Endocrine Abstracts

Introduction: Diabetic ketoacidosis (DKA) can occur when the body is in an insulin-deficient state, which results in an inability to suppress lipolysis and thus ketone production¹. Certain recreational drugs, particularly cocaine, have been found to increase the risk of developing DKA². What is less clearly defined is whether methamphetamines act as a DKA-precipitant. This case depicts a patient with insulin-dependent diabetes and negative autoantibodies who was found to have severe DKA following methamphetamine ingestion.

Case Description: A 54-year-old male with a past medical history of insulin-dependent diabetes and polysubstance use disorder presented to the emergency department for altered mental status (AMS). History unable to be obtained secondary to AMS. Physical exam was notable for tachypnea, diffuse abdominal tenderness, and profound confusion. Initial work-up revealed severe DKA and hyperkalemia. Toxicology screen was positive for amphetamines and THC. Head imaging was unremarkable. The patient was treated with regular insulin and bicarbonate drips, intravenous calcium, and fluids. Autoantibodies associated with type 1 diabetes were negative and C-peptide was low, suggesting a diagnosis of type 2 diabetes with depletion of pancreatic islet cells. The patient’s DKA and hyperkalemia resolved with the above therapies. His hospital course was complicated by ongoing AMS and heavy oral secretions due to a lung abscess. This necessitated intubation and ultimately a tracheostomy. The patient was ultimately discharged to a long-term acute care facility.

Discussion: This case demonstrates severe DKA in a patient with insulin-dependent diabetes with negative autoantibodies following methamphetamine ingestion. While research on the interplay between methamphetamine use and DKA is scarce, one study examined autopsy and toxicology case files for the presence of methamphetamine in post-mortem blood samples¹. They found a significantly increased rate of DKA in patients with insulin-dependent diabetes who use methamphetamine (66.7%) compared to patients with insulin-dependent diabetes alone (6%). While cause and effect cannot be established by that study or this patient case, further investigation into the role of methamphetamine as a possible precipitator for DKA is warranted.

References: 1. Methamphetamine use and the risk of diabetic ketoacidosis. Lewis D, van den Heuvel, Kenneally M, Byard RW - Med Sci Law - January 1, 2022; 62 (1); 39-42. 2. Active use of cocaine: an independent risk factor for recurrent diabetic ketoacidosis in a city hospital. Nyenwe EA, Loganathan RS, Blum S, Ezuteh DO, Erani DM, Wan JY, Palace MR, Kitabchi AE - Endocr Pract - January 1, 2007; 13 (1); 22-9