MON-609 - Diabetic Ketoacidosis Associated with Themenstrual Cycle: A Case of Catamenial Diabeticketoacidosis

Catamenial diabetic ketoacidosis (DKA) is a rare presentation of recurrent DKA triggered by menstrual cycle related hormonal fluctuations. Cyclical increases in luteal phase progesterone can induce transient insulin resistance and predispose susceptible women with type 1 diabetes to metabolic decompensation. We report a 34-year-old woman with type 1 diabetes who experienced repeated DKA episodes occurring at the onset of menstruation. Evaluation during each admission consistently excluded common precipitants such as infection, medication non-compliance, or insulin pump failure. Review of menstrual timing and glucose trends demonstrated a reproducible temporal association between menses and DKA onset. During her most recent episode, she presented with severe hyperglycemia, ketosis, and high anion gap acidosis, requiring intravenous fluids, electrolyte repletion, and continuous insulin infusion. Her metabolic abnormalities resolved within 24 hours, allowing transition to subcutaneous insulin and discharge with endocrinology follow-up.
This case highlights the endocrine mechanisms underlying catamenial DKA and reinforces the importance of recognizing menstrual cycle associated insulin resistance as a contributor to recurrent DKA. Anticipatory management strategies such as luteal phase insulin adjustments, closer glucose monitoring, and consideration of hormonal therapy may help prevent recurrence. Awareness of this entity is essential for improving diagnostic accuracy and optimizing individualized care for reproductive age women with type 1 diabetes.

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