Catalina Victoria Kenney

Corewell
USA

Abstract Title: The Successful Management of The Rare Case of A Keytruda Induced Diabetes

Biography: Catalina Kenney is a Wayne State School of Medicine Graduate and Internal Medicine Resident at Corewell Health. Her expertise involves investigating rare cases and providing efficient management in bettering patient care outcomes.

Research Interest: The Successful Management of The Rare Case of A Keytruda Induced Diabetes Pembrolizumab causing diabetes occurs in .1% of the patients in various clinical trials performed. Immunotherapy is an important tool for cancer therapy, however This case presents a 65 year old female with a history of gastric adenocarcinoma status post chemotherapy use including pembrolizumab who presented to the hospital and was found to be in DKA. Patient had glucose that was found to be in 500 with a ph of 7.31, betahydroxybutyrate of 4.94, and anion gap of 17. Patient had an insulin pump that was malfunctioning and therefore could not adequately use her insulin for the last couple of days. She stated she also was experiencing nausea and vomiting. Patients who have a medication induced type one diabetes are more susceptible to a DKA complication compared to other diabetics. In regards to the medication mechanism of action, Pembrolizumab is a monoclonal antibody that blocks inhibitory ligand of PD-1 on T-cells which prevents t-cells from releasing cytokines and destroying the cell with the PD-1. However, problem comes when the cancer cells also express PD-L1 which protect them from destroying T-cells. Patient’s pembrolizumab functions by binding to PD-1 cells and blocking the inhibitory association with PD-L1 thereby allowing T-cell to mount an immune response against cancer cells. However studies have shown that pembrolizumab can cause type one diabetes. The mechanism by which PD-1 can cause diabetes is due to the drug’s ability to destroy cells in the islets of Langerhans leading to destruction in the production of insulin. Due to the sudden drop in insulin stores, this can result in patient who experience DKA quickly. Recognition of a Keytruda induced diabetic patient can help a provider recognize a potential complication such as DKA in this highly susceptible population.