Relapsing and remitting insulin requiring diabetes: type 1 or type 2?

We present a case of ketosis prone type 2 diabetes—an unusual presentation of diabetes seen predominantly in African-Caribbean patients. CASE HISTORY A 28-year-old previously healthy Barbadian man presented in May 1998 with acute polyuria, polydipsia and weight loss of approximately 4 kg. He was dehydrated, and his random plasma glucose was 21 mmol/L, with ++ketonuria and arterial pH 7.24 (normal range 7.35–7.45). He was treated for diabetic ketoacidosis, with intravenous fluids and insulin and, subsequently, subcutaneous twice daily mixtard 30 insulin, 15 units twice daily. Anti-islet cell antibodies were negative. He remained on this dose for about 4 months after diagnosis, but was subsequently troubled by frequent hypoglycaemia. Thereafter, he took insulin intermittentl