In the best tradition of medical practice, this essential text shares a wealth of insight into some of the most challenging diagnoses and clinical experiences from leading diabetologists around the world.
Regardless of where a clinician is in their practice, learning never ends. The 49 detailed case studies presented in Diabetes in Practice can broaden understanding and elevate patient care across the spectrum of settings.
Further, expert commentaries by Mary Korytkowski, MD, Louis Philipson, MD, PhD, Anne Peters, MD, and Boris Draznin, MD, PhD, highlight the important lessons and takeaways from each case.
This collection has been carefully curated to enhance diabetes practice, and addresses such topics as:
Atypical Diabetes
Diabetic Ketoacidosis (DKA) and Euglycemic DKA
Cancer Therapy and Diabetes
Autoimmunity and Diabetes
Continuous Glucose Monitoring (CGM) and Insulin Pumps
Hypoglycemia, and more
"Index", Diabetes in Practice: Case Studies with Commentary, Boris Draznin, MD, PhD
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Page numbers followed by an f refer to figures. Page numbers followed by a t refer to tables.
A
acetoacetic acid ketone accumulation, in diabetic ketoacidosis (DKA), 60
acetone.ketones accumulation, in diabetic ketoacidosis (DKA), 60
acromegaly presenting with diabetic
ketoacidosis (DKA), 47–48
IGF-1 levels linear relationship with HbA1c (AIC), 48, 48f, 49
laboratory testing results, 47
pituitary macro-adenoma and, 47
rarity of, 48, 49
trans-sphenoidal pituitary resection for, 47
acute febrile neutrophilic dermatosis. See Sweet’s syndrome
adrenal steroidogenesis inhibitors medical therapy, for Cushing’s Disease (CD), 35
alcohol abuse, type 1 diabetes (T1D) and, 148
alpelisib therapy, 86, 88
phosphatidylinositol 3-kinase (PI3K) inhibition due to, 87
alpelisib-induced hyperglycemia, 86–87
laboratory test results, 86
metformin therapy, 86, 88
PIK3CA mutation, 86
American Diabetes Association (ADA) dietary recommendations of, 73
on gestational diabetes screening, 107
on latent autoimmune diabetes in adults (LADA) within type 1 diabetes (T1D) classification, 116
on low-carbohydrate diets, 63
type 2 diabetes (T2D) medical management algorithm, 163
antibiotic use, refractory hypoglycemia due to, 150–152, 151t
antibody-positive diabetes, postpartum, 108
autoimmune (AI) diabetes, 14
autoantibodies testing for, 119
β-cell function recovery, 81
features of, 13
GAD65 antibodies and, 118
immune checkpoint inhibitor (ICI) therapy cause of, 51–52, 61, 80–81, 84
autoimmune (AI) diabetes, lupus flare cause of, 118
laboratory test results, 118, 119t
autoimmune (AI) diabetes, onset
during pregnancy, 107
laboratory test results, 107
latent autoimmune diabetes in adults (LADA) and, 108, 109f
positive GAD antibodies and, 109, 109f
type 1 diabetes (T1D) education, 108
autoimmune (AI) diabetes illusion, 114–115
laboratory test results, 114, 115t
autoimmune diseases
development of multiple, 118–119
glucocorticoid therapy for, 135
latent autoimmune diabetes in adults (LADA) autoimmune markers, 115
with type 1 diabetes (T1D), 9, 112
types of, 112
autoimmune hepatitis, type B insulin resistance (TBIR) with, 97–98, 98t, 99f, 100–102, 100f
automated insulin infusion system, for blood glucose concentration control in type 1 diabetes (T1D), 132
function of, 132–133
on glycemic trend and time in range (TRI), 133f
MiniMed 670G, 132, 133, 134
patient COVID-19 virus and, 132–133, 134
autosomal-dominant familial diabetes, Maturity-Onset Diabetes of the Young (MODY) as, 38
B
basal insulin with glucagon-like peptide-1 receptor agonists (GLP-IRAs), basal-bolus insulin therapy transition to, 163–164
basal-bolus insulin therapy, 8, 50, 71, 72
transition to basal insulin with glucagon-like peptide-1 receptor agonists (GLP-1RAs), 163–164
for type 1 diabetes (T1D), 82
β-cell. See also pancreatic β-cell
dysfunction
autoimmune (AI) diabetes function recovery of, 81
immune checkpoint inhibitor (ICI) diabetes and partial destruction of, 80, 81–82, 81f, 85
immune checkpoint inhibitor (ICI) induced diabetes and function recovery of, 84
insulin secretion, 147
ββ-hydroxybutyric acid ketone accumulation, in diabetic ketoacidosis (DKA), 60
blood glucose
concentration control, with automated insulin infusion system, 132, 133–134, 133f
pembrolizumab effect on levels of, 81–82, 81f
in type B insulin resistance (TBIR), with lupus nephritis and autoimmune hepatitis, 99f
breast cancer, 91–92, 94, 96, 150 phosphatidylinositol 3-kinase (PI3K) inhibitor with fulvestrant for, 90, 93
bullous pemphigoid, dipeptidyl peptidase-4 inhibitors association with, 28
C
cancer
breast, 90–94, 96, 150
clear cell carcinoma, 50–51
clival metastasis, 20, 21
immune checkpoint inhibitor (ICI) therapy for, 50–51, 52, 77–78
lung, 77–78, 83–85
lung and bone, 86–88
melanoma, 80–82
pancreatic, 18, 20–22
PI3K/ACT pathway mutations, 94
cardiovascular disease
diabetes and prevalence of, 199– 201
glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment for protection from, 165, 193
catabolism, as cystic fibrosis-related diabetes (CFRD) result, 156, 157
childhood obesity, type 2 diabetes (TD2) and, 9
chronic obstructive pulmonary disease (COPD), 23
prednisone exacerbation of, 138 Classic Sweet’s syndrome, 26, 27t
clear cell carcinoma, immune checkpoint inhibitor (ICI) insulinopenic diabetes., 50–51
clival metastasis, 20, 21
computed tomography (CT) scan
for Cushing’s Disease (CD), 33
for pancreatic adenocarcinoma, 20, 21, 22
Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer (CPDPC), 22
continuous glucose monitor (CGM), 72, 74, 91f, 92f
for cystic fibrosis-related diabetes (CFRD), 158, 159
for glucagon-like peptide 1 receptor agonists (GLP-1RAs), type 2 diabetes (T2D) on high-dose insulin therapy, 171–172
for immune checkpoint inhibitor (ICI) induced diabetes, 83
for variable insulin doses monitoring, 93
continuous glucose monitor (CGM), with type 1 diabetes (T1D) and Down’s syndrome, 123–124
caregivers diabetes education, 125
glycemic control improvement through, 124, 124t, 125
hypoglycemic episodes findings, 123–125
laboratory test results, 123
time in range (TIR) and time below range (TBR) with, 124, 124t
treatment for, 123
continuous glucose monitor (CGM) patterns, of glucocorticoid-treated patient with diabetes, 135
algorithm for management of, 140f
clinical practice implications for, 139
glucocorticoid therapy for inflammatory and autoimmune diseases, 135
laboratory test results, 135, 136f
report before and after prednisone use, 136–137f
treatment, 135
continuous subcutaneous insulin
infusion (CSII) pump, U-500 regular (U-500R) insulin in
ambulatory glucose profile pre-intervention, 128f
daily report example, 128f, 130f
Evaluating U-500R Infusion Versus Injection in Type 2 Diabetes (VIVID) study, 127, 128–129
faster-acting insulin aspart (FiAsp) addition, 129, 130f
laboratory test results, 127
meal bolus need via, 129–130
patient medical history, 127
treatment, 127
corticosteroids
for refractory hypoglycemia, 147
Sweet’s syndrome challenge of, 27, 28
cortisol, glucose tolerance and insulin insensitivity from, 34, 35
COVID-19 virus
automated insulin infusion system and, 132–133, 134
euglycemic diabetic ketoacidosis (eDKA) treatment restrictions, 54–55
euglycemic diabetic ketoacidosis (eDKA) with, 54–55, 55f, 56, 57
obesity and diabetes risk factors, 177
persistent hyperglycemia in, 175
starvation ketosis and, 56
transient severe insulin resistance (IR) in prediabetes and, 175–177
CTLA-4 role, in immune checkpoint inhibitor (ICI) insulinopenic diabetes, 51, 77–78, 83, 85
Cushing’s Disease (CD)
adrenal steroidogenesis inhibitors medical therapy for, 35
computed tomography (CT) scan and, 33
cortisol influence on, 34, 35
diabetes prevalence in, 34
glucocorticoids excess, 36, 138
glucose intolerance associated with, 33–36
inferior petrosal sinus (IPS) sampling, 34, 34t, 35
intraglandular ACTH-producing microadenoma concern, 35
ketoconazole monotherapy for glycemic control in, 35
laboratory testing results, 33
pituitary exploration, 35
treatment for, 34–36
cystic fibrosis (CF)
cystic fibrosis-related diabetes (CFRD) complication from, 156, 159
cystic fibrosis-related diabetes (CFRD) pulmonary functioning worsening, 157
cystic fibrosis transmembrane
conductance regulator (CFTR) modulator
β-cell dysfunction from, 159–160
for cystic fibrosis-related diabetes (CFRD) glycemic control, 158–159
cystic fibrosis-related diabetes (CFRD), 159
catabolism as result of, 156, 157
complications associated with, 157
cystic fibrosis (CF) mortality and, 156
insulinopenia result, 156
multifactorial pathophysiology of, 156
prevalence of, 156
pulmonary function worsening from, 157
cystic fibrosis-related diabetes (CFRD), cystic fibrosis transmembrane conductance
regulator (CFTR) modulator on
glycemic control, 158–159
clinical problems from, 160
continuous glucose monitoring (CGM) and, 158, 159
laboratory test results, 158, 159
PROMISE observational study on, 160
Trikafta treatment, 158, 159
cystic fibrosis-related diabetes (CFRD), insulin therapy role in, 155
laboratory test results, 155
only recommended treatment for, 156–157
pulmonary function and weight decline, 155, 156f, 157
D
dextrose, as hypoglycemia mainstay treatment, 147
diabetes. See also type 1 diabetes (T1D); type 2 diabetes (T2D) cardiovascular disease prevalence with, 199–201
COVID-19 risk factor of, 177
Cushing’s Disease (CD) prevalence of, 34
glucocorticoid-induced, 137, 138t
ketogenic diet (KD) advocated for, 73, 74
steroid-induced, 35
as Sweet’s syndrome trigger, 27
systemic lupus erythematosus (SLE) comorbidity with, 111, 112, 120
diabetes, unusual type, 12–13
GAD65 trends, 13t
patient characteristics, 13t
diabetes management, for ventricular assist device (VAD) implantation, 199, 200–201
diabetes progression
in latent autoimmune diabetes in adults (LADA), 14
in Maturity-Onset Diabetes of the Young (MODY)-4, 6–7
diabetes types
appropriate pharmacological therapy for, 10
characteristics comparison, 10t
classification of, 14t
genetic testing importance, 11
diabetes-related complications, of Maturity-Onset Diabetes of the Young (MODY)-4, 5
diabetic ketoacidosis (DKA), 20
acetoacetic acid, β-hydroxybutyric acid, and acetone.ketones accumulation, 60
acromegaly presenting with, 47–48, 48f, 49
characteristics of and defects in, 67
in end-state renal disease (ESRD), 66
histiocytosis-lymphadenopathy plus (HLP) syndrome, 42–43
hyperglycemia and, 49, 67, 68
with preserved renal function, 68 rapid-onset type 1 diabetes (T1D), 50, 51
from severe insulin deficiency, 48, 49
sodium-glucose cotransporter 2 (SGLT2) inhibitors and ketone body production, 72
type 1 diabetes (T1D) age and presentation of, 22
Wolcott-Rallison syndrome (WRS) and, 30
diabetic kidney disease, type 1 diabetes (T1D) risk for, 180–182, 181f
dietary recommendations, of American Diabetes Association (ADA), 73
dipeptidyl peptidase-4 inhibitors, bullous pemphigoid association with, 28
Down’s syndrome
continuous glucose monitoring (CGM) and type 1 diabetes (T1D) with, 123–124, 124t, 125
inability to express hypoglycemia symptoms, 124
type 1 diabetes (T1D) prevalence in, 124
Drug-induced Sweet’s syndrome, 26, 27t
durvalumab, for immune checkpoint inhibitor (ICI) induced diabetes, 83
E
encephalitis complications, of Sweet’s
syndrome, 26
endocrinopathy
immune checkpoint inhibitor (ICI) therapy cause of, 51, 52
irreversible, 51
endoscopic ultrasound (EUS), 20, 21
end-stage renal disease (ESRD), diabetic ketoacidosis (DK) in, 66
complications risk from, 66–67
diagnosis challenge in, 68, 69
hypokalemia and hypophosphatemia, 67–68
hypovolemia in, 67–68
laboratory test results for, 66, 67t
lower insulin infusion rate for, 68, 69
management guidelines absence, 67
management recommendations, 69t
metabolic acidosis rapid development in, 67
treatment for, 66, 67t
Enriching New-Onset Diabetes for Pancreatic Cancer (END-PAC) model, 21
eosinophilic vasculitis, high-dose steroids treatment for, 37 euglycemic diabetic ketoacidosis (eDKA), 67
causes of, 63
diagnosis challenge for, 72
diagnostic criteria for, 55
precipitants for, 56, 72
recovery with recognition and appropriate treatment, 64
euglycemic diabetic ketoacidosis (eDKA), after ketogenic diet (KD) with type 2 diabetes (T2D) on sodium-glucose cotransporter 2 (SGLT2) inhibitor, 62
clinical signs and symptoms recognition failure, 63–64
laboratory test results, 62
mechanisms from, 63
presentation of, 62, 63
subarachnoid hemorrhage, 62, 63, 64
euglycemic diabetic ketoacidosis (eDKA), due to sodium-glucose cotransporter 2 (SGLT2)
inhibitor use, 58–59
challenges of, 60
immunotherapy-induced type 1 diabetes concern, 58–59
laboratory test results, 58, 59t
low-carbohydrate diets caution, 60
presentation of, 58
urine and serum ketones monitoring for, 60, 61, 64
euglycemic diabetic ketoacidosis (eDKA), with COVID-19
infection
laboratory test results, 54
metabolic profile trends, 55f
presentation of, 54
with sodium-glucose cotransporter 2 inhibitor use, 54–55
treatment for, 54–55, 56, 57
euglycemic diabetic ketoacidosis (eDKA) with type 1 diabetes (T1D) treated with sodium-glucose cotransporter 2 (SGLT2) inhibitor while on ketogenic diet (KD), 71–72
basal-bolus insulin therapy for, 71
continuous glucose monitor (CGM) for, 72, 74
laboratory test results, 71, 72t
presentation of, 71
serum changes graphic representation, 73f
treatment of, 71–72
Evaluating U-500R Infusion Versus Injection in Type 2 Diabetes (VIVID) study
continuous subcutaneous insulin infusion (CSII) settings protocol, 128–129
nocturnal hypoglycemia observation, 128
F
Faisalabad histiocytosis classification, of histiocytosis-lymphadenopathy plus (HLP) syndrome, 43
faster-acting insulin aspart (FiAsp), 129, 130f
fasting hypoglycemia, in Roux-en-Y gastric bypass (RYGB) patients, 143–145
fetal malformation related to obesity and type 2 diabetes (T2D), 184
increased folate before and during pregnancy, 184–186
of neural tube defect (NTD), 184–186
preconception counseling importance, 185, 186
folate intake, before and during pregnancy, 184–186
FOLFIRINOX chemotherapy, for pancreatic adenocarcinoma, 20
Food and Drug Administration (FDA), U.S.
durvalumab approved immunotherapy by, 83
phosphatidylinositol 3-kinase (PI3K) inhibition approval by, 87
Trikafta approval by, 160
Fournier’s gangrene, sodium–glucose
cotransporter 2 (SGLT2) inhibitors association with, 28
fractures, Wolcott-Rallison syndrome (WRS) and multiple, frequent, 31
fulvestrant with phosphatidylinositol 3-kinase (PI3K) inhibitor, for breast cancer, 90, 93
G
GAD65 antibodies, 8, 9, 12, 72
autoimmune (AI) diabetes and, 118
immune checkpoint inhibitor (ICI) therapy and anti-, 52, 78
in neurologic diseases, 119
seroconversion of, 119, 120
systemic lupus erythematosus (SLE) increase in, 120
trends, 13t
GCK gene mutation, in Maturity-Onset Diabetes of the Young (MODY)-2, 39
gemcitabine, for pancreatic adenocarcinoma, 20–21
gene therapy research, on Maturity-Onset Diabetes of the Young (MODY)-4, 6
genetic testing, 2, 5
diabetes types importance of, 11
glucokinase mutation, 37
heterozygous IPF1 mutation, 6
homozygous mutation in the EIF2AK3 gene, 29
PIK3CA mutation, 86
R122H PRSS1 (protease serine 1) variant, 16, 18
SLC29A3 gene mutation, 43, 45
gestational diabetes, 107
Maturity-Onset Diabetes of the Young (MODY)-4 presenting as, 5
ongoing indefinite screening with history of, 108
glucagon-like peptide-1 (GLP-1) agonist
for immune checkpoint inhibitor (ICI) diabetes, with partial
β-cell destruction, 81–82
liraglutide as, 82
glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment benefits of, 193
cardiovascular protection from, 165, 193
for Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B), 3
for type 2 diabetes (T2D) and rethinking insulin, 192–193
glucagon-like peptide-1 receptor agonists (GLP-IRAs), type 2 diabetes (T2D) on high-dose insulin therapy effects, 164, 171–172, 192–193
cautions for, 172–173
continuous glucose monitoring (CGM) for, 171–172
patient education importance, 173–174
risks for, 173
treatment with, 171–172
glucagon-like peptide 1 receptor
agonists (GLP-IRAs) treatment basal-bolus insulin therapy transition to, 163–164
cardiovascular benefits of, 165, 193
type 2 diabetes (T2D) management by, 164, 171–172, 173–174, 192–193
glucocorticoid therapy
for inflammatory and autoimmune diseases treatment, 135
prednisone as, 136–137f, 137, 138
glucocorticoid-induced diabetes, 137, 138t
glucocorticoids excess, Cushing’s Disease and, 36, 138
glucocorticoid-treated patient, continuous glucose monitoring (CGM) of, 135, 136–137t, 136–139, 140f
glucose homeostasis, phosphatidylinositol 3-kinase (PI3K)/AKT pathway for, 93, 94
glucose intolerance associated with Cushing’s Disease (CD), 33–36
glucose tablets, 189
glycemic control
insulin regimen simplification for elderly patients and improvement in, 167–168
ketoconazole monotherapy for Cushing’s Disease (CD), 35
granulocyte colony-stimulating factor (G-CSF) treatment
for Wolcott-Rallison syndrome (WRS), 29, 30, 31
Graves’ hyperthyroidism, 12
growth retardation
histiocytosis-lymphadenopathy plus (HLP) syndrome and, 42
Wolcott-Rallison syndrome (WRS) and, 30, 31
H
H syndrome
clinical characteristics and presentation of, 44–45t
hyperpigmentation of, 42–46, 43f
sensorineural hearing loss of, 42–46
type 1 diabetes (T1D) of, 42–46
Hashimoto’s thyroiditis, 9, 179
HbA1c (AIC), IGF-1 levels linear relationship with, 48, 48f, 49
hepatocyte nucleotide factor 1B (HNF1B), Maturity-Onset Diabetes of the Young (MODY) and, 3
hereditary pancreatitis
pancreatic cancer and, 18
R122H PRSS1 (protease serine 1) variant and, 16, 18
heroin, insulin and, 202–203
heterozygous IPF1 mutation, Maturity-Onset Diabetes of the Young (MODY)-4 and, 5, 6
histiocytosis-lymphadenopathy plus (HLP) syndrome
diabetic ketoacidosis (DKA) and, 42–43
Faisalabad histiocytosis classification, 43
growth retardation and, 42
H syndrome classification, 43–46
hyperpigmented area and, 42–46, 43f
laboratory tests for, 42
pigmented hypertrichosis with insulin-dependent diabetes (PHID) classification, 43
Rosai-Dorfman disease classification, 43
SLC29A3 gene mutation, 43, 45
histopathology slide, of Sweet’s
syndrome, 26f
homozygous IPF1 mutation, neonatal pancreatic agenesis and, 6
homozygous mutation in the EIF2AK3 gene, in Wolcott-Rallison syndrome (WRS), 29, 30, 31
hybrid closed-loop system, as automated insulin infusion system, 134
hyperglycemia, 2
COVID-19 and persistent, 175
diabetic ketoacidosis (DKA) and, 49, 67, 68
diet modification for, 101
medication considerations, 93
metformin as first-line treatment for, 93
pancreatic β-cell dysfunction and, 10, 81, 84
phosphatidylinositol 3-kinase (PI3K) inhibition side effect, 87, 88
recurrent, 15
sodium-glucose cotransporter 2 (SGLT2) inhibitors for management of, 101, 102
stress, 176, 177
hyperglycemia from oral comfort feeds, 188–189
laboratory test results, 188
oral mucosa evaluation in, 189
of patient with mental health and polysubstance abuse concerns, 188–189
presentation of, 188
hyperinsulemic hypoglycemia after Roux-en-Y gastric bypass (RYGB) surgery, 143–144
fasting and postprandial, 143–145
low-carbohydrate diet or low-carbohydrate mixed meals for, 144
nesidioblastosis of patient, 143, 144, 145
patient pancreatectomy, 144
selective arterial calcium stimulation testing, 145
hyperinsulinemia, in Maturity-Onset
Diabetes of the Young (MODY)-4, 6, 7
hyperpigmented area, in histiocytosis-lymphadenopathy plus (HLP) syndrome, 42–46, 43f
hypoglycemia, 12
alcohol use and, 146, 148
continuous glucose monitoring (CGM) for Down’s syndrome adult episodes of, 123–125
dextrose as mainstay treatment for, 147
Down’s syndrome inability express symptoms of, 124
Evaluating U-500R Infusion Versus Injection in Type 2 Diabetes (VIVID) study observation of nocturnal, 129
in hospitalized patients and glucose tablets, 189
medication interactions and, 151
pancreatogenic (Type 3c) diabetes higher risk for, 18
hypokalemia, 33
in diabetic ketoacidosis (DK) in end-stage renal disease (ESRD), 67–68
hypophosphatemia, in diabetic
ketoacidosis (DK) in end-stage renal disease (ESRD), 67–68
hypothyroidism
immune checkpoint inhibitor (ICI) diabetes, with partial
β-cell destruction and, 81, 82, 85
Na-l-thyroxine supplementation for treatment of, 30
type 1 diabetes (T1D) and aging risk for, 112
I
immune checkpoint inhibitor (ICI) diabetes, with partial β-cell destruction, 80
clinical course for, 81–82, 81f
glucagon-like peptide-1 (GLP-1) agonists for, 81–82
hypothyroidism and, 81, 82, 85
pembrolizumab effect on blood glucose levels, 81–82, 81f
presentation and laboratory test results for, 80
immune checkpoint inhibitor (ICI) induced diabetes, 83
β-cell function recovery, 84
characteristics for, 84
continuation of immunotherapy challenge, 84, 85
continuous glucose monitoring (CGM) for, 83
diabetes education for, 83, 84
diagnosis for, 83
durvalumab Food and Drug Administration (FDA)-approved immunotherapy for, 83
insulin as mainstay treatment from, 78, 84, 85
laboratory test results, 83
manifestations of, 84
immune checkpoint inhibitor (ICI) induced type 1 diabetes (T1D), 77
insulin therapy requirement, 78, 84, 85
laboratory test results, 77
presentation and treatment, 77
risk assessment strategies for, 78
immune checkpoint inhibitor (ICI) insulinopenic diabetes, rapid-onset, 50–51
immune checkpoint inhibitor (ICI) therapy
anti-GAD65 predominance and, 52, 78
autoimmune (AI) diabetes due to, 51–52, 61, 80–81, 84
endocrinopathy caused by, 51, 52
hypothyroidism side effect of, 81, 82, 85
malignancies management by, 50–51, 52, 77–78
PD-1 and CTLA-4, 51, 77–78, 83, 85
Immunology of Diabetes Society, 10
immunotherapy-induced type 1 diabetes, 58–59
inferior petrosal sinus (IPS), Cushing’s Disease (CD) sampling, 34, 34t, 35
inflammatory diseases, glucocorticoid therapy for, 135
inflammatory skin condition, Sweet’s syndrome as, 27
insulin allergy
first-line management for, 105
local reactions to, 104
to subcutaneous (SQ) insulin, 103
insulin and heroin patient, 202–203
Medtronic G670 pump, 202–203
presentation, 202
insulin autoantibodies (IAAs), 9
insulin deficiency, diabetic ketoacidosis (DKA) from, 48, 49
insulin insensitivity, from Cushing’s Disease (CD), 34, 35
insulin overdose
corticosteroids for, 147
non-pharmacological therapies for, 147–148
refractory hypoglycemia due to massive unintentional, 146–147
insulin receptor antibodies (AIRAs) testing, 98, 100f, 101
insulin regimen simplification, for elderly patients with type 2 diabetes (T2D), 167–168
glycemic control improvement from, 167–168
insulin resistance (IR)
features and risk factors for, 116
obesity-related, 172
transient severe, in COVID-19 and prediabetes, 175–177
insulin therapy, 5
for immune checkpoint inhibitor (ICI) induced type 1 diabetes (T1D), 78, 84, 85
for pancreatogenic (Type 3c) diabetes, 17, 18
role in cystic fibrosis-related diabetes (CFRD), 155–157
insulinopenia
cystic fibrosis-related diabetes (CFRD) and, 156
PD-1 role in immune checkpoint inhibitor (ICI) insulinopenic diabetes, 51, 77–78, 83, 85
insulin-sensitizing role, of opioids, 203
intraglandular ACTH-producing
microadenoma, Cushing’s Disease (CD) and, 35
islet cell autoantibodies (ICAs), 5, 8, 9, 109f, 118
systemic lupus erythematosus (SLE) increase of, 120
K
ketoacidosis. See diabetic ketoacidosis (DKA)
ketoconazole monotherapy, for Cushing’s Disease (CD) glycemic control, 35
ketogenic diet (KD) advocated for diabetes, 73
effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors and, 87, 88
L
late dumping syndrome, 144
latent autoimmune diabetes in adults (LADA), 2, 9, 10, 108, 109f
autoimmune markers for, 115
disease progression in, 14
features of, 13
immune checkpoint inhibitor (ICI) induced diabetes differentiated from, 84
personalized treatment approach for, 116
within type 1 diabetes (T1D) classification, 116
as type 1.5 diabetes, 13
type 2 diabetes (T2D) differentiation from, 13
latent autoimmune diabetes in adults (LADA), with insulin allergy, 103–104
hospital course of treatment for, 104
laboratory test results, 103
physical exam for, 104
presentation of, 103–104
lifestyle modifications, for Maturity-Onset Diabetes of the Young (MODY)-4, 6
liraglutide, as glucagon-like peptide-1 (GLP-1) agonist, 82
low-carbohydrate diets
alpelisib-induced hyperglycemia and, 87
caution for euglycemic diabetic ketoacidosis (eDKA), due to sodium-glucose cotransporter 2 (SGLT2) inhibitor use, 60
for hyperinsulinemic hypoglycemia, 144
type 2 diabetes (T2D) and, 63
lung cancer, 77–78, 83–85, 86–88
lupus. See also systemic lupus
erythematosus (SLE)
autoimmune (AI) diabetes from flare of, 118, 119t
pneumonitis, 118
type B insulin resistance (TBIR) with nephritis of, 97–98, 98t, 99f, 100–102, 100f
M
Malignancy-associated Sweet’s syndrome, 26, 27t
Maturity-Onset Diabetes of the Young (MODY)
as autosomal-dominant familial diabetes, 38
criteria for, 38
genetic testing glucokinase mutation for, 37
hepatocyte nucleotide factor 1B (HNF1B) role in, 3
identified gene mutations of, 38–39
misdiagnosis of, 38
pancreatic β-cell dysfunction, 3
single-gene mutations, 3
steroid-induced diabetes misdiagnosis of, 37
Maturity-Onset Diabetes of the Young (MODY)-2, CK gene mutation, 39
Maturity-Onset Diabetes of the Young (MODY)-4
diabetes progression in, 6–7
diabetes-related complications, 5
gestational diabetes presenting as, 5
heterozygous IPF1 mutation, 5, 6
lifestyle modification for, 6
limited treatment strategies reports for, 6
medication intolerance, 5
metformin treatment for, 6
obesity and hyperinsulinemia in, 6, 7
oral antihyperglycemic agents for, 6
Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B)
17q12 deletion syndrome, 3
genetic testing for, 2, 3
glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment for, 3
monotherapy with metformin response, 2–3
mutation presentations in, 3
MDI Liraglutide Trial, 164–165
meal bolus need via continuous
subcutaneous insulin infusion (CSII) pump, U-500 regular (U-500R) insulin, 129–130
Medical Research Council (MRC) study, on obesity and NTD risk, 185
Medtronic 670G insulin pump, 5, 7, 202–203
melanoma cancer, 80–82
meningitis complications, of Sweet’s syndrome, 26
mental health concerns, comfort food intake and, 188–189
metabolic acidosis, 67
metabolic trends, of euglycemic diabetic ketoacidosis (eDKA) with COVID-19 infection, 55f
metformin treatment, 8
for alpelisib-induced
hyperglycemia, 86, 88
as hyperglycemia first-line, 93
for Maturity-Onset Diabetes of the Young (MODY)-4, 6
for Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B), 2–3
against pituitary corticotroph tumors, 35
for steroid-induced diabetes, 37
for type 2 diabetes (T2D), 33
MiniMed 670G automated insulin infusion system, 132, 133, 134
mixed-density/hypo-enhancing mass, pancreatic adenocarcinoma and, 20
monotherapy with metformin, Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B) response to, 2–3
multiple daily insulin (MDI)
injections, 163
MDI Liraglutide Trial on, 164– 165
mutation presentations, in Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B), 3
N
Na-l-thyroxine supplementation treatment, for hypothyroidism, 30
National Birth Defects Prevention Study, 185
National Institutes of Health (NIH) protocol for, type B insulin resistance (TBIR), with lupus nephritis and autoimmune hepatitis, 98, 100, 101
nephritis, 118
type B insulin resistance (TBIR) with lupus, 97–98, 98t, 99f, 100–102, 100f
nesidioblastosis, 143, 144, 145
neural tube defect (NTD), of fetus, 184–186
neurologic manifestations
with high GAD65 antibodies, 119
of Sweet’s syndrome, 26
neuropathy
peripheral, Sweet’s syndrome and, 23, 26
treatment-induced neuropathy of diabetes (TIND), 197
type 1 diabetes (T1D), with worsening, 195, 196, 197
type and severity testing, 196
new-onset diabetes, pancreatic cancer and, 20–22
nondiabetic renal disease (NDRD) in type 1 diabetes (T1D), renal biopsy and, 179–180, 181–182, 181f
laboratory test results, 179, 180
treatment, 179
nutrition therapy. See also ketogenic diet (KD); low-carbohydrate diets for pancreatogenic (Type 3c) diabetes, 17, 18
O
obesity
childhood, 9
COVID-19 risk factor of, 177
fetal malformation due to type 2 diabetes (T2D) and, 184–186
insulin resistance related to, 172
in Maturity-Onset Diabetes of the Young (MODY)-4, 6, 7
pregnancy complications and, 184–186
Roux-en-Y gastric bypass surgery (RYGB) for, 143–145
type 2 diabetes (T2D) and rethinking insulin, 191–193
octreotide
for sulfonylurea and antibiotic use, 152
for sulfonylurea overdose, 147
opioids
behavioral changes from abuse of, 204
insulin-sensitizing role of, 203
withdrawal, 188
oral antihyperglycemic agents, for Maturity-Onset Diabetes of the Young (MODY)-4, 6
oral comfort feeds, hypoglycemia from, 188–189
oral mucosa evaluation, for hyperglycemia, 189
osteoporosis, pamidronate treatment for, 30
overnight hypoglycemia, 118, 123, 127, 199
P
pamidronate treatment
for osteoporosis, 30
for Wolcott-Rallison syndrome (WRS), 30
pancreatectomy, 16, 18
of Roux-en-Y gastric bypass (RYGB) patient, 144
pancreatic adenocarcinoma
computed tomography (CT) scan for, 20, 21, 22
CPDPC study on, 22
endoscopic ultrasound (EUS) for, 20
FOLFIRINOX chemotherapy, 20
mixed-density/hypo-enhancing mass, 20
radiation therapy for clival metastasis, 21
treatment for, 20–21
pancreatic β-cell dysfunction
Cushing’s Disease (CD) increase of, 34
from cystic fibrosis transmembrane conductance regulator (CFTR), 159–160
hyperglycemia and, 10, 81, 84
latent autoimmune diabetes in adults (LADA) therapy for, 14
of Maturity-Onset Diabetes of the Young (MODY), 3
pancreatic cancer and, 21
from plasma glucose decrease, 147
pancreatic cancer
diabetes as risk factor for, 21
as form of pancreatogenic (Type 3c) diabetes, 22
hereditary pancreatitis, 18
new-onset diabetes and, 20–22
pancreatic enzyme replacement therapy, for pancreatogenic (Type 3c) diabetes, 16, 17, 18
pancreatic exocrine insufficiency, 17, 22
pancreatogenic (Type 3c) diabetes, 16–17
abdominal pain and, 16
hypoglycemia risk, 18
insulin administration timing, 18
insulin therapy, 17, 18
laboratory studies and vitamin levels, 16–17
nutrition therapy for, 17, 18
oral pancreatic enzyme replacement therapy for, 16, 17, 18
pancreatic cancer diabetes form of, 22
pancreatic exocrine insufficiency and, 17
postprandial nausea, 16
pregnancy and, 16
vitamin supplements treatment, 17
PD-1 role, in immune checkpoint inhibitor (ICI) insulinopenic diabetes, 51, 77–78, 83, 85
pembrolizumab, blood glucose levels effect from, 81–182, 81f
peripheral neuropathy, Sweet’s syndrome and, 23, 26
pharmacological therapy, diabetes types and appropriate, 10
phosphatidylinositol 3-kinase (PI3K) inhibition
due to alpelisib therapy, 87
Food and Drug Administration (FDA) approval for, 87
with fulvestrant, for breast cancer, 90, 93
hyperglycemia side effect of, 87, 88
manifestations of, 87
phosphatidylinositol 3-kinase (PI3K) inhibitor-induced hyperglycemia, 90
glycemic control on insulin glargine 10 units daily, 90, 91f
glycemic control on insulin glargine 20 units daily, 92f
laboratory tests results, 90
treatment for, 90
photosensitivity role, in Sweet’s syndrome, 26
PI3K/AKT pathway
activating mutations in cancers, 94
cellular physiology role of, 90
for glucose homeostasis, 93, 94
insulin reactivation research on, 94
side effects for inhibition of, 94
pigmented hypertrichosis with insulin-dependent diabetes (PHID) classification, of histiocytosis-lymphadenopathy plus (HLP) syndrome, 43
PIK3CA mutation, alpelisib-induced hyperglycemia and, 86
pituitary corticotroph tumors, metformin against, 35
pituitary exploration, Cushing’s Disease (CD) and, 35
pituitary macro-adenoma, 47
PKR-like ER kinase (PERK) expression loss, in Wolcott-Rallison syndrome (WRS), 30, 31
plasma glucose, pancreatic β-cell
dysfunction from decrease in, 147
polysubstance abuse
comfort food intake and, 188–189
opioids, 188, 203, 204
positive GAD antibodies, autoimmune (AI) diabetes onset during pregnancy and, 109, 109f
postpartum pregnancy, antibody-positive diabetes and, 108
postprandial hypoglycemia, in Roux-en-Y gastric bypass (RYGB) patients, 143–145
potassium chloride, for hypokalemia treatment, 68
potassium supplements, for Cushing’s Disease (CD), 34, 36
prednisone, as glucocorticoid therapy, 137
chronic obstructive pulmonary disorder (COPD) exacerbation from, 138
continuous glucose monitor (CGM) report before and after, 136f–137f
pregnancy
autoimmune (AI) diabetes onset during, 107, 108–109, 109f
gestational diabetes during, 5, 107, 108
increased folate before and during, 184–186
obesity and complications of, 184–186
pancreatogenic (Type 3c) diabetes and, 16
Preventive Services Task Force, U.S., on pancreatic cancer screening, 21
PROMISE observational study, on Trikafta, 160
protein tyrosine phosphatase (IA-2), 9
R
R122H PRSS1 (protease serine 1) variant, hereditary pancreatitis and, 16, 18
radiation therapy, for clival metastasis, 21
rapid-onset type 1 diabetes (T1D) and diabetic ketoacidosis (DK), 50
immune checkpoint inhibitor (ICI) insulinopenic diabetes, 50–51
stage IV clear cell carcinoma and, 50
refractory hypoglycemia, due to massive unintentional insulin overdose, 146–147
alcohol use and, 146, 148
corticosteroids for, 147
laboratory test results, 146–147, 147f
seizures from, 146
treatment, 146–147, 148
refractory hypoglycemia, due to sulfonylurea and antibiotic use, 150–151
antibiotics associated with, 151–152, 151t
laboratory test results, 150, 151
medication interactions and, 151
treatment, 150–151
renal biopsy, for nondiabetic renal disease (NDRD) in type 1 diabetes (T1D), 179–180, 181–182, 181f
Rosai-Dorfman disease, of histiocytosis-lymphadenopathy plus (HLP) syndrome, 43
Roux-en-Y Gastric Bypass Surgery (RYGB) surgery, hyperinsulemic hypoglycemia after, 143–144, 145
S
selective arterial calcium stimulation testing, 145
sensorineural hearing loss, of H syndrome, 42–46
seroconversion, of GAD65 antibodies, 119, 120
17q12 deletion syndrome, Maturity-Onset Diabetes of the Young (MODY)-5 (MODY-HNF1B) and, 3
skin lesions of Sweet’s syndrome, topical triamcinolone therapy for, 23, 26
SLC29A3 gene mutation, histiocytosis-lymphadenopathy plus (HLP) syndrome and, 43, 45
sodium-glucose cotransporter 2 (SGLT2) inhibitors
discontinuance reasons for, 56, 59–60
effectiveness of ketogenic diet (KD) and, 87, 88
euglycemic diabetic ketoacidosis (eDKA) complication from, 54–55, 62–64
euglycemic diabetic ketoacidosis (eDKA) development mechanisms of, 56, 58–60, 59t
euglycemic diabetic ketoacidosis (eDKA) with type 1 diabetes (T1D) while on ketogenic diet (KD), 71–72, 72t, 73f, 74
Fournier’s gangrene association with, 28
for hyperglycemia management, 101, 102
ketonic state and dehydration from, 73, 74
with phosphatidylinositol 3-kinase (PI3K) inhibitors use, 93
serum ketone measurement for symptoms, 64
type 2 diabetes (T2D) and ketogenic diet (KD), 62–64, 71
type 2 diabetes (T2D) treatment with, 55
spironolactone, for Cushing’s Disease (CD), 34, 36
starvation ketosis, 56
steroid treatments, for eosinophilic vasculitis, 37
steroid-induced diabetes, 35
laboratory tests for, 37, 38t
Maturity-Onset Diabetes of the Young (MODY) misdiagnosis as, 37
stress hyperglycemia, 176, 177
subarachnoid hemorrhage, 62, 63, 64
subclassification stages, of type 1 diabetes (T1D), 10
subcutaneous (SQ) insulin, allergy to, 103
sulfonylurea
octreotide use in overdoses, 147
refractory hypoglycemia due to use of, 150–152
type 2 diabetes (T2D) therapy of, 33
Sweet’s syndrome, 23–26
Classic Sweet’s syndrome, 26, 27t
corticosteroids challenge to, 27, 28
diabetes as trigger for, 27
Drug-induced Sweet’s syndrome, 26, 27t
etiologies and causes of, 27t
as inflammatory skin condition, 28
laboratory data, 23, 24–25t
Malignancy-associated Sweet’s syndrome, 26, 27t
meningitis and encephalitis complications, 26
neurologic manifestations of, 26
peripheral neuropathy and, 23, 26
photosensitivity role in, 26
skin lesions, 23, 25f, 26
treatment for, 27
triamcinolone topical therapy, 23, 26
typical histopathology slide of, 26f
systemic lupus erythematosus (SLE) and diabetes comorbidity, 111
GAD65 and islet cell autoantibodies (ICAs) increase in, 120
laboratory test results and treatment, 111
presentation of, 111
type 1 diabetes (T1D) suspected diagnosis, 112
T
thiamine-responsive megaloblastic anemia (TRMA) syndrome, 44
thyroid testing results, in Wolcott-Rallison syndrome (WRS), 30
thyroxine replacement, for Wolcott-Rallison syndrome (WRS), 30
transient severe insulin resistance, in COVID019 and prediabetes, 175, 177f
transporter 8 (ZnT8), 9
trans-sphenoidal pituitary resection, 47
treatment-induced neuropathy of diabetes (TIND), 197
triamcinolone therapy, for skin lesions, 23, 26
Trikafta, as cystic fibrosis
transmembrane conductance regulator (CFTR), 158, 159
Food and Drug Administration (FDA) approval of, 160
PROMISE observational study on, 160
type 1 diabetes (T1D)
alcohol abuse and, 148
antibodies associated with, 9
autoimmune (AI) diabetes
education, 108
autoimmune diseases with, 9, 112
characteristics of, 3
continuous glucose monitoring (CGM) and Down’s syndrome, 123–124
C-peptide level in, 8
diabetic ketoacidosis (DKA) age and presentation, 22
diabetic kidney disease risk, 180– 182, 181f
Down’s syndrome prevalence of, 124
Finnish Nationwide Study on autoimmune diseases with, 112
of H syndrome, 42–46
ketoacidosis presentation and age of, 22
ketogenic diet (KD) safety and efficacy research, 74
laboratory results, 9t
latent autoimmune diabetes in adults (LADA) within classification of, 116
nondiabetic renal disease (NDRD) and, 180–182
subclassification stages of, 10
systemic lupus erythematosus (SLE) suspected diagnosis of, 112
type 2 diabetes (T2D) distinguished from, 8
Wolcott-Rallison syndrome (WRS) and early-onset, 30
type 1 diabetes (T1D), with worsening neuropathy, 195
carbohydrate ratio adjustment, 195
presentation of, 195
treatment, 195, 196
treatment-induced neuropathy of diabetes (TIND), 197
type 1.5 diabetes, latent autoimmune diabetes in adults (LADA) as, 13
type 2 diabetes (T2D)
American Diabetes Association (ADA) medical management algorithm on, 163
characteristics of, 3, 163
childhood obesity, 9
etiology and pathogenesis understanding, 115
insulin regimen simplification for elderly patients with, 167–168
ketogenic diet (KD) and euglycemic diabetic ketoacidosis (eDK), 62–64, 71
laboratory results, 9t
latent autoimmune diabetes in adults (LADA) differentiation from, 13
low-carbohydrate diets and, 63
metformin and sulfonylurea therapy for, 33
older patients misdiagnosis for, 74
sodium-glucose cotransporter 2
(SGLT2) inhibitors treatment for, 55
systemic lupus erythematosus (SLE) and, 120
type 1 diabetes (T1D) distinguished from, 8
type 2 diabetes (T2D), rethinking insulin in, 191–192
glucagon-like peptide-1 receptor agonist (GLP-IRA) and, 192–193
obesity and, 191
treatment and laboratory test results, 191–192, 192t
type B insulin resistance (TBIR), with lupus nephritis and autoimmune hepatitis, 97–98
blood glucose and insulin trend, 99f
classic manifestation of, 100
high mortality of, 101
insulin receptor antibodies (AIRAs) testing, 98, 100f, 101
laboratory test results, 97, 98, 98t, 99f, 100, 100f
National Institutes of Health (NIH) protocol for, 98, 100, 101
onset characterizations, 102
patient characteristics for, 99
presentation of, 97
treatment management of, 101
V
ventricular assist device (VAD)
implantation, diabetic management of, 199, 201
complications of, 200
healthy lifestyle instructions, 200
vitamin supplements, for pancreatogenic (Type 3c) diabetes, 17
W
Wolcott-Rallison syndrome (WRS), 29–30
clinical features of, 30, 31
early-onset type 1 diabetes (T1D) and, 30
genetic testing, 29
granulocyte colony-stimulating factor (G-CSF) treatment for, 29, 30, 31
growth retardation, 30, 31
homozygous mutation in the EIF2AK3 gene, 29, 30, 31
laboratory tests for, 29
multiple frequent fractures and, 31
pamidronate treatment for, 30
physical examination, 29
PKR-like ER kinase (PERK) expression loss in, 30, 31
thyroid testing results, 30
thyroxine replacement for, 30