Diabetic ketoacidosis caused by fulminant type 1 diabetes during adjuvant chemotherapy for colon cancer: A case report

Iwata, Yoshinori; Matsuhashi, Nobuhisa; Takahashi, Tsuyoshi; Suetsugu, Tomonari; Fukada, Masahiro; Yasufuku, Itaru; Imai, Takeharu; Tanahashi, Takao; Matsui, Shinji; Imai, Hisashi; Tanaka, Yoshihiro; Yamaguchi, Kazuya; Yoshida, Kazuhiro

doi:10.3892/mco.2019.1862

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Tegafur-uracil is another 5-FU prodrug, for which there have been two case reports of not only associated hyperglycaemic but also fulminant type 1 diabetes 7 8. Similar to capecitabine, tegafur is hepatically metabolised via thymidine phosphorylase to 5-FU 9.…”

Section: Discussionmentioning

confidence: 99%

Capecitabine-induced hyperosmolar hyperglycaemic state

2021

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An elderly woman with metastatic breast cancer was admitted with hyperglycaemic hyperosmolar state (HHS) and an elevated haemoglobin A1C. For 1 week, she had experienced confusion, nausea and frequent urination. Preceding this, she had completed seven cycles of capecitabine chemotherapy for her breast cancer. She did not have a history of diabetes prior to chemotherapy. Given the temporal dysglycaemia following the patient’s chemotherapy regimen, capecitabine was thought to be a probable offending agent. The patient was acutely treated for HHS, and was discharged on a basal-bolus insulin regimen. Her capecitabine was held pending review with her oncology team. The patient was ultimately titrated down to basal insulin only by her family doctor. Given the common use of capecitabine, it is important to recognise the risk of hyperglycaemic and hyperglycaemic emergencies as potential adverse effects. This highlights the need to monitor blood glucose throughout treatment to prevent hyperglycaemic emergencies.

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Section: Discussionmentioning

confidence: 99%

Capecitabine-induced hyperosmolar hyperglycaemic state

2021

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“…While 5-FU-associated hyperglycemia was typically mild during active treatment (95% had glucose < 14 mmol/L), after therapy was complete it was noted that seven out of 42 patients developed significant hyperglycemia (>14 mmol/L), and one patient in the study died of ketoacidosis[ 3 ]. Aside from this study, there are two additional case reports of DKA associated with 5-FU based treatments[ 72 , 73 ].…”

Section: -Fu and Derivativesmentioning

confidence: 99%

Current cancer therapies and their influence on glucose control

Yim¹,

Mansell²,

Hussein³

et al. 2021

WJD

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This review focuses on the development of hyperglycemia arising from widely used cancer therapies spanning four drug classes. These groups of medications were selected due to their significant association with new onset hyperglycemia, or of potentially severe clinical consequences when present. These classes include glucocorticoids that are frequently used in addition to chemotherapy treatments, and the antimetabolite class of 5-fluorouracil-related drugs. Both of these classes have been in use in cancer therapy since the 1950s. Also considered are the phosphatidyl inositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR)-inhibitors that provide cancer response advantages by disrupting cell growth, proliferation and survival signaling pathways, and have been in clinical use as early as 2007. The final class to be reviewed are the monoclonal antibodies selected to function as immune checkpoint inhibitors (ICIs). These were first used in 2011 for advanced melanoma and are rapidly becoming widely utilized in many solid tumors. For each drug class, the literature has been reviewed to answer relevant questions about these medications related specifically to the characteristics of the hyperglycemia that develops with use. The incidence of new glucose elevations in euglycemic individuals, as well as glycemic changes in those with established diabetes has been considered, as has the expected onset of hyperglycemia from their first use. This comparison emphasizes that some classes exhibit very immediate impacts on glucose levels, whereas other classes can have lengthy delays of up to 1 year. A comparison of the spectrum of severity of hyperglycemic consequences stresses that the appearance of diabetic ketoacidosis is rare for all classes except for the ICIs. There are distinct differences in the reversibility of glucose elevations after treatment is stopped, as the mTOR inhibitors and ICI classes have persistent hyperglycemia long term. These four highlighted drug categories differ in their underlying mechanisms driving hyperglycemia, with clinical presentations ranging from potent yet transient insulin resistant states [type 2 diabetes mellitus (T2DM) -like] to rare permanent insulin-deficient causes of hyperglycemia. Knowledge of the relative incidence of new onset hyperglycemia and the underlying causes are critical to appreciate how and when to best screen and treat patients taking any of these cancer drug therapies.

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Tegafur/uracil

2019

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Diabetic ketoacidosis caused by fulminant type 1 diabetes during adjuvant chemotherapy for colon cancer: A case report

Cited by 3 publications

References 21 publications

Capecitabine-induced hyperosmolar hyperglycaemic state

Capecitabine-induced hyperosmolar hyperglycaemic state

Current cancer therapies and their influence on glucose control

Tegafur/uracil

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