Rapid Progression of Prediabetes to Diabetes after Booster Dose

A 69-year-old male with a past medical history of hypertension and prediabetes presented with worsening fatigue, polyuria, polydipsia, blurry vision, and 14 pounds of weight loss over three weeks that started soon after receiving the 3rd booster dose of BNT162b2 mRNA vaccine. He also reported intermittent upper abdominal pain and episodic ambulatory lightheadedness for two weeks. He also reported a loss of taste and smell for two weeks with a diminished appetite. His family history was significant for some members with Graves' disease and celiac disease. He was a non-smoker with no alcohol or illicit drug use. On examination, he was afebrile with normal blood pressure, sinus tachycardia, and mild tachypnea. Physical exam was remarkable for mild upper abdominal tenderness and dry oral mucosa. 

Complete blood count (CBC) was normal; blood glucose was severely elevated with mild corrected hyponatremia; elevated anion gap metabolic acidosis with glucosuria and ketonuria. He received an insulin drip, normal saline, and potassium in the intensive care unit. 

On a three-week endocrinology follow-up, his repeat HbA1c improved to 10.3%. He continues to be insulin dependent and regularly follows up with his physician.


Kshetree B, Lee J, Acharya S. COVID-19 Vaccine-Induced Rapid Progression of Prediabetes to Ketosis-Prone Diabetes Mellitus in an Elderly Male. Cureus. 2022 Sep 6;14(9):e28830. doi: 10.7759/cureus.28830. PMID: 36225440; PMCID: PMC9535996.


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