micafungin and Diabetes-Mellitus--Type-1

Patients with type 1 diabetes mellitus (T1DM) are insulin dependent. Infection increases insulin resistance and subsequently increases insulin needs. We are reporting a case of a patient with T1DM and severe infection who has reduced insulin needs after starting micafungin therapy.. A 29-year-old Hispanic woman with known history of long-standing, uncontrolled T1DM presented for evaluation of worsening dysphagia and dyspnea. She was found to have cervical necrotizing fasciitis extending into the mediastinum and required several debridement surgeries along with broad-spectrum antibiotics and antifungal therapy. She had uncontrolled diabetes with a glycosylated hemoglobin of 13.4% (18.8 mM) on admission. Her insulin requirements progressively increased as a result of worsening infection, continuous tube feeds, and multiple debridement surgeries. She was started on micafungin, a potent 1,3-β-D glucan synthase inhibitor, to broaden antimicrobial coverage when her insulin requirement decreased to zero for >48 hours. Right after discontinuation of micafungin and her switch to a different antifungal, insulin requirements increased back to her baseline needs.. This is a report of decreased insulin requirements in a patient with T1DM correlating with micafungin administration. The mechanism of micafungin-induced hypoglycemia is not yet established. Oral administration of linear 1,3-β-D glucan has been documented to decrease blood glucose levels significantly by inhibition of expression of sodium-glucose transporter 1 (SGLT1) in intestinal mucosa.. We hypothesize that micafungin may inhibit SGLT-1 function and decrease insulin requirements in patient with T1DM.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Blood Glucose; Debridement; Diabetes Mellitus, Type 1; Dose-Response Relationship, Drug; Drug Substitution; Drug Therapy, Combination; Fasciitis, Necrotizing; Female; Glycated Hemoglobin; Humans; Hypoglycemia; Insulin; Intestinal Mucosa; Micafungin; Sodium-Glucose Transporter 1

Invasive pulmonary aspergillosis (IPA) patients with non-hematological malignancy are far less than with hematological malignancy patients. We encountered a very rare case of IPA in which type 1 diabetes was the only conceivable risk factor. Further, according to the diagnostic categories of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria for IPA, the frequency of proven diagnosis is very low. Here we report a proven IPA, which rapidly developed when the patient with type 1 diabetes was being treated for diabetic ketoacidosis, which was successfully treated with the combination therapy of voriconazole (VRCZ) and micafungin (MCFG), based on early diagnosis using bronchoscopy.

Topics: Antifungal Agents; Aspergillus fumigatus; Biopsy; Bronchoalveolar Lavage Fluid; Bronchoscopy; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Drug Therapy, Combination; Humans; Hypoglycemic Agents; Insulin; Invasive Pulmonary Aspergillosis; Male; Micafungin; Middle Aged; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome; Voriconazole