infectious diseases in type 2 diabetes can complicate diabetic ketoacidosis , derange hyperglycemia , or precipitate new onset diabetes . among infections ,
novel pandemic influenza virus h1n1 strain needs to be kept in mind when dealing with new onset diabetes with co - existing infectious agent , which , if present , is associated with high mortality .
a 63-year - old female , with no known chronic illness , was hospitalized in month of aug 2010 with fatigue , breathlessness on exertion , productive cough with scanty sputum , and high - grade fever of 04 days duration .
quick emergency assessment had shown temp 101f , tachycardia , tachypnea , p02 : 90% at room air , and normotensive .
further evaluation revealed nho in both lung fields on chest x - ray , hyperglycemia 325 mg / dl , detected for first time .
her symptoms and oxygen desaturation were out of proportion to clinical finding and chest x - ray findings . patient was managed with insulin infusion and empirical broad - spectrum antibiotic coverage in icu . as her condition worsened over next 12 hours , infection with novel influenza virus
was thought and empirically started on oseltamivir after taking throat swab for h1n1 test and later , the sample was tested positive for h1n1 influenza by rt - pcr [ figures 1 and 2 ] .
clinical course in the hospital was complicated by oxygen dependence requiring 10 - 12 ltr / hour of oxygen administration by nasal mask .
oseltamivir was continued for 02 weeks with escalation of antibiotic coverage for any methicillin - resistant staphylococcus aureus organisms .
appropriate prophylaxis against h1n1 was given to all nurses and paramedical staff and proper disposal of waste as per who guidelines .
she made an uneventful recovery and was discharged on biphasic insulin @ 35 units / day with well - controlled blood sugar levels .
chest x - ray showing pluffy opacities in both lung fields computed tomography scan chest : done at 48 hrs of admission , showing confluence of opacities with consolidation the first pandemic of 21 century , witnessed with detection of the first case in mexico 2009 , became evident that human - to - human transmission is caused by novel influenza virus , which is a re - assortment of 4 different strains of influenza virus genes causing novel h1n1 2009 pandemic strain .
though it behaved like seasonal flu virus , the morbidity and mortality were more with risk factors like diabetes , pregnancy , cardiovascular status , obesity ; chronic illness suffered more from this pandemic flu .
presently , we are in post - pandemic phase , and there are sporadic cases reported with mortality in high - risk cases [ figure 3 ] . the non - specific symptoms like fever ,
running nose , sore throat , body aches in flu make it difficult to identify and isolate cases initially [ table 1 ] .
who has listed diabetes as silent - epidemic , which is prevalent worldwide , taking toll of deaths in the age group of 35 - 65 years ; 1 out of 10 deaths are attributed to diabetes , a ratio that increases to 1 out of 4 in certain vulnerable populations .
people with diabetes and influenza are 3 times more likely to die from complications than without diabetes
. immunological research from the hospital clinico universitario de valladolid in spain and the university health network found high levels of a molecule called interleukin 17 in the blood of severe h1n1 patients and low levels in patients with the mild form of the disease .
two cases from iran with precipitation of diabetic ketoacidosis and h1n1 infection had fatal outcome . in a known diabetic ,
after h1n1 infection , hospitalization is known to triple and quadruple risk of icu admission once hospitalized .
our case was complicated by precipitation of new onset hyperglycemia and occurrence of pneumonia with rapid decline in general condition .
to best of our opinion , there were no reported cases of precipitation of diabetes with influenza a ( h1n1 ) pdm09 virus with positive outcome from india .
[ source : who influenza laboratory surveillance information by the global influenza surveillance and response system ( gisrs ) .
india , generated on 14/09/2012 06 : 14:47 utc ] distinguishing clinical features from common cold and flu this case lays emphasis on clinical acumen in recognition of a co - existing infectious process in a new onset diabetes mellitus , h1n1 infection , and prompt institution of oseltamivir to retard the progression of disease and decrease the mortality associated with it .
 infectious diseases in type 2 diabetes can complicate diabetic ketoacidosis , derange hyperglycemia , or precipitate new onset diabetes . 
 pulmonary tuberculosis being the most common . 
 high index of clinical suspicion is required for co - existing h1n1 virus , which if present has high mortality if not treated . 
 a 63-year - old female , with no known chronic illness , was hospitalized in month of aug 2010 with influenza - like symptoms and diabetes . 
 quick evaluation revealed tachycardia , tachypnea , p02 90% at room air , and normotensive . 
 clinical chest examination was normal . 
 further evaluation revealed nho in both lung fields on chest x - ray , hyperglycemia 325 mg / dl , detected for first time . 
 her signs and symptoms were out of proportion to clinical findings and chest x - ray findings . 
 patient was managed with insulin infusion and empirical broad - spectrum antibiotic coverage in icu . 
 as her condition worsened over next 12 hrs , infection with h1n1 was suspected and empirically started on oseltamavir after taking throat swab for h1n1 test and later , the sample was tested positive for h1n1 influenza by rt - pcr . 
 clinical course in the hospital was complicated by oxygen dependence requiring 10 - 12 ltr / hr by nasal mask . 
 she made an uneventful recovery . in a known diabetic , infection with h1n1 quadruples icu hospitalization , and only few cases of new onset 
 diabetes with h1n1 were reported . 
 two reported from iran had fatal outcome . 
 this case emphasis on clinical acumen in recognition , and prompt institution of therapy will reduce associated mortality . 
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