Endocrine Abstracts

HHS is a rare hyperglycaemic emergency, typically precipitated by infection in people with T2DM. There are few recorded cases of COVID induced pure HHS. We here by report 2 further cases, including the first known reported case in a person with T1DM.

Case 1: 81yo male with T1DM (on glargine and aspart insulin, HbA1c 57 mmol/mol) presentedwith lethargy, general deterioration and a fall.Therewere no new symptoms offever/cough/breathlessness or change in taste/smell. Investigations showedGlucose 34.9 mmol/l, Ur18.3, Cr96, Na135, K4.5, S. Osm 323.2, pH7.48, HCO3 27.6, blood ketones 0.3 mmol/l. COVID PCR positive. CXR - no COVID changes. He was diagnosed with HHS and treated with IV fluids and IV insulin with clinical and biochemical improvement.

Case 2: 91yo female with T2DM (no anti-hyperglycaemic medication – metformin and linagliptin discontinued during an inpatient spell 5 months earlier with normal blood sugars), IHD and dementia was admitted with polyuria/polydipsia. No symptoms of cough/SOB/fever or change in taste/smell. Investigations showed Glucose 38.4, Ur14.4, Cr132, Na134, K5.3, S. Osm320.8, HbA1c130, pH7.39, HCO3 28.5, blood ketones 0.7. COVID PCR positive. CXR - no COVID changes. She was treated with IVF and IV Insulin with rapid biochemical improvement, and discharged home with metformin, linagliptin and gliclazide.

Discussion: Despite the COVIDpandemic affecting over 173,000,000 peopleworldwide to date, the incidence of HHS remains very low and limited to a few case reports. We have added to the knowledge base with 2 additional reports, including, to our knowledge, the first report in a patient with T1DM. Given that these cases were asymptomatic from a COVID perspective, we recommend that COVID is considered as a precipitant for all patients with hyperglycaemic emergencies without an alternative cause. The forthcoming CoviDiab study, and others, will shed further light into the interplay between COVID and hyperglycaemic emergencies