C67-25 A Novel and Rare Presentation of Latent Autoimmune Diabetes From Covid-19

Abstract As of 2020, COVID has affected 4 million people worldwide and caused 200,000 deaths. COVID infection has become a pandemic. According to WHO, the mean age was 46.7 years with 51.8% being male and a mortality rate of 5.6%. Although rare, COVID has been shown to lead to autoimmunity via upregulation of the ACE messenger, which can induce damage and acute dysfunction of beta cells leading to new onset diabetes. COVID has also been shown to upregulate PKR via viral RNA and cytokine storm which is a second mechanism that can lead to a viral induced new onset diabetes. This case highlights a novel presentation of a latent autoimmune diabetes triggered by a recent COVID infection. A 65 year old male with a past medical history of primary hyperparathyroidism s/p right inferior parathyroidectemy 2022, ulcerative proctitis, appendiceal neoplasm s/p right hemicolectomy 2017 had presented to the hospital for abdominal pain. He was discovered to have SMA thrombosis which was managed by heparin. Upon further investigation during this hospital course the patient had a HgA1C of 12%. GAD at that hospitalization was elevated at .14 and blood glucose was elevated at 201, leading the diagnosis to be a new onset autoimmune diabetes. With the relative time of new onset diabetes the suspected trigger was a recent COVID-19 infection that the patient had prior to the development of this autoimmune condition. During this hospitalization, the patient was provided insulin and instructed on dietary modifications for better glycemic control for this new onset diabetes mellitus. LADA is a type of diabetes that is characterized by the gradual autoimmune destruction of the beta islets in the pancreas. One mechanism of how COVID instigates diabetes is its increased expression of ACE2 messenger ribonucleic acid (mRNA). The expression of ACE2 mRNA in the pancreas has been shown to induce damage and acute dysfunction of beta cells, which leads to diabetes in healthy individuals or exacerbation of an already existing diabetes with the developing of ketoacidosis. COVID has also been shown to increase insulin resistance through activation of PKR through viral RNA and cytokine storm leading to diabetes. This case highlights a novel presentation of diabetes from a recent COVID-19 infection. Vigilance and awareness of this relationship can help a provider recognize this novel presentation to help achieve better outcomes of glycemic control in a latent autoimmune diabetic patient. This abstract is funded by: none