The Meaning of Autoantibody Titers, Exercise, and Alcohol in a Thin 65-Year-Old Man Hospitalized for Cholangitis and Coincidental New Diabetes

Abstract

T.R. is a thin 65-year-old white man who was admitted for acute choledocholithiasis and ascending cholangitis. The patient, who had not seen a physician for many years, also had symptoms of polyuria, polydipsia, and nocturia for 1 week before admission. While hospitalized, his blood glucose levels were 123-223 mg/dl. His weight was 154 lb (BMI 22.1 kg/m2). Inpatient blood pressure readings were 180-190/100-110 mmHg. He had no family history of diabetes, took no medications except occasional nonprescription analgesics, and exercised regularly. An eye examination 2 years previously was normal. He had no known kidney disease, peripheral neuropathy symptoms, or foot lesions. Outpatient follow-up revealed random capillary blood glucose (CBG) levels of 227 and 139 mg/dl and a hemoglobin A1c (A1C) of 6.5%. His normal weight and regular exercise regimen suggested the possibility of type 1 diabetes. However, islet-cell antibodies (ICAs) and GAD antibodies were negative. He also had hypercholesterolemia, with an LDL of 154 mg/dl. To avoid having to take diabetes medications, the patient increased his exercise and modified his diet by decreasing his carbohydrate intake. T.R. monitored his CBG levels at home and returned to clinic after 2 weeks with a log and graph of his results. He noticed a significant increase in his blood glucose …