A 67-year-old man presented with a complaint of persistent cough. He used to smoke 40 cigarette packets a year. His medical history included type 2 diabetes mellitus (T2DM), well-controlled by medication for six years, apart from hypertension, chronic obstructive pulmonary disease, and hypercholesterolemia. He had no family history of diabetes or autoimmune diseases. He was diagnosed with squamous cell carcinoma (SSC).
Chemotherapy (with carboplatin and paclitaxel) was initiated along with radiotherapy. After a year and a half, a repeat bronchoscopic biopsy confirmed a left middle lobe SSC. The patient was then put on nivolumab 312 mg (3 mg/kg) every two weeks. Two weeks later, when the patient presented for chemotherapy, random blood tests revealed a blood glucose level of 28.6 mmol/L and a ketone level of 7.0 mmol/L. Other laboratory test results were as follows: pH - 7.0 (7.32–7.42)…
