Background: Type 1 diabetes mellitus has three common presentations: Typical (hyperglycaemia with cardinal symptoms), ketoacidosis and asymptomatic hyperglycaemia.
Case presentation: A 7.5-year-old girl with a history of bronchial asthma presented to the emergency department with acute-onset diabetic symptoms. The previous year she was admitted to the Paediatric Ward for a pneumonia complicated by pleural effusion. She then developed hyperglycemia (400 mg/dl) related to IV corticosteroid administration and glycosuria without ketonuria. Insulin therapy (maximum 0.86 IU/kg per day) was administered for 5 days. On discharge preprandial glycaemia was normal but her postprandial hyperglycaemia (230240 mg/dl) persisted for another week. Outpatient follow-up labs revealed positive HLA DR3, normal insulin and C-peptide, HbA1c 5.4% (NGSP), positive antiGAD (2 000 U/ml), pancreatic islet cell, positive antitransglutaminase and antiendomysium antibody levels, negative anti-insulin antibody and a normal oral glucose challenge test. 6 months later she was admitted for acute bronchospasm which required treatment with oral corticosteroids. A hyperglycaemia (400 mg/dl) with glycosuria absent ketonuria was detected. Corticosteroids were suspended and SC insulin was started (maximum 0.75 UI/kg per day) for 3 days, which resulted in normalization of glycemic values. 4 months postdischarge she was readmitted with a 3 days history of polydipsia and nocturnal enuresis. At home her blood glucose measured 500 mg/dl. Hospital labs revealed: a normal venous pH, a venous blood glucose of 511 mg/dl, glycosuria absent ketonuria or ketonemia, glycohemoglobin 8.5%, positive microsomal antibody levels, normal thyroid function, appropriate bone age and a normal fundoscopic exam. Repeat pancreatic autoinmunity tests and antitransglutaminase antibody levels remained positive.
Conclusion: Close monitoring of iatrogenic hyperglycaemia may help in early detection of type 1 diabetes and to prevent further complications.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology