ODP649 COVID-19 Induced Diabetic Ketoacidosis Which Unmasked Latent Autoimmune Diabetes In Adult
Authors: Alqaisi Sura , Rahman Ali 
Published: November 2022

Abstract
Latent autoimmune diabetes in adults (LADA)" is a kind"of autoimmune diabetes" that progresses slowly. Numerous studies have termed LADA type 1.5 diabetes because it is often associated with antibodies against insulin-producing pancreatic cells. In contrast to type 1 diabetes, patients with LADA may go six months without insulin following diagnosis. Individuals with LADA are often well beyond the age of 30. Because they develop symptoms later than patients with type 1 diabetes and because their pancreases initially generate some insulin, persons with LADA are sometimes misdiagnosed as having type 2 diabetes. Individuals with LADA have a lower BMI and a better metabolic profile than patients with type 2 diabetes. The majority of individuals with LADA are diagnosed after the age of 30, exhibit detectable islet antibodies — most often to glutamic acid decarboxylase (GAD65) — and advance more rapidly on insulin than those with Type 2 diabetes. COVID-19 is a pandemic virus produced by the SARS-CoV-2 virus. The researchers discovered that this virus may damage"insulin-producing cells in the pancreas in a variety of ways. It may cause direct harm to the pancreatic beta cells required for normal insulin production since SARS-CoV-2 has a spike protein that binds to the target cell's receptor. Recent research established that angiotensin-converting enzyme-2 (ACE2) functions as a functional receptor for the SARS-CoV-2 S-protein, promoting viral entry into target cells, most notably the lung, ileum, and various other cardiovascular, renal, gastrointestinal, and pancreatic organs". It"has been shown that overexpression of ACE2 mRNA in the pancreas causes islet cell destruction and acute beta cell malfunction, manifesting as new-onset diabetes in healthy persons or increasing hyperglycemia or ketoacidosis in diabetic patients." A 37-year-old male with no major previous medical history except than COVID-19 infection seven months before admission arrived at the emergency department complaining of two days of nausea, vomiting, and stomach discomfort. He has also advocated for polyuria, polydipsia, and accidental weight loss after contracting COVID-19. His vital signs were abnormal for a heart rate of 124 beats per minute". "His BMI was 24, he had an unremarkable physical examination, and he had no substantial family history". "His laboratory values were as"follows: Na 135 mEq/L, K 3.2 mEq/L, Cl 108 mEq/L, HCO3 10 mEq/L, Anion Gap 17, Glucose 500 mg/dl, Hemoglobin A1C 13%. His urine analysis revealed ketones, TG 120 mg/dl, LDL 60 mg/dl, and HDL 50 mg/dl. The patient was diagnosed with diabetic ketoacidosis, admitted to the intensive care unit, and began on an insulin drip, intravenous fluid hydration, and potassium supplements. "After" one night, his anion gap was closed then bridged with the use of five units of Lantus. Further testing indicated that the laboratory tested positive for Glutamic Acid Decarboxylase antibodies (GAD65) at a concentration of 2U/ml (1 U/ml) and C-Peptide at a value of "0.4 ng/ml (0.8-3 ng/ml). The patient met the Immunology of Diabetes Society's (IDS) criteria for LADA diagnosis: adult-onset, islet cell autoantibody, and initial insulin independence. The patient was finally sent home with Insulin and a referral to an Endocrinologist, and at his three-month follow-up visit, he reports that his symptoms have improved, he has gained some weight, and his A1C is 6.9 percent. Due to the similarities between many kinds of diabetes and LADA, it may be difficult to determine which type a patient has. Type 1 diabetes often manifests early in life, before the age of 30, with positive autoantibodies and the need for insulin treatment. While patients diagnosed with type 2 diabetes after the age of 30 are often obese, lack autoantibodies, and react favorably to lifestyle changes and oral hypoglycemic medications. However, since LADA manifests late in life, it has features of both type 1 and types 2 diabetes. Typically, the patient has a low BMI and initially reacts somewhat to lifestyle changes and oral hypoglycemic medications but eventually develops insulin resistance.
Presentation: No date and time listed