Catamenial diabetic ketoacidosis in a rural area of Kananga, Democratic Republic of the Congo: a case report

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Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus most commonly triggered by infection, metabolic stress, or inadequate insulin therapy. We report an unusual case of a young woman with type 1 diabetes who experienced recurrent episodes of ketoacidosis during the premenstrual period, suggesting a catamenial form of DKA. This case highlights the importance of considering hormonal fluctuations related to the menstrual cycle in diabetes management and in identifying factors of imbalance. The patient presented with abdominal pain, severe fatigue, and polyuria-polydipsia, with a blood glucose level of 560 mg/dL, beta-hydroxybuturate of 3.6 mmol/L, potassium of 2.4 mmol/L and pH of 7.24. Inflammatory markers were absent and no usual precipitating factors were identified. Management included intravenous insulin therapy, rehydration, potassium supplementation, and transition to basal-bolus insulin. Part of the serum was sent to France for diabetes typing, confirming type 1 diabetes and additional assays. The patient reported that these episodes occurred 3 to 4 days before menstruation. This case underscores the need to consider hormonal fluctuations related to the menstrual cycle in diabetes management, particularly in a resource-limited settings, to adjust insulin strategies and prevent serious complications.

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