Qiang Wei, Chen Xia, Gao Chuqi, Wang Zhaoxu, Shang Jin, Fu Jiao, Guo Hui
Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Endocrinology, Luohe Central Hospital, Luohe, China.
Ther Adv Endocrinol Metab. 2020 Jul 24;11:2042018820938236. doi: 10.1177/2042018820938236. eCollection 2020.
A 71-year-old man without previous history of diabetes was hospitalized after suffering polyuria for 1 month and involuntary movement of the left arm for 1 week. His random serum glucose was 42.05 mmol/l and his hemoglobin A1C was 14% (129 mmol/mol). His serum osmolarity was normal and his urine ketone was negative. Cerebral CT revealed hyperdensity in the right basal ganglia. The patient was diagnosed with diabetic hemiballism-hemichorea (HH). Intravenous insulin was given and later shifted to continuous subcutaneous insulin infusion. During the hospital stay, insulin titration was guided mainly by flash glucose monitoring (FGM). Finger-prick glucose was occasionally checked to verify the accuracy of the FGM. Rapid correction of severe hyperglycemia was achieved without hypoglycemia. HH resolved within 1 week after euglycemia was achieved. This case emphasized the importance of being alert for HH as the initial presentation of diabetes and neuroimaging negative diabetic HH. In addition, interstitial glucose-monitoring technologies including continuous glucose monitoring and FGM can facilitate inpatient intensive insulin therapy in diabetic HH by avoiding hypoglycemia.
一名71岁男性，既往无糖尿病史，因多尿1个月、左臂不自主运动1周入院。其随机血糖为42.05mmol/L，糖化血红蛋白为14%（129mmol/mol）。血清渗透压正常，尿酮体阴性。脑部CT显示右侧基底节区高密度影。该患者被诊断为糖尿病性偏侧投掷症-偏侧舞蹈症（HH）。给予静脉胰岛素治疗，随后改为持续皮下胰岛素输注。住院期间，胰岛素剂量调整主要以动态血糖监测（FGM）为指导。偶尔检测指尖血糖以验证FGM的准确性。在未发生低血糖的情况下实现了严重高血糖的快速纠正。血糖正常后1周内HH症状消失。该病例强调了警惕HH作为糖尿病的首发表现以及神经影像学阴性的糖尿病性HH的重要性。此外，包括持续葡萄糖监测和FGM在内的组织间葡萄糖监测技术可通过避免低血糖促进糖尿病性HH患者的住院强化胰岛素治疗。
