A Case of Type 1 Diabetes Mellitus Associated with Ketoacidosis Triggered by a Rapid Reduction of the Dose of Insulin with the Administration of a Very-low-carbohydrate Diet

Abstract

A 19-year-old female was diagnosed with Type 1 diabetes mellitus and began insulin therapy at 8 years of age. Although she took 20 units of glargine at bedtime and 14-18 units of lispro before each meal at 19 years of age, her glycemic control worsened [HbAlc (NGSP) 15 %] due to increased food intake. She was admitted to another hospital to begin a very-low-carbohydrate diet The dose of glargine was reduced to 4-8 units at bedtime, and the lispro taken before each meal was discontinued after admission. However, the patient began to vomit at midnight on day 2, and her plasma glucose level was 532 mg/d/at 7:30 AM on day 3. Intravenous infusion of saline and insulin was initiated under a suspected diagnosis of diabetic ketoacidosis. She was subsequently urgently transferred to our hospital because her symptoms did not improve in spite of the administration of treatment for half a day. Following the urgent admission, her symptoms were markedly improved by intensive intravenous infusion of saline and insulin. This case suggests that insulin requirements should be carefully estimated when starting a very-low-carbohydrate diet in patients with insulin-dependent diabetes mellitus.