Diabetic Ketoacidosis in Type 1 DM: A Novel Presentation of CML

Abstract

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterized by metabolic acidosis, hyperglycemia, and ketosis. It most commonly occurs secondary to a precipitating event such as an infection, non-infectious illness, or insulin non-compliance. We report a case of a 28-year-old male with a history of well-controlled type 1 diabetes mellitus who began having frequent and repeated episodes of DKA. Evaluation for compliance lapses was negative. The further review noted a worsening white blood cell count over the same period, despite repeated negative infectious workups. A bone marrow biopsy revealed a hypercellular marrow with granulocyte and megakaryocyte proliferation. Testing for the BCR-ABL fusion gene was positive in 92% of cells. This led to a final diagnosis of chronic myeloid leukemia as the precipitator for repeated presentation with DKA. The two diseases do not commonly present simultaneously due to differences in median age. No previous reports of adults with DKA precipitated by CML are present in the literature. However, worsening hyperglycemia has been reported with other hematologic malignancies, particularly in the setting of acute lymphoblastic leukemia in the pediatric population. This is thought in some instances to be due to the leukemic process itself, potentially through cytokine release.