micafungin and Fasciitis--Necrotizing

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