In a brand new publication from Cardiovascular Improvements and Purposes; DOI https:/
Atezolizumab, an immune checkpoint inhibitor, is a humanized monoclonal, anti-programmed demise ligand 1 (PD-L1) antibody used for the remedy of metastatic urothelial carcinoma that has progressed after chemotherapy. PD-L1 inhibitors can induce kind 1 diabetes, and sufferers can current with diabetic ketoacidosis. Blood glucose ranges must be often monitored in sufferers who’re prescribed these drugs.
The authors describe a affected person with a identified historical past of urothelial carcinoma who offered with diabetic ketoacidosis 6 weeks following his second cycle of atezolizumab. His serum lactate stage was barely elevated and his β-hydroxybutyrate stage was elevated. Excessive anion hole metabolic acidosis secondary to diabetic ketoacidosis was recognized. Subsequent testing demonstrated hemoglobin A1c stage of 9.9%, positivity for antiglutamic acid decarboxylase antibody and suppressed C-peptide stage within the absence of detectable anti-islet antigen 2 (IA-2) or anti-insulin antibodies.
His preliminary administration included cessation of atezolizumab remedy, intravenous sodium chloride administration, and insulin pump infusion, after which metabolic acidosis steadily resolved. The insulin pump was subsequently switched to Protaphane at 18 items earlier than breakfast and eight items earlier than dinner, along with metformin at 1000 mg twice day by day. 4 weeks later his treatment was modified to human isophane insulin plus impartial insulin. Linagliptin at 5 mg was added 1 month later. His hemoglobin A1c stage declined to eight.1% 1 12 months later.
Quotation info: A Affected person with Atezolizumab-Induced Autoimmune Diabetes Mellitus Presenting with Diabetic Ketoacidosis, Sharen Lee and Gary Tse, Cardiovasc. Innov. App., 2021,
Key phrases: Atezolizumab; diabetic ketoacidosis; PD-L1 inhibitors; Sort 1 diabetes
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