Abstract #1402477: Sixth-Nerve Palsy in Uncontrolled Type 1 Diabetes with Insulin Dependence

Diabetic retinopathy is the most common and well-known ophthalmologic complications in diabetic patients. However, oculomotor palsy one of frequent neuro-ophthalmologic Specifically, sixth nerve common, however infrequently studied. Our patient a 51-year-old female with past medical history insulin-dependent diabetes mellitus, hypertension, chronic sinusitis, pain syndrome that presented complaints worsening headache diplopia. Patient was hemodynamically stable on admission. Upon examination eye, patient's right eye did not cross midline lateral gaze found to have diplopia primary left eye. She recurrent upon further evaluation her visual deficit. Labs showed creatinine 0.61 mg/dl (0.66-1.25 mg/dL), sodium 129 mmol/L (135-145 mmol/L), potassium 4.4 (3.5-5.1 an anion gap 2 (3-13 blood glucose 300-400 mg/dL range (70-100 mg/dL) recent 168 mg/dL. Her hemoglobin A1C 13.0 (< 6%). complete count shows white cell 6,000/uL (3,600-10,700/uL) 14 g/dL (13.0-18.0 g/dL). Magnetic resonance venography head negative for cerebral venous sinus thrombosis magnetic imaging brain acute abnormalities. treated basal insulin 30 units nightly bolus 3 three times day before meals type 1 hyperglycemia long-term use. Visual deficit by observation ophthalmology symptomatic help through eyeglass prisms. discharged after night hospital stay recommendations control home carbohydrate-controlled dose during meals. recommended follow-up endocrinology outpatient discuss use pump better diabetes. Sixth-nerve but lesser-known complication poorly controlled Studies shown higher incidence patients sixth-nerve palsy, warranting more focused along close tighter levels A1C.