Presentation
A 19-year-old Somali-origin male presented to the emergency department after three days of persistent vomiting. The medical history revealed obesity (BMI 40 kg/m²) and previous immune thrombocytopenia. The patient also reported a preceding two-week history of fatigue, polydipsia, and polyuria.He also had strong family history of type 2 diabetes mellitus, with his father being affected.

Examination
On examination, the patient was dehydrated and tachycardic. He was presented with deep, labored Kussmaul breathing, indicating metabolic acidosis. He also had mild epigastric tenderness. Physical signs included marked obesity and acanthosis nigricans.

Diagnosis
Patient had a pH of 7.061, suggesting severe acidosis. Laboratory examination revealed elevated serum ketones (>6 mmol/L), and blood glucose (38 mmol/L, critically high).These findings confirmed diabetic ketoacidosis (DKA).HbA1c was 9.7%, suggesting chronic hyperglycemia.

Management
The patient was shifted to the intensive therapy unit (ITU) for managing severe DKA. He was administered intravenous fluids and insulin. He required high insulin doses initially even with DKA resolution. Upon discharge, he was prescribed a basal-bolus insulin regimen using Humulin I and Novorapid.

Follow-up
The autoantibody screen returned negative for all tested markers, indicating diagnosis of ketosis-prone diabetes rather than classic type 1 diabetes. Over the next three months, the patient had symptomatic improvement. He adopted dietary modifications, and achieved weight loss, leading reduction in daily insulin requirements (96 units to 64 units).She had excellent glycemic control.