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‘Disappearing diabetes’—resolution of apparent Type 1 diabetes in a patient with AIDS and cytomegalovirus (CMV) infection
Author(s) -
Evans E. M.,
Nye F.,
Beeching N. J.,
Gill G. V.
Publication year - 2005
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2005.01364.x
Subject(s) - medicine , diabetes mellitus , insulitis , diabetic ketoacidosis , ketoacidosis , insulin , type 2 diabetes , endocrinology , type 1 diabetes , immunopathology , gastroenterology
A 30‐year‐old African female with established acquired immunodeficiency syndrome (AIDS) and no history of diabetes, presented in severe diabetic ketoacidosis (DKA). Blood pH was 6.96, serum bicarbonate 5 mmol/l, plasma glucose (PG) 33.0 mmol/l, and urine heavily positive for ketones. She responded to standard treatment and was established on twice‐daily subcutaneous insulin. Four months later her insulin was stopped because of hypoglycaemic attacks on small doses. A glucose tolerance test (GTT) at 6 months postdiagnosis was normal (fasting PG 4.4 mmol/l and 2 h PG 7.5 mmol/l), and at 12 months random PG was 4.1 mmol/l and HbA 1c 4.3%. The onset of her apparent Type 1 diabetes coincided with an HIV‐associated cytomegalovirus (CMV) infection, and a reversible ‘CMV insulitis’ may be an explanation. Alternatively, the patient may have had what has recently been described as ‘atypical diabetes’ in African or Afro‐Caribbean diabetic patients. Here resolution of diabetes may occur after presentation, though complete return to normoglycaemia after true DKA is very unusual.