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Chemotherapy Induced Diabetes Mellitus

How Does Having Diabetes Affect My Cancer Treatment?

How Does Having Diabetes Affect My Cancer Treatment?

More than 25 million people in the United States have been diagnosed with diabetes, according to the Centers for Disease Control and Prevention. Among people 65 and older, nearly 27 percent have diabetes. The vast majority of diabetes cases are type 2 diabetes, which is associated largely with older age and being overweight as well as family history. Older age and obesity also are risk factors for developing cancer, which means that people with type 2 diabetes are diagnosed with cancer more often than those in the general population. Having diabetes can complicate cancer treatment due to a number of factors. At the same time, some treatments for cancer, including certain newer targeted therapy drugs, can spur the development of diabetes, especially in patients who already had a propensity toward developing the disease, although this effect is usually reversible. Azeez Farooki is a Memorial Sloan Kettering endocrinologist who specializes in treating cancer patients who also have diabetes. We spoke with Dr. Farooki about what special considerations are taken into account when treating this group of patients. A Disease of Blood Sugar “Diabetes is a disease in which a person has increased levels of glucose, or sugar, in the blood,” Dr. Farooki explains. “It can occur because the pancreas does not produce enough insulin — the hormone that allows glucose to be absorbed — or because cells do not respond to the insulin that is produced. Cells should normally take in sugar from the blood; if they don’t, then high blood sugar or ‘hyperglycemia’ results.” The majority of people with type 2 diabetes are overweight, which often causes the body to become resistant to the effects of insulin. Type 2 disease may be treated with insulin injections, other hormonal inject Continue reading >>

Diabetes Management In Cancer Patients

Diabetes Management In Cancer Patients

Hyperglycemia is a common challenge during cancer treatment and palliation. In addition, many patients with pre-existing type 1 or type 2 diabetes undergoing cancer treatment develop iatrogenic hyperglycemia with unique features. The most common example is steroid-induced hyperglycemia,[1] but several other scenarios are common and clinically important (Table 1). Special considerations are often necessary regarding standard lifestyle recommendations, optimal choice of antidiabetic drug (Table 2), and goals of therapy.[2] In patients with active cancer, the focus of hyperglycemia management shifts from preventing long-term complications toward avoiding acute and subacute outcomes, such as dehydration from polyuria, infection, catabolic weight loss, hyperosmolar nonketotic states (HNK), and diabetic ketoacidosis (DKA; Table 3).[3,4] It should be noted that the truly emergent conditions HNK and DKA are rare. The more common scenario of an asymptomatic severe elevation in blood glucose level (> 400 mg/dL, for example), although requiring a treatment plan with good hydration and close follow-up, does not typically require an emergency room visit or admission. Two representative clinical cases are presented here. Clinical Vignette #1 Corticosteroid-induced hyperglycemia A 53-year-old woman with a history of pre-diabetes and peripheral blood stem cell transplant for acute myelogenous leukemia (AML) presented with asymptomatic elevated random blood glucose levels. After transplant she developed graft-versus-host disease (GVHD) with liver injury, which was treated with 60 mg of prednisone daily, tapered gradually to 20 mg daily at the time of presentation 2 months later. Random serum glucose level was 396 mg/dL. Previously, all serum glucose levels had been less than 160 mg/dL u Continue reading >>

Drug Induced Diabetes

Drug Induced Diabetes

Tweet A number of medications have side effects which include the raising of blood glucose levels. Drug induced diabetes is when use of a specific medication has lead to the development of diabetes. In some cases the development of diabetes may be reversible if use of the medication is discontinued, but in other cases drug-induced diabetes may be permanent. Drug induced diabetes is a form of secondary diabetes, in other words diabetes that is a consequence of having another health condition. Which drugs can induce diabetes? A number of drugs have been linked with an increased risk development of type 2 diabetes. Corticosteroids Thiazide diuretics Beta-blockers Antipsychotics Is diabetes permanent? Diabetes may not be permanent but this can depend on other health factors. With some medications, blood glucose levels may return back to normal once the medication is stopped but, in some cases, the development of diabetes may be permanent. Managing drug induced diabetes If you need to continue taking the medication that has brought on diabetes, it may make your diabetes more difficult to control than would otherwise be the case. If you are able to stop the course of medication, you may find your blood glucose levels become slightly easier to manage. Following a healthy diet and meeting the recommended exercise guidelines will help to improve your chances of managing your blood glucose levels. Can drug induced diabetes be prevented? It may be possible to reduce the risk of developing diabetes by ensuring you to keep to a healthy lifestyle whilst you are on the medication. Being on smaller doses of the medication or shorter periods of time may help to reduce the likelihood of developing high blood sugar levels and diabetes. Doctors will usually try to put you on the smallest e Continue reading >>

Glucocorticoid-induced Hyperglycemia Is Prevalent And Unpredictable For Patients Undergoing Cancer Therapy: An Observational Cohort Study

Glucocorticoid-induced Hyperglycemia Is Prevalent And Unpredictable For Patients Undergoing Cancer Therapy: An Observational Cohort Study

Glucocorticoid-induced hyperglycemia is prevalent and unpredictable for patients undergoing cancer therapy: an observational cohort study Glucocorticoid-induced hyperglycemia is prevalent and unpredictable for patients undergoing cancer therapy: an observational cohort study D. Harris, MD ,* a , A. Barts, MD* a , J. Connors, M. Dahl, MD PhD*, T. Elliott, MBBS*, J. Kong, MD*, T. Keane, MD, D. Thompson, MD*, S. Stafford, MD*, E. Ur, MBBS*, S. Sirrs, MD* *Division of Endocrinology, University of British Columbia, Vancouver, BC. Division of Medical Oncology, University of British Columbia, Vancouver, BC. Division of Radiation Oncology, University of British Columbia, Vancouver, BC. Patients with cancer are often treated with glucocorticoids (gcs) as part of therapy, which may cause hyperglycemia. We sought to define the prevalence of, and risk factors for, hyperglycemia in this setting. Adult patients taking gc as part of therapy protocols for primary brain tumour or metastasis, for lymphoma, or for bone marrow transplant (bmt) were screened with random glucometer measurements taken at least 3 hours after the last dose gcs. We screened 90 patients [44.4% women, 55.6% men; mean age: 59.6 years (range: 2582 years); mean body mass index (bmi): 26.4 kg/m2 (range: 15.845.3 kg/m2)] receiving gc as part of cancer treatment. Mean total daily gc dose in the group was 238.5 mg (range: 301067 mg) hydrocortisone equivalents. Hyperglycemia (glucose 8.0 mmol/L) was found in 58.9% (53 of 90), and diabetes mellitus (dm)range hyperglycemia (glucose 11.1 mmol/L) in 18.9% (17 of 90). The mean time from gc ingestion to glucometer testing was 5.5 hours (range: 320 hours). Presence of hyperglycemia did not correlate with traditional dm risk factors such as age, sex, bmi, and personal or family Continue reading >>

Overcoming Treatment-induced Diabetes

Overcoming Treatment-induced Diabetes

Good nutrition is key Betty Overfelt's oncologist back home in Missouri informed her that she had stage IV small-cell lung cancer. His prognosis was grim — "I think I can get you three months if you'll take treatment," he said. Jerry, her husband of 45 years, decided immediately to seek a second opinion, which led them to Cancer Treatment Centers of America© (CTCA). There, Jerry remembered, doctors told Betty that they couldn't promise a cure but thought they might be able to control the cancer. Subsequent blood tests at CTCA delivered unexpected news — Betty had developed treatment-induced diabetes, in a big way. "We had just visited the pulmonologist and were waiting at the scheduler's desk when my cell phone rang," Jerry recalled. It was Sue, [the pulmonologist's nurse], who said, "Don't move; stay right there." Sue came to their location and told them Betty needed an immediate infusion of insulin. Her initial lab screening indicated a blood sugar of 863. Normal range is from 80 to 110, with above 500 signaling a critical situation. The diagnosis for diabetes was confusing because Betty never had diabetes, nor did it run in her family. The Overfelts were not alone — 8 to 18 percent of all cancer patients also have diabetes, according to CTCA. Type 1 diabetes is linked to cervical cancer and stomach cancer, and type 2 diabetes is linked to breast, endometrial, pancreatic, liver, kidney and colon cancers. Treatmentinduced diabetes can be triggered by chemotherapy and steroid use. "It is very overwhelming to a patient to be diagnosed with cancer, and then be told that they have diabetes as well," said Andrea Reser, RD, LD, nutrition supervisor/diabetes program coordinator at CTCA. "People need to know how to regulate their blood sugar while on a cancer-fighting d Continue reading >>

What Is The Relationship Between Breast Cancer And Diabetes?

What Is The Relationship Between Breast Cancer And Diabetes?

What is the relationship between breast cancer and diabetes? Survivors of breast cancer, who are post-menopausal, have a higher chance of developing diabetes. Scientists are becoming increasingly aware of an association between diabetes and cancer. In this article, we discuss the link. A study, published in Diabetologia, is the largest to observe the link between surviving breast cancer and eventually developing diabetes; it also showed that whether the patient went on to develop diabetes was closely associated with having undergone chemotherapy . The opposite interaction has also been observed: females with diabetes have a 20 percent chance of developing postmenopausal breast cancer. A study from last year demonstrated that people with diabetes over the age of 60 are more likely to develop breast cancer, compared with their counterparts without diabetes. Fast facts on breast cancer and diabetes: It has been observed that having diabetes increases the likelihood of breast cancer, and that having breast cancer increases the likelihood of developing diabetes. Lifestyle changes can help reduce risk long-term. How has the connection between breast cancer and diabetes been established? There has been increased study into the correlation of breast cancer and diabetes. The connection has been made as a result of improvements in diagnosis and treatment of breast cancer. As more women survive breast cancer, it is becoming increasingly important to understand the long-term outcomes for survivors as they grow older. However, few studies have tried to determine what the risk of developing diabetes is for a breast cancer survivor. The study in Diabetalogia is an example of the new research that has established the connection between breast cancer and diabetes more firmly. The team, Continue reading >>

Hyperglycemia (high Blood Sugar)

Hyperglycemia (high Blood Sugar)

What Is Hyperglycemia? Hyperglycemia may be described as an excess of sugar (glucose) in the blood. Your endocrine system regulates the amount of sugar that is stored and used for energy. It is important in brain cell function, and energy levels. Since the sugar that you consume in your diet is either used or stored, certain conditions and disorders may cause you to have difficulty processing and storing blood glucose, resulting in hyperglycemia or hypoglycemia. One hormone that is important to the normal storing and processing of sugar is insulin. Insulin is a hormone that is made in the pancreas that is responsible for maintaining "normal" blood sugar levels. If you have a problem with your pancreas, then you may have increased blood sugar levels. Normal blood Glucose (sugar) levels are 60-110 mg/dL. Normal values may vary from laboratory to laboratory. Levels higher than these might indicate hyperglycemia. Causes of Hyperglycemia: Diabetes. About 90% of people with diabetes, have diabetes of adult onset (Diabetes type 2). You are more at risk for developing diabetes if you are older, extremely overweight (obese), if you have a family history of diabetes (parents, siblings), and if you are of African-American, Hispanic American, or Native-American heritage. People who have diabetes have an underproduction of the hormone, insulin, which lowers your blood sugar levels. If you have diabetes, you will have problems with elevated blood sugar levels. If you develop diabetes type 2, and you are an adult, your healthcare provider may prescribe medications in a pill form, which allow your body to process insulin that is needed for maintaining "normal" blood glucose levels. It is likely that your pancreas is producing enough insulin, but your body is resistant to the insulin, a Continue reading >>

Impact Of Hyperglycemia On The Efficacy Of Chemotherapya Systematic Review Of Preclinical Studies

Impact Of Hyperglycemia On The Efficacy Of Chemotherapya Systematic Review Of Preclinical Studies

Impact of hyperglycemia on the efficacy of chemotherapyA systematic review of preclinical studies Author links open overlay panel Maaike C.Gerardsa Antineoplastic agents can provoke hyperglycemia in cancer patients with and without diabetes mellitus. We systematically reviewed the impact of hyperglycemia on the efficacy of chemotherapy. MEDLINE was searched for preclinical intervention studies which compared chemotherapy response in hyperglycemic and euglycemic conditions. Thirteen preclinical studies, including 23 cell lines and 2 animal experiments were identified. In 14 cell lines and 2 animal studies, chemotherapy response was lower in a hyperglycemic (>15mmol/L) compared to a euglycemic environment (5mmol/L). The response was similar in 4 cell lines. In the remaining 5 cell lines, the hyperglycemic environment potentiated chemotherapy efficacy. Hyperglycemia attenuated the antiproliferative effect of chemotherapy in preclinical experiments, but the results are inconsistent. Whether hyperglycemia influences efficacy of chemotherapy in patients needs to be explored. Continue reading >>

Management Of Diabetes In Patients With Cancer

Management Of Diabetes In Patients With Cancer

Introduction Fuelled by rapid urbanization leading to changes in obesity, diet and physical activity on the background of genetic predisposition, rising levels of type 2 diabetes worldwide appear to show no sign of abating.1,2 Although it is widely recognized that diabetes is associated with vascular complications, it is less well known that the condition is also associated with an increased risk of cancer, independent of its association with obesity.3–6 Cancer and diabetes are both common conditions, but their co-diagnosis in the same individual occurs more commonly than might be expected. Consensus statements from the American and European Diabetes and Oncology Associations report that observational data suggest a strong link between diabetes and breast, colorectal, endometrial, liver and pancreatic cancers.7 They suggest that the likely pathogenesis of this association is through hyperinsulinaemia, hyperglycaemia, inflammation and possibly some diabetes therapies. This article aims to review the management of diabetes in patients with cancer, discussing the challenges of anti-cancer therapies in patients with diabetes, the relative importance of glucose control in such patients, and the management of diabetes at the end of life. Many cancer chemotherapeutic regimes include glucocorticoids which may induce diabetes or exacerbate pre-existing diabetes. Other therapies, such as androgen-deprivation therapy (ADT) with luteinizing hormone-releasing hormone agonists for prostate cancer, are linked with increased risk of the development of type 2 diabetes, possibly due to loss of insulin sensitivity.8 Use of ADT in patients with pre-existing type 2 diabetes and prostate cancer leads to worsening glycaemic control over 2 years, along with increased insulin requirements.9 C Continue reading >>

Nivolumab-induced Autoimmune Diabetes Mellitus Presenting As Diabetic Ketoacidosis In A Patient With Metastatic Lung Cancer

Nivolumab-induced Autoimmune Diabetes Mellitus Presenting As Diabetic Ketoacidosis In A Patient With Metastatic Lung Cancer

Abstract Advances in cancer immunotherapy have generated encouraging results in multiple malignancies refractory to standard chemotherapies. As the use of immune checkpoint inhibitors (ICI) proliferates, the incidence of autoimmune side effects associated with these agents, termed immune related adverse events (irAE), is expected to increase. The frequency of significant irAE in ICI treated patients is about 10–20% and early recognition is critical to prevent serious morbidity and even mortality. New onset autoimmune diabetes mellitus (DM) associated with immune checkpoint inhibitor treatment is extremely rare, occurring in less than 1% of patients. Autoimmune DM often presents as diabetic ketoacidosis, a medical emergency requiring immediate treatment. We describe the first reported case of a patient with lung cancer who developed autoimmune diabetes after nivolumab treatment and was found to have three diabetes related (islet) autoantibodies present before ICI treatment and seroconversion of another after ICI treatment and onset of autoimmune DM. A 34 year old African American woman with metastatic non-small cell lung cancer (NSCLC) was treated with nivolumab in the second line setting after disease progression following standard chemoradiation therapy. After receiving two doses of nivolumab, the patient developed abrupt onset of hyperglycemia and diabetic ketoacidosis. Autoimmune diabetes was diagnosed on the basis of undetectable C-peptide levels, seropositivity of three diabetes related (islet) autoantibodies and absolute insulin dependence. The patient eventually required use of continuous subcutaneous insulin infusion (insulin pump) due to erratic glycemic excursions and multiple readmissions for DKA. Human leucocyte antigen (HLA) genoyping revealed none of the Continue reading >>

A Pilot Study Evaluating Steroid-induced Diabetes After Antiemetic Dexamethasone Therapy In Chemotherapy-treated Cancer Patients

A Pilot Study Evaluating Steroid-induced Diabetes After Antiemetic Dexamethasone Therapy In Chemotherapy-treated Cancer Patients

A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients Jeong, Han, Lee, Yang, Jeong, Choi, Kwon, Jeon, Oh, Lee, and Kim: A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients Cancer Research and Treatment : Official Journal of Korean Cancer Association 2016; 48(4): 1429-1437. DOI: A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients Yusook Jeong, MD , Hye Sook Han, MD , Hyo Duk Lee, MD , Jiyoul Yang, MD , Jiwon Jeong, MD , Moon Ki Choi, MD , Jihyun Kwon, MD , Hyun-Jung Jeon, MD , Tae-Keun Oh, MD , Ki Hyeong Lee, MD , Seung Taik Kim, MD Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea Correspondence: Hye Sook Han, MD Department of Internal Medicine, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea Tel: 82-43-269-6306 Fax: 82-43-273-3252 E-mail: [email protected] Received December 1, 2015 Accepted February 5, 2016 Copyright 2016 by the Korean Cancer Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Dexamethasone is a mainstay antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting. The aim of this pilot study was to assess the incidence of and factors associated with steroid-induced diabetes in cancer patients receiving chemotherapy with dexamethasone as an antiemetic. Non-diabetic patients with newly diag Continue reading >>

Acute Hyperglycemia Associated With Anti-cancer Medication

Acute Hyperglycemia Associated With Anti-cancer Medication

Acute Hyperglycemia Associated with Anti-Cancer Medication Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea. Corresponding author: Eun Kyung Lee. Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea. Tel: +82-31-920-1743, Fax: +82-31-920-2798, [email protected] Received 2017 Jan 16; Revised 2017 Feb 1; Accepted 2017 Feb 16. Copyright 2017 Korean Endocrine Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Hyperglycemia during chemotherapy occurs in approximately 10% to 30% of patients. Glucocorticoids and L-asparaginase are well known to cause acute hyperglycemia during chemotherapy. Long-term hyperglycemia is also frequently observed, especially in patients with hematologic malignancies treated with L-asparaginase-based regimens and total body irradiation. Glucocorticoid-induced hyperglycemia often develops because of increased insulin resistance, diminished insulin secretion, and exaggerated hepatic glucose output. Screening strategies for this condition include random glucose testing, hemoglobin A1c testing, oral glucose loading, and fasting plasma glucose screens. The management of hyperglycemia starts with insulin or sulfonylurea, depending on the type, dose, and delivery of the glucocorticoid formulation. Mammalian target of rapamycin (mTOR) inhibitors are associated with a high incidence of hyperglycemia, ranging from 13% to 50%. Immunotherapy, such as anti-programmed death 1 (PD-1) antibody treatment, induces hyperglycem Continue reading >>

Cyclophosphamide And Epirubicin-induced Diabetes Mellitus In Breast Cancer: A Rare Occurrence

Cyclophosphamide And Epirubicin-induced Diabetes Mellitus In Breast Cancer: A Rare Occurrence

Cyclophosphamide and epirubicin-induced diabetes mellitus in breast cancer: A rare occurrence Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 1Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Address for correspondence: Arup Kumar Misra, Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan, India. E-mail: [email protected] Received 2016 May 1; Revised 2016 May 27; Accepted 2016 Jul 15. Copyright : Journal of Pharmacology and Pharmacotherapeutics This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. This article has been cited by other articles in PMC. Breast cancer is the leading cause of death in women. Epirubicin and cyclophosphamide (EC) is one of the chemotherapeutic regimens used for the treatment of breast cancer. We describe a case treated with EC regimen and who presented to us with symptoms suggestive of diabetes mellitus postchemotherapy. Absence of family history of diabetes and normal blood sugar level, prechemotherapy points toward drug-induced hyperglycemia. These chemotherapeutic agents capable of altering immune response and might act synergistically to cause immunological damage to the islets of pancreas which might precipitate diabetes mellitus. Causality analysis on Naranjo's scale indicates a possible association with regimen. Key words: Cyclophosphamide, diabetes mellitus, epirubicin, hyperglycemia Breast cancer is one of the leading cancers and causes of mortality Continue reading >>

Retrospective Review Of The Incidence Of Monitoring Blood Glucose Levels In Patients Receiving Corticosteroids With Systemic Anti-cancer Therapy

Retrospective Review Of The Incidence Of Monitoring Blood Glucose Levels In Patients Receiving Corticosteroids With Systemic Anti-cancer Therapy

Leigha Rowbottom1, Jordan Stinson2, Rachel McDonald1, Urban Emmenegger3, Susanna Cheng3, Julia Lowe4, Angie Giotis2, Paul Cheon1, Ronald Chow1, Mark Pasetka2, Nemica Thavarajah1, Natalie Pulenzas1, Edward Chow1, Carlo DeAngelis2 1Rapid Response Radiotherapy Program, Department of Radiation Oncology, 2Department of Pharmacy, 3Department of Medical Oncology, 4Department of Endocrinology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada Correspondence to: Dr. Carlo DeAngelis, PhD. Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Email: [email protected] Background: Corticosteroids are used adjuvant to certain chemotherapy regimens, either as an antiemetic, to reduce other side effects, or to enhance cancer treatment. Additionally, they are frequently used for symptom control in cancer patients with end stage disease. Corticosteroid use may induce hyperglycemia in approximately 20-50% of patients, which may negatively affect patient outcomes. Objective: To determine the frequency of blood glucose monitoring in patients with and without diabetes receiving continuous corticosteroids with chemotherapy, and to determine the incidence of treatment-emergent abnormal blood glucose levels and steroid-induced diabetes mellitus (DM). Methods: A retrospective review was conducted for 30 genitourinary (GU) cancer patients who were treated with continuous oral corticosteroids as part of their chemotherapy regimen. The Canadian Diabetes Association (CDA) criterion for diagnosis of diabetes was applied to categorize patients into two distinct groups, patients with diabetes and patients without diabetes. This categorization was made based on Continue reading >>

Folfiri Chemotherapy-induced Diabetic Ketoacidosis

Folfiri Chemotherapy-induced Diabetic Ketoacidosis

Received Date: September 02, 2016; Accepted Date: September 22, 2016; Published Date: September 28, 2016 Citation: Bello CT, Fonseca RC, Duarte JS, Vasconcelos C (2016) FOLFIRIChemotherapy-Induced Diabetic Ketoacidosis. J Clin Case Rep 6:863. doi:10.4172/2165-7920.1000863 Copyright: 2016 Bello CT, et al. This is an open-access article distributedunder the terms of the Creative Commons Attribution License, which permitsunrestricted use, distribution, and reproduction in any medium, provided theoriginal author and source are credited. Diabetic ketoacidosis (DKA) is a frequently encountered medical emergency that usually develops in the setting of severe insulin deficiency. It may be the initial clinical presentation of newly diagnosed diabetes mellitus; however, it is usually triggered by a severe medical illness or insulin therapy omission in patients with previously diagnosed diabetes mellitus. FOLFIRI (FOLinic acid, 5-fluorouracil and IRInotecan) is a systemic chemotherapy regiment frequently employed in the management of advanced colorectal carcinoma. Besides the common and well known hematological toxicity, 5-fluorouracil based chemotherapy has been associated with new onset diabetes and worsening glycemic control in known diabetics. The authors report on a case of DKA in a previously well-controlled type 2 diabetic patient upon exposure to FOLFIRI chemotherapy. Diabetes; Ketoacidosis; FOLFIRI; 5-Fluorouracil Diabetic ketoacidosis (DKA) is a frequent life-threatening condition developing in the setting of severe insulin deficiency accompanied by high contrarregulatory hormone levels (glucagon, catecholamines, cortisol and growth hormone). It is characterized by a high anion gap metabolic acidosis, hyperglycemia and elevated circulating ketone bodies. In the majority Continue reading >>

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