Case Report

Patient with Interferon-Induced Type 1 Diabetes Mellitus

2023/11/21
Identity
• Age: 85
• Sex: Male
• Occupation: Retired (Past: Office worker)
• Diagnosed with T1DM at 70 years old
• Aim of hospitalization: Blood glucose management
Suspected Complications
Microvascular
Neuropathy:
§ Peripheral Neuropathy
• Decreased achilles reflex
• Decreased patellar reflex
• Decreased superficial sensation (monofilament test)
• Decreased vibration sensation (tuning fork)
§ Autonomic Neuropathy
• Schellong test (+)
• CV-RR: normal parasympathetic nervous activity
Suspected Complications
Microvascular
Nephropathy:
§ eGFRcreat: 76.5
§ Albumin/Creatinine rate: 17.47 mg/CRE
§ Urine Albumin: 14 mg/L
§ Urine Glucose: 4+

Data as of November 2, 2023

Suspected Complications
Microvascular
Retinopathy:
Undergoing regular evaluations
No signs of retinopathy
Suspected Complications
Macrovascular
• Pulse wave testing: arteriosclerosis
• Carotid artery imaging: plaque (+)
• CAVI: 11.3/11.4 -> mild stenosis
Current Medical History
• Blood glucose level: 455 mg/dl
• Glycated albumin: 30.0%

Continuous Glucose Monitoring (As of November 20; In percent %)

7 days 14 days 30 days Target

Time above 16 24 35
range (TAR)
Time in range 63 52 54 > 50%
(TIR)
Time below 21 14 11 < 1%
range (TBR)
Current Medical History
• Hydroxybutyrate-3: 1126 𝜇mol/L
• Acetoacetic acid: 351 𝜇mol/L
• Ketone body concentration: 1477 𝜇mol/L
• Urine ketone dipstick test: ++
Past Medical History
• 50s: Hepatitis C, treated with interferon
• 70: Hepatocellular carcinoma, 2 surgical proc., 3 RFA proc.
Weight History
• Recent: 57.7 kg, BMI: 20.5 kg/m^2
• 20s: 68 kg
• 18: 74 kg

Family History
• Mother: DM
Current Treatment
• 4 insulin injections/day
• 1 basal injection before sleeping – 5 units
• 3 bolus injections before breakfast, lunch, and dinner – dose depends on
carbohydrate count
• Pregabalin and epalrestat
Lifestyle
• Taking lessons on:
• Self-administering insulin
• Carbohydrate count
• Diet:
• Meals at 08.00, 12.00, 18.00
• Doesn’t usually eat snacks
• Exercise:
• 60-minute walks, 2-3x a week + after meals
• Smoking:
• Ages 19-45
• 40 sticks/day
• Alcohol:
• used to drink 3-5 glasses of straight whiskey and 2 large bottles of beer
• Stopped at 75
Summary
• CGM: Frequent fluctuations -> Stabilize
• Maintain HbA1c at around 8.0%
Thank you