Endocrine Abstracts

Little is known on the impact of acute COVID-19 infection on causation of diabetes. We report on a 36 years old man from Nigeria who presented with diabetic ketoacidosis (DKA) with typical osmotic symptoms of polyuria and polydipsia, fatigue and weight loss over 2 weeks. He tested positive for SARS-COV2 by PCR. The initial laboratory results: Random glucose 30.6 mmol/l, capillary blood ketones 7.4 mmol/l, pH 7.22, bicarbonate 7.5 mmol/l. Despite insulinopaenic state, at presentation, he was insulin resistant requiring several upward adjustment of IV insulin therapy, requiring over 200 units IV Actrapid infusion in the first 24 h i.e. 8–9 units per hour. At 2 weeks, basal bolus subcutaneous insulin requirement was 1.2 U/kg per day. Currently, 6 weeks after diagnosis, insulin requirement was lower at 0.52 U/kg with drop in HbA1c from 125 to 67 mmol/mol. Retrospectively, random C-Peptide 0.41 µg/l (1.1–4.4) and repeated 6 weeks 0.9 µg/l, Islet cell Ab 14 U/ml (<28), AntiGAD Ab 24 IU/ml (<17) repeated 6 weeks 11 IU/ml.

Discussion

New presentation of DKA with acute COVID-19 in a young Nigerian man. Initially insulin resistant despite insulinopaenia but resolution of insulin resistance by 6 weeks, and persistence of ketonemia despite normal acid base. Initially elevated Anti GAD Ab but six weeks later normalised. Is it latent autoimmune diabetes, or ketosis prone diabetes, or a hybrid pleiotropic metabolic effects of COVID-19 infection from as yet undefined mechanism?