Bilateral cataracts as the presenting feature of type 1 diabetes

334 Pract Diab Int October 2010 Vol. 27 No. 8 Copyright © 2010 John Wiley & Sons Case report Our patient, a 29-year-old female nursing student from Zimbabwe, described a six-month history of gradual deterioration in her eyesight. She had attended the optician on several occasions in that time and was reassured there was no abnormality. Her eyesight continued to deteriorate and she attended her GP who diagnosed bilateral cataracts. She was referred for urgent surgery but, in the interim, lost her eyesight completely and attended eye casualty. On examination she had snowflake cataracts bilaterally (Figure 1) and was admitted for urgent surgery. During pre-operative assessment she was found to have a random blood glucose of 26mmol/L and urinary glucose of 3+ and ketones of 2+. On further questioning, the patient described osmotic symptoms (polyuria and polydipsia) and recurrent candidal infection over a timescale similar to that of the visual loss. She had also lost approximately 30kg in weight over the previous year but had attributed this to a diet she had been on. She denied lethargy or any other symptoms on systemic enquiry. She had no significant past medical history, no family history of diabetes or cataract, and was not on any regular medication. She was transferred to the acute medical receiving ward. Venous bicarbonate was 16 and arterial blood gas measurement revealed a mild metabolic acidosis. HbA1c was 18.2% (175mmol/mol) confirming prolonged hyperglycaemia. She was commenced on an insulin sliding scale and then converted to subcutaneous insulin. This was administered by nursing staff because of her visual impairment. Urgent cataract surgery was carried out on the left eye and eyesight was restored. She was discharged home on a basal bolus regimen and further surgery was arranged for the right eye.