antibodies against cytoplasmic proteins in the beta cell), Antibodies to glutamic acid decarboxylase (GAD-65), Insulin autoantibodies Are important investigation to diagnose LADA

For Diagnosis of MODY - Should have history of diabetes of three successive generations required in absence of monogenetic abnormalitiy of MODY gene like HNF1 alpha or Glucokinase gene . Do C -Peptide estimation after sugar control . Because glucotoxicoty leads to low c peptide level . In absence of positive family history of three successive generations , rule out LADA. But probability of DM2 is still high , because no diabetic ketoacidosis in presence of high blood sugar level. Mixed hyperlipidemia also

? MODY .. NEED'S.. SULFONYLUREAS.. LIFE STYLE CHANGES.. DIET.. REGULAR EXERCISE..

Tnx Dr Pranab Bera
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Try: 1.Vasantkusumakar rasa tabs 1 bd. 2.Arogyawardhini tabs 1 bd. 3.Chandraprabha tabs 1 bd. 4.Yogabasti with Madhutailika basti minimum 3 courses. 5.Proper aahar vihar instructions. May be sufficient.

Uncontrolled diabetic I feel should be shifted on basal bolus insulin Dapagliflozin Vildagliptin Metformin

I am agree with@Dr. Kute Ankush Sir.

What about family history of the patient,as pt cannot be labelled as MODY with out appropriate family history. And see for signs of insulin resistance which point more towards T2 DM

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