2023 Volume 66 Issue 11 Pages 783-789
A 66-year-old man had been treated with nivolumab and ipilimumab for non-squamous cell carcinoma of the lung since May X−1. In October Y−7, X, his blood glucose level and blood C-peptide were 147 mg/dL and 1.76 ng/mL, respectively. In October Y, he visited the emergency room with complaints of dry mouth, polydipsia, nausea, and decreased appetite. His blood glucose level and blood C-peptide were 1,684 mg/dL and 0.09 ng/mL, respectively, and he had ketoacidosis, which was diagnosed as diabetic ketoacidosis due to fulminant type 1 diabetes associated with immune checkpoint inhibitors. This case is unique in that the onset of DKA occurred 17 months after administration. The insulin secretory capacity was maintained one week before the onset of the disease, and it was confirmed that this capacity decreased rapidly. Based on this experience, we held a case conference, revised the in-hospital algorithm for immune-related adverse events, prepared a manual for reverse engineering, conducted educational activities for patients, and shared the information with physicians. We report the activities of our hospital in this study.
