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Departments

Insulin Resistance and Portal Vein Thrombosis

  1. Nay Linn Aung1 and
  2. Fiona J. Cook2
  1. 1Diabetes Fellow and
  2. 2Director, Endocrinology Fellowship Program, East Carolina University, Greenville, NC
  1. Corresponding author: Nay Linn Aung, naylin9{at}gmail.com
Clinical Diabetes 2019 Apr; 37(2): 183-187. https://doi.org/10.2337/cd18-0060
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  • FIGURE 1.
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    FIGURE 1.

    Management of DKA with IV insulin during first 24 hours after admission. The patient presented with DKA, which was managed with IV insulin using the DKA Endotool software protocol (Monarch Medical Technologies, Charlotte, N.C.). Anion gap was closed within a few hours after IV insulin was started and remained normal throughout the course. IV dextrose saline was started when blood glucose dropped to <250 mg/dL, according to protocol. Dextrose saline was continued for ∼12 hours at a rate of 75 mL/hour and discontinued 2 hours before discontinuation of IV insulin.

  • FIGURE 2.
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    FIGURE 2.

    CT scan of the abdomen with contrast. Complete thrombosis of main portal vein and right and left portal vein and hepatic branches. There were no abnormalities in liver or ascites. There was no mass or suspicion of malignancy.

  • FIGURE 3.
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    FIGURE 3.

    Insulin requirement over time. The patient initially needed IV insulin at a high dose and was transitioned to a much lower dose of subcutaneous insulin after resolution of DKA. However, due to his high blood glucose level, IV insulin was started again for a few hours and then transitioned to a relatively higher dose of subcutaneous insulin.

  • FIGURE 4.
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    FIGURE 4.

    CT scan of the abdomen with contrast. Although BMI is only in overweight range, CT showed visceral adiposity with relatively low subcutaneous adiposity. These findings are consistent with insulin resistance.

  • FIGURE 5.
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    FIGURE 5.

    Prothrombotic risk in diabetes. IL-1, interleukin-1.

Tables

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  • TABLE 1.

    Admission Laboratory Values

    Test (Reference Range)Result
    White blood count, K/μL (4.5–11.0)24.10
    Neutrophil, % (NA)91
    Glucose, mg/dL (70–108)418
    Sodium, mg/dL (136–145)127
    Potassium, mEq/L (3.5–5.0)4.7
    Chloride, mEq/L (98–107)89
    Bicarbonate, mEq/L (23–31)20
    Blood urea nitrogen, mg/dL (8–36)30
    Creatinine, mg/dL (0.72–1.25)1.83
    Anion gap, mEq/L (4–12)18
    Calcium, mg/dL (8.4–10.2)10.5
    Phosphorus, mg/dL (2.3–4.7)3.7
    Beta-hydroxybutyrate, mg/dL (0.00–2.81)25.14
    PCO2, venous, mmHg (38–50)33
    PO2, venous, mmHg (30–50)30
    pH, venous (7.33–7.43)7.43
    Bicarbonate, venous, mEq/L (24–28)22
  • TABLE 2.

    Liver Function Profile

    Test (Reference Range)Result on AdmissionResult 3 Days Later
    Bilirubin, mg/dL (0.22–1.2)2.41.3
    Alkaline phosphatase, units/L (40–150)174148
    Aspartate aminotransferase, units/L (5–34)3748
    Alanine aminotransferase, units/L (0–55)3447
    Protein, total, units/L (6.2–8.1)10.48
    Albumin, g/dL (3.2–4.6)3.52.6
  • TABLE 3.

    Coagulopathy Profile, Autoimmune Profile, and Tumor Markers

    TestResult
    Coagulopathy profile test (reference range)
     International normalized ratio1.0
     Prothrombin time, seconds (9.5–10.9)10.7
     Partial thromboplastin time, seconds (21.5–26.2)22.8
     Antithrombin III, % normal human pooled plasma (75–125)89
     Homocysteine, μmol/L (<11.4)10.9
     Protein C, % (70–180)83
     Protein S, total, % (70–140)143
     Protein S, free, % (57–171)101
     Dilute Russell’s viper venom time screen, seconds (≤45)29
    Autoimmune profile test (reference range)
     Antinuclear antibodies (<40)<40
     IgA, mg/dL (101–645)567
     IgG, mg/dL (540–1,822)1,884
     IgM, mg/dL (22–240)639
    Tumor markers test (reference range)
     Carcinoembryonic antigen, ng/mL (<5.0)2.6
     Carbohydrate antigen 19-9, units/mL (<34)6
     Alpha-fetoprotein, ng/mL (<6.1)1.2
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Clinical Diabetes: 37 (2)

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Insulin Resistance and Portal Vein Thrombosis
Nay Linn Aung, Fiona J. Cook
Clinical Diabetes Apr 2019, 37 (2) 183-187; DOI: 10.2337/cd18-0060

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Insulin Resistance and Portal Vein Thrombosis
Nay Linn Aung, Fiona J. Cook
Clinical Diabetes Apr 2019, 37 (2) 183-187; DOI: 10.2337/cd18-0060
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