TRANSIENT STATE OF NIDDM IN A PATIENT WITH AIDS

OBJECTIVE- To describe a glucose abnormality in AIDS that is character ized by transient NIDDM followed by hyperinsulinemic normoglycemia. RE SEARCH DESIGN AND METHODS- A 36-yr-old Hispanic man with AIDS was on l ong-standing aerosolized pentamidine therapy in 1986. He received a co urse of intravenous pentamidine 5 mo before the onset of diabetes. Non ketotic hyperglycemia responded to sulfonylurea, which had to be disco ntinued 3 mo later because of normoglycemia. RESULTS- Diabetes diagnos is was made by three separate fasting blood glucose values of 16.2, 18 .1, and 29.9 mM, and HbA1c of 10.1% (normal 4.2-5.9). The patient beca me euglycemic 5 mo after diagnosis while on no treatment. An oral gluc ose tolerance test was then normal, and C-peptide stimulation showed s upranormal response. CONCLUSIONS- Transient severe NIDDM in this case could not be linked to acute stress. Pentamidine, in a progressively i ncreasing cumulative dose, is one possible, albeit unusual, etiology b ecause the diabetes was not permanent. After diabetes remission, the d ata suggest residual insulin resistance that is unusual in HIV-positiv e patients. Diverse glucose abnormalities exist in AIDS. Awareness of their presentation is clinically helpful.