Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case Report
A 15-year-old boy was admitted to the intensive care unit of our hospital with complaints of increased urination, extreme tiredness, and nausea for the past 15 days. He had also lost 6.5 kg of weight (almost 10% of total body weight) in 1 month. On admission, his plasma glucose was 780 mg/dL, glycat...
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Wolters Kluwer Medknow Publications
2024-07-01
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| Series: | Journal of Diabetology |
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| author | Manoharan Sriraam Sadagopan Sri Lekha Ranjit Unnikrishnan Ranjit Mohan Anjana Viswanathan Mohan |
| author_facet | Manoharan Sriraam Sadagopan Sri Lekha Ranjit Unnikrishnan Ranjit Mohan Anjana Viswanathan Mohan |
| author_sort | Manoharan Sriraam |
| collection | DOAJ |
| description | A 15-year-old boy was admitted to the intensive care unit of our hospital with complaints of increased urination, extreme tiredness, and nausea for the past 15 days. He had also lost 6.5 kg of weight (almost 10% of total body weight) in 1 month. On admission, his plasma glucose was 780 mg/dL, glycated haemoglobin (HbA1c) 11.6%, serum ketones >10.0 mmol/L, osmolality 346 mosm/kg, arterial pH 7.28, and bicarbonate 9 mEq/L. The C-peptide report initially indicated poor pancreatic beta cell reserve (fasting: 0.41 pmol/mL and stimulated: 0.46 pmol/mL). He was diagnosed with diabetic ketoacidosis and responded well to treatment, after which time he was switched to subcutaneous insulin. Ten days later, in the outpatient clinic, his fasting blood glucose was 132 mg/dL, postprandial blood glucose was 183 mg/dL, and C-peptide had improved to fasting: 0.89 pmol/mL and stimulated: 1.42 pmol/mL. Considering the presence of acanthosis nigricans on the neck, a body mass index in the overweight range, a positive family history of diabetes, and negative tests for pancreatic autoantibodies, an early onset diagnosis of type 2 diabetes mellitus was considered. Insulin was gradually withdrawn, and he was switched to metformin. Sustained recovery of C-peptide in this case indicates that lack of insulin at admission was due to beta cell stunning, rather than a total and irreversible loss of beta cells as expected in type 1 diabetes mellitus. Beta cell stunning is often reversible, as shown in this case. |
| format | Article |
| id | doaj-art-1cdbd267765a40f981d59ef8726090ec |
| institution | OA Journals |
| issn | 2078-7685 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Diabetology |
| spelling | doaj-art-1cdbd267765a40f981d59ef8726090ec2025-08-20T02:09:52ZengWolters Kluwer Medknow PublicationsJournal of Diabetology2078-76852024-07-0115331031210.4103/jod.jod_15_24Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case ReportManoharan SriraamSadagopan Sri LekhaRanjit UnnikrishnanRanjit Mohan AnjanaViswanathan MohanA 15-year-old boy was admitted to the intensive care unit of our hospital with complaints of increased urination, extreme tiredness, and nausea for the past 15 days. He had also lost 6.5 kg of weight (almost 10% of total body weight) in 1 month. On admission, his plasma glucose was 780 mg/dL, glycated haemoglobin (HbA1c) 11.6%, serum ketones >10.0 mmol/L, osmolality 346 mosm/kg, arterial pH 7.28, and bicarbonate 9 mEq/L. The C-peptide report initially indicated poor pancreatic beta cell reserve (fasting: 0.41 pmol/mL and stimulated: 0.46 pmol/mL). He was diagnosed with diabetic ketoacidosis and responded well to treatment, after which time he was switched to subcutaneous insulin. Ten days later, in the outpatient clinic, his fasting blood glucose was 132 mg/dL, postprandial blood glucose was 183 mg/dL, and C-peptide had improved to fasting: 0.89 pmol/mL and stimulated: 1.42 pmol/mL. Considering the presence of acanthosis nigricans on the neck, a body mass index in the overweight range, a positive family history of diabetes, and negative tests for pancreatic autoantibodies, an early onset diagnosis of type 2 diabetes mellitus was considered. Insulin was gradually withdrawn, and he was switched to metformin. Sustained recovery of C-peptide in this case indicates that lack of insulin at admission was due to beta cell stunning, rather than a total and irreversible loss of beta cells as expected in type 1 diabetes mellitus. Beta cell stunning is often reversible, as shown in this case.https://journals.lww.com/jodb/fulltext/2024/15030/stress_induced_diabetic_ketoacidosis_due_to.11.aspxstress-induced dka; transient beta cell stunning; type 1 diabetes mellitus; type 2 diabetes mellitus |
| spellingShingle | Manoharan Sriraam Sadagopan Sri Lekha Ranjit Unnikrishnan Ranjit Mohan Anjana Viswanathan Mohan Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case Report Journal of Diabetology stress-induced dka; transient beta cell stunning; type 1 diabetes mellitus; type 2 diabetes mellitus |
| title | Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case Report |
| title_full | Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case Report |
| title_fullStr | Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case Report |
| title_full_unstemmed | Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case Report |
| title_short | Stress-Induced Diabetic Ketoacidosis Due to Transient Beta Cell Stunning in a Youth with Type 2 Diabetes Mellitus: A Case Report |
| title_sort | stress induced diabetic ketoacidosis due to transient beta cell stunning in a youth with type 2 diabetes mellitus a case report |
| topic | stress-induced dka; transient beta cell stunning; type 1 diabetes mellitus; type 2 diabetes mellitus |
| url | https://journals.lww.com/jodb/fulltext/2024/15030/stress_induced_diabetic_ketoacidosis_due_to.11.aspx |
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