Ketoacidosis in type 2 diabetes--is it type 1 and 1/2 diabetes?

A 64-year-old female with a background of type 2 diabetes became acutely unwell after being transferred from insulin to liraglutide, which is one of the new glucagon like peptide 1 analogues. On assessment in accident and emergency, she was diagnosed with diabetic ketoacidosis and pancreatits. Glutamic acid decarboxylase antibodies were positive at 45 (0-1 U/ml) and C-peptide was low <94 pmol/l in keeping with the diagnosis of latent autoimmune diabetes of adults (LADA). This type of diabetes is characterised by slow autoimmune destruction of β cells of pancreas and can often be mistaken for type 2 diabetes. Patients suffering from LADA or type 1 and 1/2 diabetes require insulin to prevent ketoacidosis. She recovered with insulin treatment.