Transient state of NIDDM in a patient with AIDS.
OBJECTIVE
To describe a glucose abnormality in AIDS that is characterized by transient NIDDM followed by hyperinsulinemic normoglycemia.


METHODS
A 36-yr-old Hispanic man with AIDS was on long-standing aerosolized pentamidine therapy in 1986. He received a course of intravenous pentamidine 5 mo before the onset of diabetes. Nonketotic hyperglycemia responded to sulfonylurea, which had to be discontinued 3 mo later because of normoglycemia.


RESULTS
Diabetes diagnosis was made by three separate fasting blood glucose values of 16.2, 18.1, and 29.9 mM, and HbA1C of 10.1% (normal 4.2-5.9). The patient became euglycemic 5 mo after diagnosis while on no treatment. An oral glucose tolerance test was then normal, and C-peptide stimulation showed supra-normal response.


CONCLUSIONS
Transient severe NIDDM in this case could not be linked to acute stress. Pentamidine, in a progressively increasing cumulative dose, is one possible, albeit unusual, etiology because the diabetes was not permanent. After diabetes remission, the data suggest residual insulin resistance that is unusual in HIV-positive patients. Diverse glucose abnormalities exist in AIDS. Awareness of their presentation is clinically helpful.
Abourizk
N N
NN
Department of Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105.
Lyons
R W
RW
Madden
G M
GM
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D005934:Glucagon / Q000627:therapeutic use; D005951:Glucose Tolerance Test; D005905:Glyburide / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D010419:Pentamidine / Q000627:therapeutic use; D011384:Proinsulin / Q000097:blood
D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D010419:Pentamidine; D005934:Glucagon; D011384:Proinsulin; D005905:Glyburide