Transient state of NIDDM in a patient with AIDS

• Published in: Diabetes care Vol. 16; no. 6; pp. 931 - 933
• Main Authors: ABOURIZK, N. N, LYONS, R. W, MADDEN, G. M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-06-1993
• Subjects: Acquired Immunodeficiency Syndrome - blood; Acquired Immunodeficiency Syndrome - complications; Adult; AIDS-Related Opportunistic Infections - prevention & control; AIDS/HIV; Biological and medical sciences; Blood Glucose - metabolism; C-Peptide - blood; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - etiology; Glucagon - therapeutic use; Glucose Tolerance Test; Glyburide - therapeutic use; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Insulin - blood; Male; Medical sciences; Pentamidine - therapeutic use; Pneumocystis carinii; Proinsulin - blood; Endocrinopathy; Infection; Case study; Human; Immunopathology; Hyperinsulinemia; Concomitant disease; Viral disease; AIDS; Male; Hemopathy; Non insulin dependent diabetes
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.16.6.931

Transient state of NIDDM in a patient with AIDS.
N N Abourizk ,
R W Lyons and
G M Madden
Department of Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105.
Abstract
OBJECTIVE--To describe a glucose abnormality in AIDS that is characterized by transient NIDDM followed by hyperinsulinemic
normoglycemia. RESEARCH DESIGN AND METHODS--A 36-yr-old Hispanic man with AIDS was on long-standing aerosolized pentamidine
therapy in 1986. He received a course of intravenous pentamidine 5 mo before the onset of diabetes. Nonketotic hyperglycemia
responded to sulfonylurea, which had to be discontinued 3 mo later because of normoglycemia. RESULTS--Diabetes diagnosis was
made by three separate fasting blood glucose values of 16.2, 18.1, and 29.9 mM, and HbA1C of 10.1% (normal 4.2-5.9). The patient
became euglycemic 5 mo after diagnosis while on no treatment. An oral glucose tolerance test was then normal, and C-peptide
stimulation showed supra-normal response. CONCLUSIONS--Transient severe NIDDM in this case could not be linked to acute stress.
Pentamidine, in a progressively increasing cumulative dose, is one possible, albeit unusual, etiology because the diabetes
was not permanent. After diabetes remission, the data suggest residual insulin resistance that is unusual in HIV-positive
patients. Diverse glucose abnormalities exist in AIDS. Awareness of their presentation is clinically helpful.