P-447: Missed signals on the skin: cutaneous manifestations of poor glycaemic control in an adolescent with type 1 diabetes and ketoacidosis: a case report

Introduction

Cutaneous manifestations are common in diabetes mellitus and may serve as external markers of metabolic dysregulation. In resource-limited settings, these signs can provide important clues to poor glycaemic control and complications.

Objectives

Not applicable

Methods

Not applicable

Results

A 13.5-year-old male, diagnosed with type 1 diabetes mellitus at age 8, presented with a 3-day history of polyuria, vomiting, and altered sensorium. His diabetes management had been suboptimal, with poor adherence to insulin therapy and intermittent use of herbal remedies administered by his caregiver. He had a prior admission for diabetic ketoacidosis one year earlier and multiple undocumented hyperglycaemic episodes managed outside formal healthcare settings. On examination, he was dehydrated, tachypnoeic with Kussmaul respiration, and unconscious. His weight was 25kg, height was 124cm and BMI was 16.2kg/m2 (all <3rd centile) His SMR were stage 1 for testicles, axillary and pubic hair Dermatologic examination revealed multiple hyperpigmented macules and patches over the extensor aspects of the knuckles, anterior shins, and posterior neck, with a symmetrical distribution. Complete blood count showed relative neutrophilia, HbA1c was 14.8%; no skin biopsy was done due to financial constraints.

He was managed according to standard DKA protocol with clinical improvement and was discharged home after 1 week of admission. At follow-up one-week post-discharge, the skin lesions had significantly regressed. Repeat HbA1C 3 months later was 10.5%.

Conclusions

Cutaneous findings in children and adolescents with type 1 diabetes may serve as visible indicators of poor glycaemic control and treatment non-adherence. In resource-limited settings, where access to laboratory monitoring may be inconsistent, these signs can play a critical role in clinical assessment. Strengthening diabetes education and addressing sociocultural barriers to adherence are essential to improving outcomes.