Saey, Stephanie

Abstract An 86-year-old woman with metastatic non-small cell lung carcinoma on Pembrolizumab presented to the Emergency Department with diabetic ketoacidosis; after appropriate treatment she was transitioned to basal/bolus insulin regimen. She had chosen to receive Immune Checkpoint Inhibitor (ICI) instead of radiotherapy, as she wished to preserve her quality of life. With the demands of management of ICI-induced irreversible insulin deficient diabetes she now has substantial worsening of quality of life with considerable anxiety and depressed mood. ICI-induced diabetes and DKA is more common in patients treated with Pembrolizumab than suggested by early trials. In addition to highlighting the importance of counseling patients on the signs and symptoms of hyperglycemia for earlier detection, our case calls for considering the psychological impact of managing a chronic illness in patient education prior to initiating ICI therapy.