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- Title
Case Report of Severe Hyperglycemia in a Previously Non-Diabetic Veteran Exposed to Agent Orange after 10 Day Course of Low-Dose Prednisone.
- Authors
Gosmanov, Niyaz; Whorton, Joshua; Gosmanov, Aidar; Huycke, Mark
- Abstract
Carbohydrate metabolism abnormalities are not unusual in patients receiving steroid therapy with incidence of new-onset diabetes being reported as high as 40% range. We report case of new-onset severe hyperglycemia in a patient receiving short course of steroids with rapid taper. Sixty-four year old Caucasian retired veteran with history of mild hypertension, BMI of 29 kg/m², Agent Orange exposure and no family history of diabetes has initially presented to outpatient clinic with right-facial Bell's palsy for which he was given oral prednisone 30 mg bid. After ten days of the therapy, while on 6 mg of prednisone bid, the patient was admitted to the OKC VA Medical Center with complaints of severe fatigue, malaise and non-ketotic hyperglycemia with plasma glucose concentration of 1184 mg/dl, Cr of 2.4 and K of 6.0 mmol/L and signs of painless pancreatitis, amylase of 349 U/L. HbA1c measured 6 months prior to admission was 6.0%. Intensive therapy with IV fluids and insulin was initiated and resulted in a rapid normalization of glucose levels, kidney and electrolyte abnormalities. Twenty four hours after initiation of the therapy, C-peptide was drawn and revealed level of 3.4 pm/L with plasma glucose of 248 mg/dl. This paralleled rapid clinical improvement. He was uneventfully discharged home off of Prednisone, on 15 units of NPH qam with 5mg of Glyburide twice a day. His outpatient glucose values all were within normal range and NPH was tapered off over 1 week period without any evidence of worsening of blood sugar control. The major effect of prednisone on glucose metabolism is an increase of insulin resistance on peripheral and hepatic levels with suppression of beta-cell function. While most of the patients are capable of overcoming the resistance by increasing insulin output, this ability subsides with age and in presence of other factors "stressing" beta-cell function and/or worsening peripheral insulin resistance, like central obesity/metabolic syndrome, especially in the setting of family history of diabetes or history of exposure to Agent Orange. In accordance with ADA position statement, awareness about possibility of new-onset glucose metabolism abnormalities in patients having the risk factors is recommended and very close attention should be paid to glucose levels in those undergoing severe stress or receiving glucocorticoid treatment even at much lower doses as consequences of underestimating effects of the diabetogenic effects might be life-threatening.
- Publication
Diabetes, 2007, Vol 56, pA626
- ISSN
0012-1797
- Publication type
Academic Journal