Age: 49.0
Sex: M
Vaccine: HEPA
Symptoms: Asthenia, Blood glucose increased, Diabetes mellitus, Fatigue, Hypothyroidism
Clinical narrative: On 9/17/05 service member received Hep A vaccine #2. He dose not recall any unusual or prolonged local or systemic reactions. He recalls some local redness and tenderness surrounding vaccine site, but not lasting more than 5-7 days, his local symptoms never limited performance of duties. he denies experiencing generalized body aches, headaches, fever and fatigue following vaccine receipt. Service member was in his usual state of excellent health until April 2006. Looking back, the first symptoms of diabetes that he can recall are polyuria, fatigue and polydipsia which all began around the beginning of April 2006, which was shortly after he started HCTZ. Service member attributed his increase urination to the medication and related the increased thirst to the increased urination. He recalls drinking 8 ounces of gator, cokes or water about every 20 minutes. Service member recalls while he was in a 40 minute class, it was difficult to hold it until the break. When he was not in class, he typically was urinating every 20 minutes during the day and 5-6 times per night. He was extremely tired. It was difficult for him to walk between buildings on campus. He was tired just sitting in class and driving to class. He recalls over Easter weekend, he slept a majority of the time. He rated his level of energy at the time as 30%, with 0 equaling bedridden due to extreme fatigue and 100% equaling his baseline energy level. Service member normally wears bifocals and during this period, he could see clearly without wearing his glasses, especially at night. He also described having sugar cravings and was eating muffins, ice cream, cookies and candy. He denies weight loss and numbness or tingling of his extremities. Service members symptoms increased over a 3 week period and he sought evaluation on 4/17/06. At that time, his symptoms were related to his HCTZ, so his dose was reduced, but there was no improvement of symptoms. Lab work was completed on 4/19/06. On 4/20/06, service member was contacted by the emergency department that his blood glucose level from the previous day was 780, He was admitted that day and hospitalized between April 20 and 22. he was discharged on a long acting insulin analog with sliding scale for regular insulin, as well as oral diabetes medications (Metformin and Glyburide). He has not taken any regular insulin since the end of April. He had a follow up appointment on 5/02 when he was told that he likely had Latent Autoimmune Diabetes in the adult (LADA). He then returned home where he was evaluated by DR, who agreed with the diagnosis of LADA and stopped his glyburide. He was evaluated by an endocrinologist in early July who recommended discontinuation of Metformin and initiation of Rosiglitazone. Service member currently is in optimal glycemic control on Lantus 20 units and Rosiglitazone 2mg. A medical board was completed and service member was found fit for duty with some restrictions. Service member has no family history of Type 1 or Type 2 diabetes that he is aware of. He denies being overweight, and prior to diagnosis, he typically exercised about 30 minutes daily (push ups, sits ups, walk or run). He does not recall any viral like symptoms within 6 months prior to diagnosis. Hypothyroidism was incidentally diagnosed based on lab work drawn in May. Other than fatigue, service member denies symptoms of hypothyroidism, no weight gain, nail or skin changes, cold intolerance, changes in bowel habits or muscle pains. He denies a history of thyroid nodules or masses. He was started on levothyroxine shortly after diagnosis at a dose of 0.75 mcg per day and continues on that dose.