23-Year-Old with Recurrent Diabetic Ketoacidosis: A Case of Catamenial Hyperglycemia

Diabetic ketoacidosis is a medical emergency with somatic and psychological implications in patients with type 1 diabetes mellitus (DM1). Menstrual cycle-related glycemic change is rarely described as a precipitant of diabetic ketoacidosis. We present a case of a 23-year-old female with a history of DM1, on her second day of menstruation, who presents with diabetic ketoacidosis. In absence of other precipitating factors, examination of the time pattern of her recurrent diabetic ketoacidosis was consistent with catamenial diabetic ketoacidosis. To date, the reports of catamenial diabetic ketoacidosis are few and without consistent results. Moreover, most of the reports investigated only women with tight glycemic control. Systematic studies of catamenial hyperglycemia suggest variation in hyperglycemic patterns among individuals and even inconsistent glycemic variability patterns with consecutive cycles, making the management of catamenial hyperglycemia challenging. This case illustrates recurrent adverse outcomes (including diabetic ketoacidosis) due to complexities in DM1 management influenced by catamenial hyperglycemia. The complexity of diabetes management suggests the need of closed-loop glucose control systems that self-adjust basal insulin patterns to respond to the glucose management needs throughout menstrual cycles, which may ultimately prevent the risk for catamenial diabetic ketoacidosis, improve overall glycemic control, and reduce psychological burden of DM1.