Case analysis of abnormal increase in blood glucose after targeted combination chemotherapy in a patient with colon cancer

Published on Jan. 15, 2024Total Views: 1546 times Total Downloads: 1332 times Download Mobile

Affiliation: 1. Department of Pharmacy, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou 215101, Jiangsu Province, China 2. Department of Nephrology and Endocrinology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou 215101, Jiangsu Province, China

Keywords: Diabetic ketoacidosis High blood sugar Fluorouracil Bevacizumab

DOI: 10.12173/j.issn.1005-0698.202306063

Reference: WU Yan, WANG Xin.Case analysis of abnormal increase in blood glucose after targeted combination chemotherapy in a patient with colon cancer[J].Yaowu Liuxingbingxue Zazhi,2024, 33(2):230-235.DOI: 10.12173/j.issn.1005-0698.202306063.[Article in Chinese]  Copied

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Abstract

This article introduced a case of colon cancer patient who developed abdominal pain with nausea and vomiting after two cycles of using bevacizumab combined with fluorouracil. The perfect examination founded that the blood sugar rose abnormally to 40 mmol·L^-1, the pH of blood gas was 7.24, the actual bicarbonate was 4 mmol·L^-1, ketone body 3+, and urine sugar 3+. It was judged as mild diabetes ketoacidosis. After a large amount of fluid infusion, insulin treatment, and dual insulin treatment, The patient's blood gas analysis, ketone bodies, and urine sugar have all been normal, and their fasting blood sugar is controlled at 8.6 mmol·L^-1. The patient’s condition was stable while long term use of insulin aspart was necessary. According to the association evaluation method of the National ADR Monitoring Center, the author evaluated the association of diabetes ketoacidosis, and assessed that diabetes ketoacidosis "may" be caused by the combined use of bevacizumab and fluorouracil. Through consulting domestic and foreign literature, the author analyzed and summarized tumor related glucose metabolism abnormalities, realized that abnormal blood glucose caused by chemotherapy drugs or chemotherapy adjuvant drugs can not be ignored, especially in tumor patients with diabetes history or pre diabetes. Hope the analysis can provide a certain reference for similar reactions.

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References

1.Adachi J, Mimura M, Gotyo N, et al. The development of fulminant type 1 diabetes during chemotherapy for rectal cancer[J]. Intern Med, 2015, 54(7): 819-822. DOI: 10.2169/internalmedicine.54.3413.

2.谭晓娟, 王慧, 张瑞. 新诊断合并糖尿病酮症酸中毒的1型糖尿病和2型糖尿病患者临床特征比较[J]. 中国医药, 2020, 15(2): 235-238. [Tan XJ, Wang H, Zhang R. Comparison of clinical characteristics between type 1 diabetes and type 2 diabetes patients newly diagnosed with diabetes ketoacidosis[J]. Chinese Medicine, 2020, 15(2): 235-238.] DOI: 10.3760/j.issn.1673-4777.2020.02.018.

3.中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志, 2021, 13(4): 315-409. DOI: 10.3760/cma.j.cn115791-20210221-00095.

4.中国抗癌协会肿瘤内分泌专业委员会, 重庆市中西医结合学会肿瘤内分泌分会. 肿瘤相关性高血糖管理指南(2021年版)[J]. 中国癌症杂志, 2021, 31(7): 651-688. DOI: 10.19401/j.cnki.1007-3639.2021.07.013.

5.陈静静, 钱佩佩, 曹凯, 等. 我国药品不良反应关联性评价方法与诺氏评估量表法的对比与分析[J]. 中国药事, 2020, 34(8): 988-992. [Chen JJ, Qian PP, Cao K, et al. Comparison and analysis of the correlation evaluation method for adverse drug reactions in China and the Knoop assessment scale method[J]. China Pharmaceutical Journal, 2020, 34(8): 988-992.] DOI: 10.16153/j.1002-7777.2020. 08.021.

6.黄丽霞,刘基华,刘雪莹，等. 贝伐珠单抗生物类似药与原研药疗效及不良反应的回顾性分析比较[J].中国处方药, 2022, 20(8): 1-4. [Huang LX, Liu JH, Liu XY, et al. Retrospective analysis and comparison of efficacy and adverse reactions between bevacizumab biologically similar drugs and original research drugs[J]. Chinese Prescription Medicine, 2022, 20(8): 1-4.] DOI: 10.3969/j.issn.1671-945X.2022.08.002.

7.裘琳,刘异,侯黎伟,等. 贝伐珠单抗治疗恶性肿瘤相关不良反应回顾性分析[J].药物流行病学杂志, 2019, 28(2): 118-121. [Qiu L, Liu Y, Hou LW, et al. Retrospective analysis of adverse reactions related to bevacizumab in the treatment of malignant tumors[J]. Chinese Journal of Pharmacoepidemiology, 2019, 28(2): 118-121.] DOI: 10.19960/j.cnki.issn1005-0698.2019.02.010.

8.刘秀兰, 李娟. 贝伐珠单抗致高血糖1例[J]. 中国药师, 2019, 22(2): 308-309. [Liu XL, Li J. One case of hyperglycemia caused by bevacizumab[J]. China Pharmacist, 2019, 22(2): 308-309.] DOI: 10.3969/j.issn. 1008-049X.2019.02.030.

9.Quintieri L, Selmy M, Indraccolo S. Metabolic effects of antiangiogenic drugs in tumors: therapeutic implications[J]. Biochem Pharmacol, 2014, 89(2): 162-170. DOI: 10.1016/j.bcp.2014.02.018.

10.Feng JP, Yuan XL, Li M, et al. Secondary diabetes associated with 5-fluorouracil-based chemotherapy regimens in non-diabetic patients with colorectal cancer: results from a single-centre cohort study[J]. Colorectal Dis, 2013, 15(1): 27-33. DOI: 10.1111/j.1463-1318.2012.03097.x.

11.董利森, 王越, 邬旭日, 等. 1例卡培他滨联合奥沙利铂致非糖尿病患者血糖升高的病例分析[J]. 肿瘤药学, 2021, 11(5): 645-650. [Dong LS, Wang Y, Wu XR, et al. One case analysis of non diabetes patients with hyperglycemia caused by capecitabine combined with oxaliplatin[J]. Oncology Pharmacology, 2021, 11(5): 645-650.] DOI: 10.3969/j.issn.2095-1264.2021.05.22.

12.吕国庆, 邹静, 祖木热提, 等. 以5-氟尿嘧啶为基础的联合化疗对结直肠癌患者血糖代谢和免疫细胞数量的影响[J]. 临床和实验医学杂志, 2016, 15(16): 1606-1609. [Lyu GQ, Zou J, Zumu RT, et al. Effects of 5-fluorouracil based combination chemotherapy on blood glucose metabolism and immune cell count in colorectal cancer patients[J]. Journal of Clinical and Experimental Medicine, 2016, 15(16): 1606-1609.] DOI: 10.3969/j.issn. 1671-4695.2016.16.019.

13.冯觉平,方静,袁响林,等. 5-氟尿嘧啶为基础的联合化疗对结直肠癌患者血糖代谢的影响[J].肿瘤, 2010, 30(10): 865-869. [Feng JP, Fang J, Yuan XL, et al. The effect of 5-fluorouracil based combination chemotherapy on blood glucose metabolism in colorectal cancer patients[J]. Cancer, 2010, 30(10): 865-869.] DOI: 10.3781/j.issn.1000-7431.2010.10.011.

14.Yim C, Mansell K, Hussein N, et al. Current cancer therapies and their influence on glucose control[J]. World J Diabetes, 2021, 12(7): 1010-1025. DOI: 10.4239/wjd.v12.i7.1010.

15.Stelmachowska-Banaś M, Czajka-Oraniec I. Management of endocrine immune-related adverse events of immune checkpoint inhibitors: an updated review[J]. Endocr Connec, 2020, 9(10): 207-228. DOI: 10.1530/EC-20-0342.

16.Hong AR, Yoon JH, Kim HK, et al. Immune checkpoint inhibitor-induced diabetic ketoacidosis: a report of four cases and literature review[J]. Front Endocrinol (Lausanne), 2020, 11: 14. DOI: 10.3389/fendo.2020.00014.

17.中华医学会糖尿病学分会. 中国高血糖危象诊断与治疗指南[J]. 中华糖尿病杂志, 2013, 5(8): 449-461. DOI: 10.3760/cma.j.issn.1674-5809.2013.08.001.