Catamenial hyperglycaemia: an important cause of recurrent diabetic ketoacidosis

We report the case of a female patient with type 1 diabetes mellitus with recurrent episodes of diabetic ketoacidosis (DKA ) despite previously good control and treatment with continuous subcutaneous insulin infusion (CSII ). It was noted that her episodes of uncontrolled hyperglycaemia with DKA were occurring monthly and before her menstrual periods. This effect required an increase in her basal insulin infusion rate by as much as four-fold. The phenomenon of DKA associated with the menstrual cycle has been recognised previously and is termed ‘catamenial’ DKA. We discuss the prevalence, possible causes and clinical management of catamenial DKA. Copyright © 2010 John Wiley & Sons.