Endocrine Abstracts

85-year-old female was brought into hospital with history of having gradually worsening conscious level for past 1 week. Past medical history includes Smouldering Myeloma, hypertension, stage 3 CKD and hearing impairment. Patient was receiving Daratumumab, lenalidomide and oral steroids for her MM for past few months. Patient was independent with her ADL till last week when she gradually started to deteriorate with drowsiness and confusion. On presentation to hospital patient was found to have a GCS of 9/15 and initial bloods showed ph. 7.22, hco3 14.6, glucose 24.1 and ketones of 6.4. calcium was 2.31 with adjusted calcium of 2.42, CRP of 27, TSH 1.28. CT head was done that came back normal and rest of bloods were stable. There was no previous history of DM however family said that patient was having positive osmotic symptoms for past 2-3 moths and had lost around 6-8 pounds during this time. Patient was started on treatment of DKA with insulin, fluids and K as per trusts guidelines, Hba1c was done that was found to be 121 mmol/mol. Patient was seen by diabetic team and diagnosed as having new onset of Diabetes likely secondary to immunotherapy with initial presentation with DKA. Patient improved over next 2-3 days and after resolution of DKA patient was started on biphasic insulin and was followed up the diabetic team that showed improvement in HbA1c to 41 mmol/mol. The aim of presenting his case report is to highlight the potential for newer immunotherapy regimes to cause diabetes mellitus and to be vigilant in monitoring of patients who display symptoms of hyperglycemia so that new onset of DM can be diagnosed earlier to prevent development of life-threatening complications such as DKA