Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab
A Caucasian man in his 60s with recent diagnosis of metastatic renal cell carcinoma presented to the emergency department with a 5-day history of severe polyuria, polydipsia and fatigue and 1-day history of confusion, abdominal pain, nausea and vomiting. Investigations revealed an overlap of diabeti...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Bioscientifica
2023-08-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2023/3/EDM22-0389.xml |
| _version_ | 1797741298322505728 |
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| author | Dimitra Stathi Sufyan Hussain Danielle Crawley Janaka Karalliedde |
| author_facet | Dimitra Stathi Sufyan Hussain Danielle Crawley Janaka Karalliedde |
| author_sort | Dimitra Stathi |
| collection | DOAJ |
| description | A Caucasian man in his 60s with recent diagnosis of metastatic renal cell carcinoma presented to the emergency department with a 5-day history of severe polyuria, polydipsia and fatigue and 1-day history of confusion, abdominal pain, nausea and vomiting. Investigations revealed an overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). He had received the first dose of immunotherapy with nivolumab and ipilimumab 3 weeks prior to this attendance. New-onset type 1 diabetes (T1DM) was confirmed based on the clinical features at presentation, seropositivity for glutamic acid decarboxylase antibodies and significant insulin deficiency. He is currently on a multiple daily injections of insulin and uses intermittent-scanned glucose monitoring. Given the irreversible impact on beta-cell function and clinical response with insulin resulting in improved diabetes control, immunotherapy was resumed for his metastatic cancer with good radiological response. Although rare, new-onset T1DM can present with DKA and HSS overlap after a single dose of nivolumab/ipilimumab in individuals without pre-existing history of diabetes. |
| first_indexed | 2024-03-12T14:24:48Z |
| format | Article |
| id | doaj.art-e6602f26ee2b4917be26b4fd818a19b1 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 |
| language | English |
| last_indexed | 2024-03-12T14:24:48Z |
| publishDate | 2023-08-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-e6602f26ee2b4917be26b4fd818a19b12023-08-18T11:53:29ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732023-08-01111510.1530/EDM-22-0389Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumabDimitra Stathi0Sufyan Hussain1Danielle Crawley2Janaka Karalliedde3Department of Endocrinology and Diabetes, Guy’s and St Thomas’ NHS Trust, London, UK; School of Cardiovascular Medicine & Sciences, King's College London, London, UKDepartment of Endocrinology and Diabetes, Guy’s and St Thomas’ NHS Trust, London, UKDepartment of Oncology, Guy’s and St Thomas’ NHS Trust, London, UKDepartment of Endocrinology and Diabetes, Guy’s and St Thomas’ NHS Trust, London, UK; School of Cardiovascular Medicine & Sciences, King's College London, London, UK A Caucasian man in his 60s with recent diagnosis of metastatic renal cell carcinoma presented to the emergency department with a 5-day history of severe polyuria, polydipsia and fatigue and 1-day history of confusion, abdominal pain, nausea and vomiting. Investigations revealed an overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). He had received the first dose of immunotherapy with nivolumab and ipilimumab 3 weeks prior to this attendance. New-onset type 1 diabetes (T1DM) was confirmed based on the clinical features at presentation, seropositivity for glutamic acid decarboxylase antibodies and significant insulin deficiency. He is currently on a multiple daily injections of insulin and uses intermittent-scanned glucose monitoring. Given the irreversible impact on beta-cell function and clinical response with insulin resulting in improved diabetes control, immunotherapy was resumed for his metastatic cancer with good radiological response. Although rare, new-onset T1DM can present with DKA and HSS overlap after a single dose of nivolumab/ipilimumab in individuals without pre-existing history of diabetes.https://edm.bioscientifica.com/view/journals/edm/2023/3/EDM22-0389.xml |
| spellingShingle | Dimitra Stathi Sufyan Hussain Danielle Crawley Janaka Karalliedde Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab Endocrinology, Diabetes & Metabolism Case Reports |
| title | Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab |
| title_full | Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab |
| title_fullStr | Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab |
| title_full_unstemmed | Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab |
| title_short | Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab |
| title_sort | presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab |
| url | https://edm.bioscientifica.com/view/journals/edm/2023/3/EDM22-0389.xml |
| work_keys_str_mv | AT dimitrastathi presentationofnewonsettype1diabeteswithdiabeticketoacidosisandhyperosmolarhyperglycaemiaafterasingledoseofnivolumabandipilimumab AT sufyanhussain presentationofnewonsettype1diabeteswithdiabeticketoacidosisandhyperosmolarhyperglycaemiaafterasingledoseofnivolumabandipilimumab AT daniellecrawley presentationofnewonsettype1diabeteswithdiabeticketoacidosisandhyperosmolarhyperglycaemiaafterasingledoseofnivolumabandipilimumab AT janakakaralliedde presentationofnewonsettype1diabeteswithdiabeticketoacidosisandhyperosmolarhyperglycaemiaafterasingledoseofnivolumabandipilimumab |