Medical Emergencies · patient case question
Each of the following can adversely affect this patient's glycaemic control EXCEPT one. Which is the EXCEPTION?
Patient case: HIV with poorly controlled diabetes
Patient: Male, 47 years old
Chief complaint: “My gums bleed and my mouth is always dry.”
History: HIV, on antiretroviral therapy, CD4 460 cells/mm³, viral load undetectable. Type 2 diabetes mellitus. Asthma, well controlled with an as-needed inhaler.
Findings: Laboratory results today: HbA1c 10%, CD4 460, undetectable viral load, haemoglobin 13.4 g/dL, platelets 210,000. Generalised bleeding on probing with 4–5 mm pockets.
Show answer and explanation
Correct answer: B. Asthma
- A. HIV itself contributes through chronic immune activation and inflammatory cytokines, which promote insulin resistance.
- B. CORRECT as the exception. Asthma as a disease has no direct effect on glucose metabolism. The qualifier worth knowing is that SYSTEMIC corticosteroids used for an asthma exacerbation certainly do cause hyperglycaemia — but this patient uses only an as-needed inhaler, and inhaled corticosteroids at standard doses have negligible systemic glycaemic effect.
- C. Antiretroviral therapy is a well-documented contributor. Older protease inhibitors and certain nucleoside reverse transcriptase inhibitors cause lipodystrophy, dyslipidaemia and insulin resistance.
- D. Any acute infection raises cortisol and catecholamines, which oppose insulin and drive glucose up. This is exactly why an untreated dental abscess and poor glycaemic control aggravate one another.
Note: The relationship between periodontitis and diabetes runs in both directions: each worsens the other, and periodontal treatment produces a measurable improvement in HbA1c.
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