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Diagnosis and Treatment > Medication

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Senhong Lee of Endocrinology, Monash Health, Clayton, Victoria, Australia

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Aparna Morgan of Endocrinology, Monash Health, Clayton, Victoria, Australia

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Sonali Shah of Endocrinology, Monash Health, Clayton, Victoria, Australia

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Peter R Ebeling of Endocrinology, Monash Health, Clayton, Victoria, Australia
Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia

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Summary

We report a case of a 67-year-old man with type 2 diabetes presented with diabetic ketoacidosis, two weeks after his first dose of nivolumab therapy for non–small-cell lung carcinoma. He was started on empagliflozin two days prior in the setting of hyperglycaemia after the initiation of nivolumab therapy. Laboratory evaluation revealed an undetectable C-peptide and a positive anti-glutamic acid decarboxylase (GAD) antibody. He was treated with intravenous fluids and insulin infusion and was subsequently transitioned to subcutaneous insulin and discharged home. He subsequently has developed likely autoimmune thyroiditis and autoimmune encephalitis.

Learning points:

  • Glycemic surveillance in patients receiving immune checkpoint inhibitors is recommended.

  • Early glycemic surveillance after commencement of anti-programmed cell death-1 (PD-1) inhibitors may be indicated in selected populations, including patients with underlying type 2 diabetes mellitus and positive anti-glutamic acid decarboxylase (GAD) antibody.

  • Sodium-glucose co transporter-2 (SGLT2) inhibitors should be used with caution in patients on immunotherapy.

Taxonomy:
Clinical Overview, Gland/Organ, Pancreas, Topic, Diabetes, Hormone, Insulin, Thyroxine (T4), TSH, Condition/ Syndrome, Autoimmune disorders, Diabetes mellitus type 2, Diabetic ketoacidosis, Hyperglycaemia, Hyperthyroidism, Iatrogenic disorder, Thyroiditis, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, White, Country of Treatment, Australia, Diagnosis and Treatment, Signs and Symptoms, Coughing, Diabetes mellitus type 2, Diabetic ketoacidosis, Fatigue, Hyperglycaemia, Hyperthyroidism, Metabolic acidosis, Polydipsia, Polyuria, Seizures, Investigation, Anion gap, Bicarbonate, Biopsy, C-peptide (blood), CT scan, FT4, GADA, Glucose (blood), Haemoglobin A1c, Ketones (plasma), TSH, Intervention, Chemotherapy, Fluid repletion, Medication, Carboplatin, DPP4 inhibitors, Empagliflozin, Insulin, Metformin, Nivolumab, Paclitaxel, SGLT2 inhibitors, Sitagliptin, Related Disciplines, Oncology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-18-0021
Volume/Issue:
Volume 2018: Issue 1
Open access