Steroid-Induced Diabetic Ketoacidosis in a Patient with Type 2 Diabetes Mellitus

ABSTRACT Objective: Diabetic ketoacidosis (DKA) is usually associated with type 1 diabetes mellitus; however, it is increasingly being recognized in patients with type 2 diabetes mellitus (T2DM). Triggering factors usually involve infections and poor medication adherence. Other potential triggers are myocardial infarction, antipsychotic drug usage, malignancy, and cerebrovascular accidents. No case of steroid-induced DKA in a patient with T2DM has been reported in the literature. Methods: Clinical and laboratory data are presented. Results: We present a case of a middle-aged patient with a history of well-controlled T2DM via metformin. The patient was started on oral prednisone for lumbar disc herniation, and then presented with acute DKA. No other trigger for DKA but steroid initiation was found. Conclusion: We conclude that patients with diabetes who receive glucocorticoids should be monitored carefully, as steroids can precipitate DKA. This may occur in the absence of any other triggering factor, and even in patients with well-controlled T2DM. Abbreviations: DKA diabetic ketoacidosis T2DM type 2 diabetes mellitus