Abstract
We report a dialysis patient with nondiabetic end-stage renal disease (ESRD) whom we subsequently diagnosed as having type 1 diabetes and chronic thyroiditis. A 62-year-old woman undergoing hemodialysis for 19 years due to nondiabetic ESRD first evidenced severe hyperglycemia (≥500 mg/dl, nonfasting plasma glucose) in December 2009. Her laboratory data showed marked hyperglycemia, i.e., nonfasting plasma glucose of 382 mg/dl, HbA1c of 14.4 %, and glycated albumin of 82.7 %. Presumably because of hemodialysis, however, she had neither acidosis nor dehydration. Anti-GAD antibody was detected at 5190 IU/ml, so we diagnosed her as having type 1 diabetes. She was also diagnosed as having autoimmune thyroid disease since several thyroid autoantibodies were positive. Intensive insulin therapy quickly restored glycemic control. This case suggests that we should consider both testing for anti-GAD antibody and excluding malignancy in dialysis patients with acute hyperglycemia.
