Diabetologists and non-specialist physicians have traditionally focused on treatment rather than diagnosis in the management of diabetes. The diagnosis of type 1 or type 2 diabetes in a busy admissions unit or a diabetes clinic is usually based on biochemical diagnostic criteria, age at onset, body mass index and the presence or absence of ketoacidosis. More challenging for the clinician is to utilise clinical skills and knowledge to detect monogenic diabetes, which has important consequences in terms of prognosis, treatment and family screening. We report an interesting case of monogenic diabetes, which solved the mystery behind a puzzling sequence of events that was a great source of confusion for the physician and concern for the patient.
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