A CASE OF NEWLY DIAGNOSED DIABETES PRESENTING WITH CHOREOATHETOSIS

Abstract

CASE
An 84-year-old hypertensive Filipino female presented with a one-day history of involuntary repetitive rotatory movements of the left upper extremity without sensorimotor deficits and no history of head trauma. Cranial MRI revealed no acute infarct, hemorrhage, or discrete mass lesion. Laboratory work-up revealed elevated capillary blood glucose of 454 mg/dL, HbA1c of 11.1%, and a normal TSH of 1.75 uIU/ml (0.55-4.78). She had CKD3B (eGFR 36 ml/min) with normal hemoglobin 13.3 g/dL (11.6-15.5), BUN 15 mg/dL (9-23), sodium 135 mmol/L (135 145), Mg 1.7 mg/dL (1.6-2.6) and iCa 1.16 mg/dL (1.09-1.30), and low potassium 3.4 mmol/L (3.5-5.1). Urinalysis showed pyuria with glucosuria but no ketonuria. She was managed with
diabetic choreoathetosis, type 2 diabetes mellitus newly diagnosed, and a complicated urinary tract infection. She was started on insulin glargine 12 units once daily with rescue doses of insulin glulisine and sitagliptin 50 mg once daily. Hypokalemia was corrected. There was resolution of choreoathetosis with an improvement of glycemia (105-164 mg/dL). She was discharged with Metformin 500 mg and Sitagliptin 50 mg twice daily.