scholarly journals Diabetic ketoacidosis precipitated by COVID-19 in patient with newly diagnosed diabetes mellitus

2021 ◽  
Vol 17 (5) ◽  
pp. 422-425
Author(s):  
E. Xhardo ◽  
P. Kapisyzi ◽  
A. Rada
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Virus Disease ◽  
Pancreatic Beta Cell ◽  
Stable Condition ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
High Blood Glucose ◽  
Viral Infectious Disease

Background. Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus (DM) have been reported frequently in patients with the new corona virus disease — 2019, COVID-19. It has been associated with progressive course and worse outcome. There is scarce data on diabetic ketoacidosis (DKA) in COVID-19 infection. There has been several cases reported on COVID-19 infection precipitating a new diagnosis of type 2 DM (T2DM). However, there is a lack of evidence regarding type 1 DM (T1DM). We report a case of DKA precipitated by COVID-19 in a patient with newly diagnosed T1DM. Recently, case reports and small cross-sectional studies described diabetic patients who develop DKA when infected with COVID-19. The incidence of DKA has been found to be high in patients with T1DM and T2DM admitted to hospital with COVID-19. Case presentation. We present a 29 year-old, previously healthy man with 5 days history of fever, fatigue, vomiting, polydipsia and polyuria. His lab results showed high blood glucose, high anion gap metabolic acidosis and ketonuria diagnostic of DKA. He also tested positive for COVID-19 and his Chest CT was consistent with bilateral COVID 19 pneumonia (ground-glass opacity, consolidation, and crazy-paving pattern). He was successfully managed with intravenous fluids and insulin as per DKA protocol. He required intravenous antibiotics, steroids and oxygenotherapy for COVID-19 pneumonia. He was discharged after 14 days in stable condition. Conclusions. COVID-19 infection can be complicated by DKA and development of DM in previously non-diabetic individuals. It is possible that SARS-CoV-2 may aggravate pancreatic beta cell function and precipitate DKA. Very few cases have been reported in the literature on COVID-19 infection precipitating DKA in a newly diagnosed patient of type 1 diabetes mellitus.

Diabetic euglycemic ketoacidosis in newly diagnosed type 1 diabetes mellitus during Ramadan fasting

2015 ◽  
Vol 28 (3-4) ◽  
Author(s):  
Veysel Nijat Baş ◽  
Salih Uytun ◽  
Yasemin Altuner Torun
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Glycogen Storage ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Ramadan Fasting ◽  
Glucose Levels ◽  
Glycogen Storage Diseases

AbstractReal euglycemic diabetic ketoacidosis [DKA; blood glucose <200 mg/dL (11.1 mmol/L)] is rare, and long-lasting starvation conditions due to intervening diseases in type 1 diabetes mellitus patients may also cause it. Euglycemic DKA is also reported in insulin-dependent diabetics with depression, alcoholics, glycogen storage diseases, and chronic liver disease apart from pregnant cases. This case report is presented to emphasize the importance of evaluation of acid-base state, urine glucose, and ketone values at the application in all newly diagnosed type 1 diabetic patients with normal glucose levels by defining euglycemic DKA that resulted from long-lasting starvation during Ramadan fasting in a newly diagnosed 14-year-old male patient.

Increased incidence and severity of diabetic ketoacidosis among uninsured children with newly diagnosed type 1 diabetes mellitus

2005 ◽  
Vol 6 (2) ◽  
pp. 79-83 ◽  
Author(s):  
Aristides K. Maniatis ◽  
Stephanie H. Goehrig ◽  
Dexiang Gao ◽  
Arleta Rewers ◽  
Philippe Walravens ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Newly Diagnosed ◽  
Uninsured Children

scholarly journals Unusual high blood glucose in ketoacidosis as first presentation of type 1 diabetes mellitus

2018 ◽  
Vol 2018 ◽  
Author(s):  
Sebastian Hörber ◽  
Sarah Hudak ◽  
Martin Kächele ◽  
Dietrich Overkamp ◽  
Andreas Fritsche ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Atypical Antipsychotics ◽  
List Type ◽  
High Blood Glucose ◽  
Increased Risk ◽  
New Onset

Summary Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus. It usually occurs in patients with type 1 diabetes where it is typically associated with only moderately increased blood glucose. Here, we report the case of a 52-year-old female patient who was admitted to the emergency unit with severely altered mental status but stable vital signs. Laboratory results on admission revealed very high blood glucose (1687 mg/dL/93.6 mmol/L) and severe acidosis (pH <7) with proof of ketone bodies in serum and urine. Past history revealed a paranoid schizophrenia diagnosed 10 years ago and for which the patient was treated with risperidone for many years. Acute treatment with intravenous fluids, intravenous insulin infusion and sodium bicarbonate improved the symptoms. Further laboratory investigations confirmed diagnosis of autoimmune type 1 diabetes. After normalization of blood glucose levels, the patient could soon be discharged with a subcutaneous insulin therapy. Learning points: Diabetic ketoacidosis as first manifestation of type 1 diabetes can occur with markedly elevated blood glucose concentrations in elder patients. Atypical antipsychotics are associated with hyperglycemia and an increased risk of new-onset diabetes. First report of risperidone-associated diabetic ketoacidosis in new-onset type 1 diabetes. Patients treated with atypical antipsychotics require special care and regular laboratory examinations to detect hyperglycemia and diabetic ketoacidosis. In cases when the diagnosis is in doubt, blood gas analysis as well as determination of C-peptide and islet autoantibodies can help to establish the definite diabetes type.

scholarly journals MON-LB126 A Benign and Favorable Diagnosis: Glycogen Hepatopathy Causing Transient Transaminitis During Diabetic Ketoacidosis in Type 1 Diabetes Mellitus

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alice Yau ◽  
Pramma Elayaperumal ◽  
Ashvin Butala ◽  
Gul Bahtiyar ◽  
Giovanna Rodriguez
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Distinct Pattern ◽  
Diabetic Patients ◽  
African American Female ◽  
Nonalcoholic Fatty Liver ◽  
Glucose Levels ◽  
Glycogen Storage Diseases ◽  
Type 1 Dm

Abstract Background: Transient transaminitis is a rarely discussed complication of uncontrolled diabetes mellitus (DM). Known as glycogenic hepatopathy (GH), it is belived to be caused by build-up of glycogen in hepatocytes. Recognized as benign and reversible, GH is associated with hepatomegaly (&gt;90% cases) and primarily seen in patients with type 1 DM during periods of inadequate hyperglycemic control. Differential diagnoses include glycogen storage diseases, nonalcoholic fatty liver disease, hepatosclerosis, autoimmune hepatitis, hemochromatosis, Wilson disease, and acute viral hepatitis.1 Case Report: A 26-year-old African American female with type 1 DM and sickle cell presented on multiple occasions to the emergency department with abdominal pain associated with nausea, vomiting and diarrhea. Initial labs consistently included glucose levels &gt;600 mg/dL (70-105 mg/dL), elevated anion gap ranging 20-40s mEq/L (5-15 mEq), and severe metabolic acidosis reflective of diabetic ketoacidosis (DKA). Labs were also significant for repeated mild transaminitis despite adequate fluid hydration. After several admissions, we observed a distinct pattern of mild transaminitis that directly fluctuated with her levels of blood glucose. With some minor lag, the patient’s liver enzymes normalized when her glucose levels normalized and DKA resolved. Further work-up ruled out more common etiologies of liver injury. Multiple abdominal ultrasounds and CT scans showed a normal sized liver without obvious structural abnormalities. Labs were significant for negative hepatitis B and hepatitis C; several negative anti-smooth muscle, anti-nuclear antibody, centromere antibody, and liver kidney microsomal type 1 antibody; normal levels of ceruloplasmin and alpha 1 anti-trypsin; low iron levels 23 ug/dL (60-180 ug/dL); borderline low IgG 627 mg/dL (700-1600 mg/dL). We hypothesized that the patient likely had GH by exclusion of other liver pathologies and given the context of transient transaminitis during DKA. Conclusion: GH is a benign and favorable diagnosis in diabetic patients with elevated transaminases.1 Given the small number of cases of GH reported, there is a need to record and analyze more patients with likely GH in order to better understand the condition. Appropriate clinician awareness of GH can also eliminate the need for time consuming and costly workup. References:1. Sherigar, Jagannath M et al. “Glycogenic Hepatopathy: A Narrative Review”. World Journal Of Hepatology, vol 10, no. 2, 2018, pp. 172-185. Baishideng Publishing Group Inc., doi:10.4254/wjh.v10.i2.172.

scholarly journals Pancreatic Beta Cell Death: Novel Potential Mechanisms in Diabetes Therapy

2018 ◽  
Vol 2018 ◽  
pp. 1-19 ◽  
Author(s):  
Joselyn Rojas ◽  
Valmore Bermudez ◽  
Jim Palmar ◽  
María Sofía Martínez ◽  
Luis Carlos Olivar ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cell Death ◽  
Beta Cell ◽  
Molecular Mechanisms ◽  
Pancreatic Beta Cell ◽  
Diabetic Patients ◽  
Pathophysiological Mechanism ◽  
Islet Amyloid ◽  
Beta Cell Death

Purpose of Review. Describing the diverse molecular mechanisms (particularly immunological) involved in the death of the pancreatic beta cell in type 1 and type 2 diabetes mellitus. Recent Findings. Beta cell death is the final event in a series of mechanisms that, up to date, have not been entirely clarified; it represents the pathophysiological mechanism in the natural history of diabetes mellitus. These mechanisms are not limited to an apoptotic process only, which is characteristic of the immune-mediated insulitis in type 1 diabetes mellitus. They also include the action of proinflammatory cytokines, the production of reactive oxygen species, DNA fragmentation (typical of necroptosis in type 1 diabetic patients), excessive production of islet amyloid polypeptide with the consequent endoplasmic reticulum stress, disruption in autophagy mechanisms, and protein complex formation, such as the inflammasome, capable of increasing oxidative stress produced by mitochondrial damage. Summary. Necroptosis, autophagy, and pyroptosis are molecular mechanisms that modulate the survival of the pancreatic beta cell, demonstrating the importance of the immune system in glucolipotoxicity processes and the potential role for immunometabolism as another component of what once known as the “ominous octet.”

scholarly journals Impact of Glycated Haemoglobin on salivary glucose among type 1 diabetic mellitus patients aged 18-22 years

2018 ◽  
Vol 30 (3) ◽  
pp. 54-58
Author(s):  
Juman D Al- Khayoun ◽  
Ban S Diab
Keyword(s):  
Diabetes Mellitus ◽  
Plasma Glucose ◽  
Total Sample ◽  
Glycated Haemoglobin ◽  
Average Concentration ◽  
Spectrophotometric Analysis ◽  
Diabetic Patients ◽  
High Blood Glucose ◽  
Positive Direction

Background: Diabetes mellitus consists of a group of diseases characterized by abnormally high blood glucose levels. Glycated haemoglobin (HbA1c) is a form of haemoglobin used to identify the average concentration of plasma glucose over prolonged periods of time. It is formed in a non-enzymatic pathway by normal exposure of hemoglobin to high levels of plasma glucose, The main alterations observed in the saliva of Type 1 diabetic patients are hyposalivation and alteration in its composition, particularly those related to the levels of glucose. The aim of the present study was to assess the effect of Glycated haemoglobin level on the level of salivary glucose which may have an effect on oral health condition. Materials and methods: The total sample composed of 50 adults aged 18-22 years. Divided into two groups: 25 uncontrolled diabetes mellitus (HbA1c > 7), 25 controlled diabetes mellitus (HbA1c ≤ 7). Stimulated salivary samples were collected under standardized condition according to the criteria of Tenovuo and Lagerlöf (1994). Salivary glucose was estimated by using spectrophotometric analysis. The data were analyzed by using SPSS version 18 (Statistical Package for Social Sciences) to specify the statistical differences between the two groups. Results: the data of the present study assessed the correlation coefficients of HbA1c and salivary glucose and found that among uncontrolled diabetic group the relation between HbA1c and salivary glucose was significantly in positive direction (r = 0.483 p

A brief campaign to prevent diabetic ketoacidosis in children newly diagnosed with type 1 diabetes mellitus: The NO-DKA Study

2018 ◽  
Vol 19 (7) ◽  
pp. 1257-1262 ◽  
Author(s):  
José G. B. Derraik ◽  
Wayne S. Cutfield ◽  
Sarah E. Maessen ◽  
Paul L. Hofman ◽  
Timothy Kenealy ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Newly Diagnosed

scholarly journals Hyperketonemia: Clinical features and diagnosis of Diabetic Ketoacidosis

2018 ◽  
Vol 2 (5) ◽  
pp. 01-04
Author(s):  
Reshad Hassannezhad
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Diabetic Patients ◽  
Provider Education ◽  
Clinical Criteria ◽  
Metabolic Complication ◽  
Electrolyte Loss ◽  
Kidney Liver

Diets that boost ketone production are increasingly used for treating several neurological disorders. Elevation in ketones in most cases is considered favorable, as they provide energy and are efficient in fueling the body's energy needs.Several physiological and pathological triggers, such as fasting, ketogenic diet, and diabetes cause an accumulation and elevation of circulating ketones. Complications of the brain, kidney, liver, and microvasculature were found to be elevated in diabetic patients who had elevated ketones compared to those diabetics with normal ketone levels. Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management.

Characteristics and Outcomes of Children with Type-I Diabetes Mellitus Hospitalized for Ketoacidosis

2020 ◽  
Vol 16 (7) ◽  
pp. 779-786
Author(s):  
Roza Zinab Ababulgu ◽  
Behailu Terefe Tesfaye
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Type I Diabetes ◽  
Type I Diabetes Mellitus ◽  
Type I ◽  
Newly Diagnosed ◽  
Family History Of Diabetes ◽  
Diabetes Patients

Background: Type 1 diabetes mellitus is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis is one of the most common and serious acute complications associated with significant morbidity and mortality. Nevertheless, limited studies are conducted in Ethiopia. Objective: The aim of this study was to assess patient-related characteristics and outcomes of diabetic ketoacidosis, and their relative difference among children with newly diagnosed and previously known type-I diabetes mellitus. Methods: This is a retrospective cross-sectional study of 63 type-1 diabetes patients admitted for ketoacidosis at Jimma university medical center, a tertiary hospital. Data was collected using a checklist, and entered into Epidata 4.2.0.0 and analyzed using STATA 13.0. Descriptive statistics was performed; Mann-Whitney and Chi-square test statistics were employed for comparison. Result: Of the total, 39 were newly diagnosed type-I diabetes patients. Polydipsia and Polyuria (each in 74.6%) were the predominant symptoms at presentation. ketoacidosis precipitants were undocumented in the majority of the patients (53.97%). Mean (±SD) Random blood sugar was 434.05 (±117.62)mg/dl. Ketoacidosis was mild in severity in 63.49%. Family history of diabetes, unknown precipitants and the first episode of ketoacidosis were significantly different among the new and known type-I diabetes patients. No mortality was documented. Conclusion: The observed patient characteristics are typical of those reported in many studies and standard resources. Despite no mortality was documented, the need for early diagnosis and management should not be overlooked. Further study, with large sample size, is recommended to point-out the real characteristics difference among new and known type-I diabetes mellitus patients admitted for ketoacidosis.

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