D2 MTE4 Case 10: Dilemma of diagnosis

14 year 6 month child presented to us with complaints of polyuria and polydipsia for 3 months. He was morbidly obese (116 kg) and had lost 22 kg in last 1.5 months. There was history of dental abscess 1 month back for which he was prescribed Tablet Wysolone (5 mg BD) for 5 days. He had normal perinatal and developmental history. Mother had history of gestational diabetes. There was history of DM, dyslipidemia and hypertension in both the parents. On examination: His height and weight were 173 cm (+1.25 SDS) and 92.9 kg (+4.1 SDS), respectively with a BMI of 31.04 kg/m2 and a waist hip ratio of 0.93. He had acanthosis nigricans over neck, axilla and thighs. His SMR staging was A2 P3 TV 12/12 ml SPL of 7 cm along with lipomastia. Rest of the systemic examination was normal. Investigations: His investigations showed fasting blood glucose of 316 mg/dl with HbA1c of 16.4% and no acidosis on blood gas. Urinary glucose was +++ and ketone bodies +++ along with urine microalbumin of 81.8 mg/L. He also had dyslipidemia with normal thyroid functions. His C-peptide level was 2.15 ng/ml and HOMA IR 2.96. He also had Vitamin D and Vitamin B12 deficiency.