An Unusual Case of Severe Hyperglycemia in an 82-Year-Old Man During Acute COVID-19 Infection

Severe hyperglycemia during acute COVID-19 infection is an uncommon but clinically significant presentation. Here, we present an unusual case of an 82-year-old COVID-19-positive man who presented with severe hyperglycemia following several days of COVID-19 symptoms, with an admission HbA1c of 14.7%. He received standard treatment for a working diagnosis of diabetic ketoacidosis (DKA), improved clinically, and was discharged after five days, but continued to require exogenous insulin to maintain appropriate fasting and postprandial blood glucose levels. This case represents possible COVID-19-associated metabolic decompensation in previously unrecognized type 2 diabetes. It highlights the importance of monitoring patients with COVID-19 for severe hyperglycemia and metabolic decompensation, particularly in elderly individuals, those with metabolic risk factors, or those with severe clinical presentations.