Abstract
Introduction
Diabetic Gustatory Hyperhidrosis is characterized by profuse sweating with eating and may be a manifestation of Diabetic autonomic dysfunction. Most patients have evidence of other microvascular complications including nephropathy, retinopathy, peripheral neuropathy and other signs of autonomic neuropathy.
We present 2 cases of gustatory hyperhidrosis associated with longstanding poorly controlled type 1 diabetes.
Case 1: 49 year old Male with past medical history of longstanding type 1 diabetes with poor control, complicated with diabetic retinopathy, polyneuropathy, albuminuria presented to endocrine clinic for management of diabetes. His hemoglobin A1c was 10.8%. He was on basal-bolus Insulin at home. However, he admitted to missing most doses of prandial Insulin. On further questioning, he mentioned having episodes of profuse head and neck sweating while eating any type of food. He attributed these episodes to “low blood sugars” without checking and therefore tried to avoid Insulin. However, he continued having these episodes. He was diagnosed with Diabetic gustatory hyperhidrosis and started on topical Aluminum hexahydrate.
Case 2: 34 year old Female with past medical history of long-standing DM type 1 complicated with poly- neuropathy, autonomic dysfunction, nephropathy, Retinopathy, chronic kidney disease stage III presented for follow up of her diabetes. Her hemoglobin A1c was 9.8%. She was on basal-bolus Insulin at home and reported good compliance. Given her extensive polyneuropathy, she was questioned about hyperhidrosis. She reported having profuse facial and neck sweating with eating all types of food which led to increased embarrassment while eating in public. She was diagnosed with diabetic gustatory hyperhidrosis and started on topical aluminum hexahydrate, with plans for Botox if symptoms persisted.
Discussion
Diabetic Gustatory Hyperhidrosis is an under- recognized condition and may be misdiagnosed as hypoglycemia, anxiety, gastroparesis or other conditions. This gustatory sweating is a source of severe distress and embarrassment for patients and can have serious emotional, social and professional implications. Associated symptoms may also be mistaken for hypoglycemia and in turn lead to nonadherence with Insulin and other diabetic medications causing suboptimal glycemic control.
Topical anti-perspirants like Aluminum Chloride hexahydrate are often used as first line therapy. Second line treatment options include glycopyrrolate, Oxybutynin and Botulinum toxin.
Conclusion
Most patients are reluctant to mention these symptoms to health care providers and diligent history taking with specific questions in high risk patients may help in early identification and management of this condition.
Early identification and management can also help promote overall confidence, quality of life and better glycemic control.
Comparable Efficacy and Safety of Insulin Glulisine and Insulin Lispro When Given as Part of a Basal–Bolus Insulin Regimen in a 26-Week Trial in Pediatric Patients with Type 1 Diabetes