THU319 Hyperglycemia Associated With Raynaud’s Phenomenon And Liver Dysfunction After COVID-19 Vaccination In Type 1 Diabetes
Authors: Zavgorodneva Zhanna , Zhang Calvin , Siddiqui Samrah , Zahedi Tooraj 
Published: October 2023

Abstract
Disclosure: Z. Zavgorodneva: None. C. Zhang: None. S. Siddiqui: None. T. Zahedi: None.
Introduction: The association of COVID-19 vaccinations and the incremental changes in glycemic control is still debatable. Some studies found the impacts of vaccination on glucose variations (1), while other investigations showed no significant changes (2,3). COVID-19 vaccinations may induce autoimmune phenomena such as autoimmune hepatitis, immune thrombotic thrombocytopenia, IgA nephropathy, SLE, and Graves’ disease. Here, we report a case of a type 1 DM patient with previously well controlled glucose on a closed-loop insulin pump, who developed a significant glucose variation with a new onset of Raynaud’s phenomenon and liver dysfunction after the COVID-19 vaccination. Case Report: Patient is a 33 year old male with type 1 diabetes since age 5 who previously had well controlled glucose with insulin pump for 17 years and an HbA1C of 6.8 %. Patient controlled his diet and exercised regularly. He used insulin pump with continuous glucose monitor (CGM) closed-loop system and his premeal insulin bolus was calculated based on the carb counting. Patient’s baseline glucose was an average of 122 mg/dL, time in range (TIR) 82 %, above target 9 %, below target 9 % (so glycemia was in the goal as per Diabetes Management Standards (4). Two days after he received the COVID-19 vaccination, his glucose started to fluctuate in the range of 46 mg/dL to 378 mg/dL. His total daily insulin dose was increased from 30 units to 60 units through insulin pump and insulin carb ratio (ICR) adjustment to correct post-prandial hyperglycemia. CGM revealed an average glucose of 192 mg/dL, TIR 71%, above target 24%, and below target 5%. Two weeks later, patient developed bilateral white-pale cold hands, weight gain, fatigue, bloating, constipation, and liver dysfunction with transaminase increasing from baseline ALT 68 U/L, AST 82 U/L, bilirubin 0.5 U/L, to AST 305 U/L, ALT 206 U/L, and bilirubin 1.1 U/L. CT abdomen revealed mild hepatomegaly without focal lesions. Lab workup found patient positive for elevated immunoglobulin A (384 ng/dl), but negative for anti-mitochondrial antibody, smooth muscle antibody, viral hepatitis, and ANA screen. One month later, his glucose became better controlled and liver function improved to ALT 199 U/L, AST 188 U/L, and bilirubin 0.3 U/L, but he still has Reynaud’s phenomenon in cold weather. Discussion: The COVID-19 vaccination in this patient resulted in significant variation and fluctuation in the glucose levels and he had to receive a much higher amount of insulin via a closed-loop insulin pump system in order to control his glucose levels. This could be explained by the vaccine induced immune response causing an increase in tissue insulin resistance such as in adipose tissue and muscle cells. Immune stimulation could have also triggered the worsening of the nonalcoholic steatohepatitis (NASH) and explain his new-onset Raynaud’s phenomenon.
Presentation: Thursday, June 15, 2023