THU380 A Case Of Alpelisib Induced Diabetic Ketoacidosis (Dka) In A Patient With Type 2 Diabetes Mellitus And Rechallenge With SGLT2 Inhibitor
Abstract
Abstract Disclosure: V. Sekar: None. S. Shaik: None. Introduction: Alpelisib is a α-selective phosphatidylinositol 3-kinase (PI3K) inhibitor recently used in treatment of advanced breast cancer. Hyperglycemia is an expected adverse effect with the use of PI3K inhibitors. We report a case of Alpelisib induced worsening hyperglycemia in a patient with type 2 diabetes mellitus who developed DKA while on Empagliflozin and was rechallenged with Dapagliflozin to achieve better glycemic control. Case Description: 60-year-old female with known history of type 2 diabetes mellitus was referred to Endocrinology prior to the start of PI3K inhibitor, Alpelisib for metastatic breast cancer. On initial visit her Hemoglobin A1C was 7.4 % and she was on Empagliflozin 25 mg daily, Sitagliptin 100 mg daily, Metformin XR 500 mg daily and Insulin Glargine 30 units daily. Three weeks after initiation of Alpelisib, patient reported uncontrolled fasting and post-prandial hyperglycemia, therefore her basal insulin was up-titrated and added on prandial insulin. Sitagliptin was discontinued. Two weeks later patient was admitted with Euglycemic diabetic ketoacidosis (DKA) which was treated with IV insulin and IV fluids. Empagliflozin was stopped and discharged on basal bolus regimen. In the next 6 weeks basal bolus regimen was significantly up-titrated and added on correctional insulin along with increasing Metformin XR to 500 mg twice a day due to poor glycemic control. During this time patient was…
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