A case of hemoglobin variant (Hb J-Lome) complicated by abnormally low HbAlc at the onset of fulminant type 1 diabetes mellitus

Fulminant type 1 diabetes mellitus (FT1DM), a new type 1 diabetes subtype, is characterized clinically by acute almost complete pancreatic β cell destruction. In contrast to markedly elevated plasma glucose, HbAlc is normal or only slightly elevated at FT1DM onset. We report the case of a 47-year-old man with FT1DM complicated by abnormally low hemoglobin. At diabetic ketoacidosis onset, glycated albumin (GA) was 25.3 %, HbAlc abnormally low at 3.6 %, and the GA/HbAlc ratio markedly high at 7.0. We identified a Lys → Asn mutation in 59 of the β-chain globin gene, yielding a diagnosis of Hb J-Lome. A complication of abnormal hemoglobin is thus to be suspected in cases of FT1DM with abnormally low HbAlc or a markedly high GA/HbAlc ratio.