A Patient with Diabetes, Hepatitis C Virus Infection, and Hemochromatosis Gene Mutation

A. R. Gosmanov, G. E. Umpierrez
2008 Clinical Diabetes  
PRESENTATION J.W., a 51-year-old African-American man, presented with fatigue, polyuria, and polydipsia. He was diagnosed with insulin-dependent diabetes mellitus 1 year ago when he presented with nonketotic hyperglycemic hyperosmolar syndrome. At the initial presentation, his blood glucose was 625 mg/dl, and his A1C was 18.9%. His adherence to a diabetes treatment, including basal and premeal insulin, was poor, which led to four different hospitalizations with hyperglycemic crises during the
more » ... st year. His family history was unknown because he was adopted. Physical examination was remarkable for sinus tachycardia and dry mucous membranes. He was afebrile, was hemodynamically stable, and had a BMI of 22.2 kg/m 2 . Initial laboratory testing showed hemoglobin of 12.8 g/dl, sodium of 133 mmol/l, creatinine of 0.9 mg/dl, glucose of 590 mg/dl, bicarbonate of 29 mmol/l, normal anion gap, and negative urinary ketones. A chest X-ray and urinalysis did not indicate the presence of infection. He was treated with forced hydration and insulin therapy, with rapid resolution of hyperglycemia. During this admission, his A1C was 12.1%; thyroid-stimulating hormone and total testosterone were within normal limits. A fasting lipid panel revealed total cholesterol of 129 mg/dl, triglycerides of 74 mg/dl, and HDL cholesterol of 32 mg/dl.
doi:10.2337/diaclin.26.4.174 fatcat:6k3lorr2zvaihgus6ckkqw4mwy