Prediabetes Directly Deteriorates into Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome Triggered by Acute Pancreatitis: A Case Report Illustrating a “Chicken and Egg” Paradigm in Ketosis-Prone Diabetes

Abstract

IntroductionDiabetic crises occur most often in patients with type 1 diabetes and occasionally in type 2 diabetes, especially under stressful conditions. However, a diabetic crisis occurring directly from prediabetes is an unusual phenomenon.Case ReportA 45-year-old woman presented with postprandial left upper quadrant abdominal pain, nausea, and vomiting. She had a past medical history of prediabetes with impaired fasting glucose and HbA1c 6.4%. On admission, routine laboratory tests showed high anion gap metabolic acidosis (pH 6.92), anion gap 41 mmol/L, blood glucose 931 mg/dL, beta-hydroxybutyrate 28 mmol/L, and calculated effective osmolarity 322 mOsm/kg; she was diagnosed with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS), and DKA-related abdominal pain. Later, the patient was found to have elevated lipase and amylase, and diagnosed with acute pancreatitis. Since DKA can induce abdominal pain and nonspecific lipase elevation, both of which are characteristics of acute pancreatitis, while acute pancreatitis can conversely trigger DKA, there exists a “chicken and egg” paradigm. Therefore, the differential diagnosis is discussed.ConclusionIt is important to differentiate DKA from concomitant causes of abdominal pain to avoid missing the underlying etiology, which can be the trigger for DKA. During diabetic crises, treating the underlying trigger is just as important as managing metabolic derangements in order to achieve favorable outcomes; meanwhile, managing acute pancreatitis-associated hyperglycemia can promote recovery. Additionally, diabetic crisis that directly evolves from prediabetes illustrates an atypical form of diabetes called ketosis-prone diabetes; we briefly discuss its clinical characteristics, classification, and follow-up.

Acute Abdomen in Diabetic Patients - What Should We Do?

“…The clinical findings in acute pancreatitis may be miscellaneous, as the physical and biological findings of metabolic disorders are quite obvious, while the abdominal signs are not very specific; they tend to be rather subtle and delayed. Therefore, treating the underlying trigger during diabetic crises is just as important as managing metabolic disturbances in order to achieve favorable outcomes; meanwhile, managing acute pancreatitis-associated hyperglycemia can promote recovery (22).…”

Developing a Classification Algorithm for Prediabetes Risk Detection From Home Care Nursing Notes

“…Although we named the categories “DKA symptoms” and “diabetic foot,” the symptoms under each category are not as severe as diabetes complications. According to Song and Cao, 29 DKA symptoms were found in prediabetic patients. In addition, patients with preDM have been documented to have skin conditions such as delayed wound healing and bulla, as well as peripheral neuropathy symptoms such as burning and soreness 30,31 .…”

Ketosis-prone diabetes mellitus in an obese adolescent

“…[7] However, as reported in this case, there may be an overlap in the presentations of the 2 disorders, which creates a diagnostic dilemma. [8–10] Questions raised as we review the clinic process of the young ketosis prone diabetes patients. How to classify type of diabetes for the young patient based on his initial presentation?…”