Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus

  • Ahmed Osman Saleh Clinical Fellow, Endocrinology and Diabetes, HMC, Qatar
  • Ruba Taha Hamad Medical Corporation, National Center for Cancer Care and Research, Qatar
  • Shehab Fareed A. Mohamed Hamad Medical Corporation, National Center for Cancer Care and Research, Qatar
  • Mohammed Bashir Department of Endocrinology, Qatar Metabolic Institute Hamad Medical Corporation, Qatar


DKA, HHS, nivolumab, diabetes mellitus, checkpoint inhibitors


Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic.



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  • Published: 2021-08-13

    Issue: 2021: Vol 8 No 8 (view)

    Section: Articles

    How to cite:
    Saleh AO, Taha R, Mohamed SFA, Bashir M. Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus. EJCRIM 2021;8 doi:10.12890/2021_002756.

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