‘Disappearing diabetes’—resolution of apparent Type 1 diabetes in a patient with AIDS and cytomegalovirus (CMV) infection

Authors: Evans, E. M.¹; Nye, F.¹; Beeching, N. J.; Gill, G. V.²

Source: Diabetic Medicine, Volume 22, Number 2, February 2005 , pp. 218-220(3)

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Abstract:

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 HbA_1c 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.

Diabet. Med. 22, 218–220 (2005)

Keywords: HIV infection; AIDS; diabetes mellitus; Type 1 diabetes; diabetic ketoacidosis; cytomegalovirus

Document Type: Case report

DOI: http://dx.doi.org/10.1111/j.1464-5491.2005.01364.x

Affiliations: 1: Department of Infectious Diseases, Royal Liverpool University Hospital and 2: Liverpool School of Tropical Medicine, Liverpool, UK

Publication date: 2005-02-01