One Sugar Too Many: A Rare Case of Fulminant Type 1 Diabetes Following Chemotherapy in Advanced Pancreatic Cancer and Comprehensive Literature Review

Fulminant type 1 diabetes (FT1D) is a category of type 1 diabetes mellitus characterized by the rapid progression of hyperglycaemia, an absolute deficit in insulin secretion, and ketoacidosis due to pancreatic β-cell destruction. Owing to unspecific symptomatology and a hasty clinical course in most cases, patients with FT1D are sometimes untreated until they become unconscious and reach a life-threatening critical state. The exact aetiology and pathogenesis are relatively elusive and may be related to various conditions including genetic predisposition, autoimmunity, viral infection, and less commonly, medications. Combination chemotherapy is the current established first-line treatment approach for advanced pancreatic adenocarcinoma but these treatments may be fraught with infrequent complications as the onset of FT1D. According to the literature, several studies have reported the occurrence of FT1D by interferon-alpha or immune checkpoint inhibitors in various cancers. Still, no cases describing the development of FT1D in pancreatic carcinoma undergoing chemotherapy have been described. Here, we report a scarce case of FT1D in a patient with no prior history of diabetes mellitus during treatment of pancreatic adenocarcinoma with chemotherapy and a comprehensive literature review.