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Endocrine Abstracts (2021) 75 D16 | DOI: 10.1530/endoabs.75.D16

1Wrightington, Wigan and Leigh Teaching Hospitals, Greater Manchester; [email protected]; 2Foundation Year Trainee, Wrightington, Wigan and Leigh Teaching Hospitals


HHS is a rare hyperglycaemic emergency, typically precipitated by infection in people with T2DM. There are few recorded cases of COVID induced pure HHS. We here by report 2 further cases, including the first known reported case in a person with T1DM.

Case 1: 81yo male with T1DM (on glargine and aspart insulin, HbA1c 57 mmol/mol) presentedwith lethargy, general deterioration and a fall.Therewere no new symptoms offever/cough/breathlessness or change in taste/smell. Investigations showedGlucose 34.9 mmol/l, Ur18.3, Cr96, Na135, K4.5, S. Osm 323.2, pH7.48, HCO3 27.6, blood ketones 0.3 mmol/l. COVID PCR positive. CXR - no COVID changes. He was diagnosed with HHS and treated with IV fluids and IV insulin with clinical and biochemical improvement.

Case 2: 91yo female with T2DM (no anti-hyperglycaemic medication – metformin and linagliptin discontinued during an inpatient spell 5 months earlier with normal blood sugars), IHD and dementia was admitted with polyuria/polydipsia. No symptoms of cough/SOB/fever or change in taste/smell. Investigations showed Glucose 38.4, Ur14.4, Cr132, Na134, K5.3, S. Osm320.8, HbA1c130, pH7.39, HCO3 28.5, blood ketones 0.7. COVID PCR positive. CXR - no COVID changes. She was treated with IVF and IV Insulin with rapid biochemical improvement, and discharged home with metformin, linagliptin and gliclazide.

Discussion: Despite the COVIDpandemic affecting over 173,000,000 peopleworldwide to date, the incidence of HHS remains very low and limited to a few case reports. We have added to the knowledge base with 2 additional reports, including, to our knowledge, the first report in a patient with T1DM. Given that these cases were asymptomatic from a COVID perspective, we recommend that COVID is considered as a precipitant for all patients with hyperglycaemic emergencies without an alternative cause. The forthcoming CoviDiab study, and others, will shed further light into the interplay between COVID and hyperglycaemic emergencies

Volume 75

ESE Young Endocrinologists and Scientists (EYES) Annual Meeting

European Society of Endocrinology 

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