Endocrine Abstracts

Well-known environmental factors which can lead to type 1 diabetes are viral infections, vaccines, diet, exposure to cow milk in infancy, vitamin D deficiency, drugs, maternal age, preeclampsia and low birth weight. Isotretinoin is an effective drug for acne treatment. It can cause dyslipidemia, elevated liver enzymes, insulin resistance and type 2 diabetes. Our case is type 1 diabetes developed after the use of isotretinoin and represented with diabetic ketoacidosis.

Case: 18-years-old male patient has admitted to hospital with complaints of abdominal pain, increased sense of thirst, frequent urination and dry mouth. In physical examination, he was dehydrated with hypotension and dry oral mucosa. He did not have family history of diabetes. With further questioning, we have learnt that he was using isotretinoin for acne treatment for 7 months. In laboratory examination, his plasma glucose level was 400 mg/dl, had heavy ketonuria and acidosis in arterial blood gas. He was hospitalized in endocrinology ward with diagnosis of diabetic ketoacidosis. Hydration with isotonic saline together with insulin infusion, potassium replacement and dextrose infusion were given to the patient. His anti GAD was positive and C-peptide level was very low leading to diagnosis of type 1 diabetes. After amelioration of ketoacidosis, we have applied intensive insulin therapy and blood glucose levels were regulated.

Conclusion: Isotretinoin is related with metabolic syndrome and type 2 diabetes because of worsened insulin resistance. However, there are few cases of type 1 diabetes in literature. Anti GAD positivity is suggestive of underlying autoimmune mechanisms triggered by the drug. Patients should be monitored with frequent plasma glucose levels during treatment.