Diabetic Ketoacidosis Occurred Just after the Colonoscopy in Previously Diagnosed Fulminant Type 1 Diabetes: A Case Report

Presentation Number: SAT 633
Date of Presentation: April 1st, 2017

Dughyun Choi*, Bo yeon Kim, Chan-Hee Jung, Jioh Mok, Chul-Hee Kim and Sung-koo Kang
Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon city, Gyeonggi-do, Korea, Republic of (South)

Abstract

Title:

Diabetic ketoacidosis occurred just after the colonoscopy in previously diagnosed fulminant type 1 diabetes: A case report

Background:

Fulminant type 1 diabetes (FT1D) is known as a distinct subtype of type 1 diabetes mellitus which is characterized by sudden insulin loss from complete destruction of pancreatic beta cells at the disease onset resulting in abrupt onset of ketoacidosis at the diagnosis[1]. Its rapid progression of insulin loss leads to hyperglycemia and ketoacidosis in relatively normal glycated hemoglobin (HbA1c). Since FT1D was described in 2000, some case reports have been published from various countries, especially from East Asia. However its disease entity is still not definitely known yet. Here we report a case of ketoacidosis occurred a day after the diagnostic colonoscopy in previously diagnosed FT1D patient.

Clinical case:

48 year old man who had no previously medical history visited emergency center of a university hospital for nausea and dyspnea started 2 days ago. He was in diabetic ketoacidosis state with initial glucose level of 1339 mg/dL and serum ketone level of 10.4 mmol/L (normal range: 0-0.6 mmol/L). But his glycated hemoglobin level was only 6.2% although his fasting and after meal C-peptide level was 0.05 ng/mL, 0.08 ng/mL, respectively. Despite of extremely low c-peptide level, anti-glutamic acid decarboxylase antibody (GAD-Ab) was negative. The patient was treated with hydration and continuous insulin injection in diagnosis of FT1D and discharged with multiple dose insulin (MDI) injection therapy. Blood level was stable at following 2 weeks of outpatient clinic and MDI regimen was changed to 2 times a day of pre-mixed type insulin regimen. A month after the first hospitalization, the patient visited emergency center again for nausea with abdominal pain started just after the diagnostic colonoscopy on the local clinic at that day. He only skipped his meal and insulin injection from previous evening and took bowel prep medication on previous night. Serum glucose level was 493 mg/dL and serum ketone level was 7.6 mmol/L. He again diagnosed diabetic ketoacidosis and treated with hydration and continuous insulin injection. After discharge, he is receiving MDI injection in outpatient clinic and glycated hemoglobin level is stable around 6 to 7%.

Conclusion

Bowel preparation and colonoscopy can be stressful event to FT1D patients. When patient undergoes colonoscopy, proper hydration and insulin injection with careful blood glucose monitoring should be needed.

 

Nothing to Disclose: DC, BYK, CHJ, JM, CHK, SKK