Association of hyperglycemia spikes induced by magnesium citrate administration in type 1 diabetes mellitus: A case report and analysis of a large claims database.

OBJECTIVES: To report the occurrence of elevations (spikes) in interstitial fluid glucose concentrations (IFGC) following magnesium citrate administration during preparation for colonoscopy in a patient with type 1 diabetes mellitus (T1DM). To ascertain, using a comprehensive analysis of large claims databases, the proportion of diabetes mellitus (DM) patients who are vulnerable to showing elevated blood glucose levels following magnesium citrate administration. CASE PRESENTATION: A female patient aged 35 years received pretreatment with 100 g of magnesium citrate in 1.8 L of water 2 hours before a colonoscopy. After an interval of 41 minutes, the patient self-administered insulin to correct an IFGC increase from 108 to 176 mg/dL. However, the IFGC reached a peak of 251 mg/dL, resulting in marked thirst, frequent urination, and palpitations. Based on a database cohort of ~ 3 million patients, there were 105,348 patients with a risk for elevations in the blood glucose level after receiving magnesium citrate, of whom 9.5% (n = 9,957) had DM and 96 had T1DM. CONCLUSION: Analysis of a colonoscopy patient with T1DM and magnesium citrate-induced elevations in IFGC, and evaluation of patients in a large database with a similar risk, emphasizes the need for caution when administering such agents and in particular in patients with T1DM. We suggest that alternative preparations for colonoscopy in diabetic patients may be warranted.