RUN YU
International Medicine - 2021;3(3):101-104
The COVID 19 vaccines are usually safe, effective, and well tolerated by the general population. After the COVID 19 vaccines are widely used, rare and potentially severe vaccine complications become more manifest. Here reported is a case of rapid and severe worsening of diabetes after the Johnson & Johnson’s Janssen COVID 19 vaccine (J&J COVID vaccine) administration. A 55 year old male heart transplant recipient with metformin (500 mg twice daily) controlled mild diabetes started to have flu like symptoms a few days after receiving the J&J COVID vaccine. His fasting glucose levels had ranged between 130 150 mg/dL (normal 65 99) before he received the J&J COVID vaccine. The fasting glucose rose to ~200 mg/dL one day after the vaccine administration and gradually rose to ~400 mg/dL over the next few weeks. He presented to the endocrine clinic urgently. Point of care fasting glucose was 382 mg/dL and A1c 13.0 (which was 6.7 six months before). Bicarbonate and anion gap were normal, insulin and C peptide in the low normal range, and β cell autoantibodies negative. Multi dosing insulin treatment was immediately started and the doses titrated up to insulin glargine 30 units daily and insulin lispro 10 units before each meal. He improved clinically with well controlled glycemia. The rapid and severe worsening of his diabetes after the vaccination suggests that the J&J COVID vaccine could severely deteriorate diabetes control in some patient populations.
