P-279: Severe transient hyperglycemia in an undernourished adolescent with cerebral palsy: a case of type 5 diabetes?
I Ferraz dos Santos, L Cudízio, R Biasi, L E CalliariAbstract
Introduction
Severe undernutrition can impair glucose metabolism and should be considered in the differential diagnosis of diabetes in pediatric patients. Diabetes associated with undernutrition (historically referred to as malnutrition-related diabetes or “type 5” diabetes) is a rare non-autoimmune condition.
Objectives
To describe a case of severe hyperglycemia in a malnourished adolescent and its clinical course after nutritional rehabilitation.
Methods
This is a retrospective case report based on a pediatric patient presenting with hyperglycemia in the context of chronic undernutrition.
Results
A 13-year-old boy with severe cerebral palsy and hydrocephalus was admitted due to significant weight loss, reduced oral intake, and severe chronic undernutrition (weight 20.9 kg, height 136 cm, BMI Z-score −7.54). There was no previous history of diabetes. During hospitalization, he developed severe hyperglycemia, with a peak glucose of 451 mg/dL, associated with moderate metabolic acidosis (pH 7.22; bic- 18.4 mmol/L), without hyperketonemia (0.1 mmol/L). HbA1c was 5.0%, and C-peptide was within normal range (1.7 ng/mL). He received insulin, with a maximum total daily dose of 11 units (∼ 0.5 UI/kg/day). Nutritional rehabilitation, including gastrostomy placement, was performed. There was a weight gain from 20.9 kg to 24.8 kg in 3 weeks, and glycemic values gradually normalized, ranging from 80–150 mg/dL, allowing discontinuation of insulin before discharge. At follow-up, glycemic levels remained stable without insulin therapy, with HbA1c of 4.5%. Autoantibodies are being measured.
Conclusions
This case highlights severe, reversible hyperglycemia in the setting of chronic undernutrition and metabolic stress. Normal HbA1c, preserved C-peptide, absence of ketosis, and sustained remission after nutritional rehabilitation strongly argue against autoimmune diabetes. The correct classification is critical, and the follow-up will determine the best possible management.