An Insulin Resistance Case Report: Uncontrolled Hyperglycaemia in type 1 Diabetic Patient Post COVID-19 Infection

Abstract

COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in late December 2019 in Wuhan, China, and has spread to become a pandemic with over 100 million confirmed cases and still growing. The infectious nature and hence, high hospitalization rates and intensive care admissions are resulting in high mortality rates. Alarmingly, COVID-19 infection and virus-induced respiratory dysfunction poses a serious threat to patients with chronic illnesses such as diabetes, Asthma, COPD and obesity. COVID-19 patients with diabetes show higher complication and mortality rate than patients without diabetes. Transient non-severe increased insulin requirement in patients hospitalized for medical conditions such as sepsis or myocardial infarction is a well-known phenomenon. However, extremely high-dose insulin requirement remains a very rarely reported entity, but this showed up in COVID-19 positive cases. Here, we report the case of transitory moderate increase in insulin requirement in a type 1 diabetic (T1D) patient who was previously well controlled in the absences of any medical conditions known to be a causative factor. We collected the data and compared total insulin daily requirement against pre-meal glycemia and blood gas results to reflect insulin resistance and multiple DKA events related to trials of multiple oral hypoglycemic agents and GLP1 analogue as potential target for intervention in addition to insulin therapy and low carb diet.