We thank Dr. Doherty-Kirby for her comments on our paper. She pointed out the possible coexistence of stress hyperglycemia and GCK-MODY in our case report, “Glucokinase maturity-onset diabetes of the young as a mimicker of stress hyperglycemia: a case report” (1). We agree with this point. Stress hyperglycemia is a transient hyperglycemic state during illness and is usually restricted to patients without previous evidence of diabetes (2). However, it also pertains to transient hyperglycemia during acute illness in patients with diabetes. Thus, the boundaries of the definition are unclear.
Dr. Doherty-Kirby emphasized that stress hyperglycemia and a genetic defect of GCK influenced the clinical presentation. The patient in the present case presented with impaired insulin secretory capacity during the hyperglycemic state, rather than insulin resistance, which is typically observed in stress hyperglycemia (3). However, in GCK-MODY patients, the fasting glucose is significantly elevated, while the casual glucose is mildly elevated due to the preserved insulin response (4). Therefore, triggers such as a high-carbohydrate diet or severe stress are necessary to induce significant hyperglycemia in GCK-MODY patients. In the present case, hyperglycemia was caused by increased gluconeogenesis secondary to febrile seizures. Moreover, concomitant stress hyperglycemia cannot be excluded.
Sincerely,
Shintaro Terashita
References
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