'Disappearing diabetes'--resolution of apparent Type 1 diabetes in a patient with AIDS and cytomegalovirus (CMV) infection.
A 30-year-old African female with established acquired immunodeficiency syndrome (AIDS) and no history of diabetes, presented in severe diabetic ketoacidosis (DKA). Blood pH was 6.96, serum bicarbonate 5 mmol/l, plasma glucose (PG) 33.0 mmol/l, and urine heavily positive for ketones. She responded to standard treatment and was established on twice-daily subcutaneous insulin. Four months later her insulin was stopped because of hypoglycaemic attacks on small doses. A glucose tolerance test (GTT) at 6 months postdiagnosis was normal (fasting PG 4.4 mmol/l and 2 h PG 7.5 mmol/l), and at 12 months random PG was 4.1 mmol/l and HbA1c 4.3%. The onset of her apparent Type 1 diabetes coincided with an HIV-associated cytomegalovirus (CMV) infection, and a reversible 'CMV insulitis' may be an explanation. Alternatively, the patient may have had what has recently been described as 'atypical diabetes' in African or Afro-Caribbean diabetic patients. Here resolution of diabetes may occur after presentation, though complete return to normoglycaemia after true DKA is very unusual.
Evans
E M
EM
Department of Infectious Diseases, Royal Liverpool University Hospital, Liverpool, UK.
Nye
F
F
Beeching
N J
NJ
Gill
G V
GV
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000279:Administration, Cutaneous; D000328:Adult; D003586:Cytomegalovirus Infections / Q000150:complications*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D012075:Remission, Spontaneous
D007004:Hypoglycemic Agents; D007328:Insulin