Abstract
Objectives
Hyperglycemia is a known side effect of anticancer chemotherapeutic drugs. This entity known as drug-induced diabetes mellitus usually does not present with the development of diabetic ketoacidosis (DKA). We hereby report a case of drug induced diabetes mellitus in a child with acute leukemia presenting with DKA.
Case presentation
We report a case of a teenage boy diagnosed with B cell acute lymphoblastic leukemia and was started on induction phase chemotherapy as per the Indian Collaborative Childhood Leukemia group (ICICLe) acute lymphoblastic leukemia-14 protocol. On day 12 of the induction phase, he developed hyperglycemia and presented to us with severe diabetic ketoacidosis (DKA). Serum anti glutamic acid decarboxylase 65 antibody levels were negative with low serum C peptide levels. Initially, the possibility of drug-induced acute pancreatitis was kept which was ruled out. Keeping the possibility of drug-induced hyperglycemia, the child was started on subcutaneous regular insulin which was titrated as per sugar records. Continuation of remaining chemotherapy was done by PEGylated L-asparaginase with titration of insulin as per home-based sugar records. Insulin requirement increased from 0.3 unit/kg/day to a maximum of 1 unit/kg/day during consolidation phase 1 with PEGylated L-asparaginase suggesting drug-induced hyperglycemia but subsequently insulin requirement decreased and insulin was stopped.
Conclusions
Drug induced diabetes mellitus can present as DKA during induction phase of acute lymphoblastic leukemia (ALL) chemotherapy. A high index of suspicion and close monitoring are required. The insulin requirements in these patients can be very fluctuant and may become nil during the course of treatment.
-
Research ethics: No research was done. This is a case report.
-
Informed consent: Appropriate informed consent was taken.
-
Author contributions: All authors contributed to the patient management, writing the manuscript and approved the final manuscript.
-
Competing interests: All other authors state no conflict of interest.
-
Research funding: None declared.
-
Data availability: Not applicable.
References
1. Kakaje, A, Alhalabi, MM, Ghareeb, A, Karam, B, Mansour, B, Zahra, B, et al.. Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study. Sci Rep 2020;10:6756. https://doi.org/10.1038/s41598-020-63528-0.Search in Google Scholar PubMed PubMed Central
2. Roberson, JR, Raju, S, Shelso, J, Pui, CH, Howard, SC. Diabetic ketoacidosis during therapy for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2008;50:1207–12. https://doi.org/10.1002/pbc.21505.Search in Google Scholar PubMed
3. Das, N, Banavali, S, Bakhshi, S, Trehan, A, Radhakrishnan, V, Seth, R, et al.. Protocol for ICiCLe-ALL-14 (InPOG-ALL-15-01): a prospective, risk stratified, randomised, multicentre, open label, controlled therapeutic trial for newly diagnosed childhood acute lymphoblastic leukaemia in India. Trials 2022;23:102. https://doi.org/10.1186/s13063-022-06033-1.Search in Google Scholar PubMed PubMed Central
4. Mondal, R, Nandi, M, Tiwari, A, Chakravorti, S. Diabetic ketoacidosis with L-asparaginase therapy. Indian Pediatr 2011;48:735–6.Search in Google Scholar
5. Jameel, PZ, Lohiya, S, Dongre, A, Damke, S, Lakhkar, BB. Concurrent diabetic ketoacidosis and pancreatitis in Paediatric acute lymphoblastic leukemia receiving L-asparaginase. BMC Pediatr 2020;20:228. https://doi.org/10.1186/s12887-020-02136-3.Search in Google Scholar PubMed PubMed Central
6. Furuta, Y, Yatoh, S, Iwasaki, H, Sugano, Y, Sekiya, M, Suzuki, H, et al.. L-asparaginase-induced continuous hyperglycemia with type 1 diabetes-related antibodies and HLA genotypes: a case study. Cureus 2022;14:e30067. https://doi.org/10.7759/cureus.30067.Search in Google Scholar PubMed PubMed Central
7. Pui, CH, Evans, WE. Treatment of acute lymphoblastic leukemia. N Engl J Med 2006;354:166–78. https://doi.org/10.1056/nejmra052603.Search in Google Scholar PubMed
8. Sahu, S, Saika, S, Pai, SK, Advani, SH. L-asparaginase (Leunase) induced pancreatitis in childhood acute lymphoblastic leukemia. Pediatr Hematol Oncol 1998;15:533–8. https://doi.org/10.3109/08880019809018315.Search in Google Scholar PubMed
9. Pui, CH, Burghen, GA, Bowman, WP, Aur, RJ. Risk factors for hyperglycemia in children with leukemia receiving L-asparaginase and prednisone. J Pediatr 1981;99:46–50. https://doi.org/10.1016/s0022-3476(81)80955-9.Search in Google Scholar PubMed
© 2024 Walter de Gruyter GmbH, Berlin/Boston
