Case report of transient neonatal diabetes in a foal

Introduction

Transient neonatal diabetes mellitus (TNDM) is described in human medicine but reports in equine medicine are scarce. The objective of this work is to describe a case of transient neonatal diabetes in a foal.

Clinical History

Male foal, small crossbreed, 15 kg, 12 days old. History of weakness and restricted intrauterine growth at birth as a consequence of fetal stress (mother with very low body condition and severe injuries), treated with antibiotic therapy and plasma transfusion. The hematology and blood biochemistry (including glycemia) at 12 hours after birth yielded results within normal values.

Relevant Clinical Findings

The patient presented weakness and depression with response to stimuli, mild hyperthermia, dehydration, weak metatarsal pulse, hyperglycemia, white colored serum and the owner commented that the stools were also whitish.

Evidence-Based Diagnosis

Hematology and blood biochemistry showed leukopenia with a left shift, a slight increase in total protein and fibrinogen, an increase in urea, a marked increase in triglycerides, and low levels of pancreatic enzymes (amylase 2 U/l), lipase 13 IU/l). Cortisol measured 1.9 g/dl and insulin <1.6 uU/ml.

Treatment and management

Medical treatment included fluid therapy, broad-spectrum antibiotics, NSAIDs, gastric protector, heparin (due to hyperlipidemia) and hypoglycemic drugs.

Evolution

The foal had a favorable response to treatment, lowering blood glucose when administered exogenous insulin. After 7 weeks he began regulating his blood glucose without insulin, so from day 55 medication began to be withdrawn.

Discussion

TNDM is defined as persistent hyperglycemia for more than 2 weeks with low insulin levels that requires exogenous insulin in patients less than 180 days of life, described in neonates from one month of life. In this case, insulin-dependent hyperglycemia began at 15 days of life, with exogenous pancreatic insufficiency (also seen in human neonatal patients with this pathology), hyperlipidemia and hypercholesterolemia.

References

1. Beltrand J, Busiah K, Vaivre-Douret L, Fauret AL, Berdugo M, Cavé H, Polak M. Neonatal diabetes mellitus. Frontiers in Pediatrics. 2020:602.
2. Navas de Solis C, Foreman JH. Transient diabetes mellitus in a neonatal Thoroughbred foal. Journal of Veterinary Emergency and Critical Care. 2010 Dec;20(6):611-5.
3. Naylor RN, Greeley SA, Bell GI, Philipson LH. Genetics and pathophysiology of neonatal diabetes mellitus. Journal of Diabetes Investigation. 2011 Jun;2(3):158-69.
4. Rajadhyaksha SB, Agarwal N, Desai LS. Neonatal diabetes mellitus with severe hypertriglyceridemia. Journal of Pediatric Endocrinology and Metabolism. 1996 May 1;9(3):435-8.