SAT-666 Possible Amelioration of Diabetic State After Intravesical BCG Instillations for Bladder Cancer

Introduction - Current research provides strong evidence that intradermal Bacillus Calmette-Guerin (BCG) vaccination improves glucose metabolism by a mechanism of switching oxidative phosphorylation to aerobic glycolysis inducing a state of high glucose utilization. We present a case that demonstrates improvement in blood sugar levels upon administration of a series of intravesical BCG instillations. There is no research, in current literature, correlating blood sugars lowering after intravesical administration of BCG vaccines. Case Description - An 81 years old male with a medical history of type 2 diabetes mellitus, coronary artery disease, and bladder cancer underwent a series of BCG instillations, as therapy for his bladder cancer. He underwent BCG treatments according the Southwest oncology protocol for bladder cancer. During his BCG treatments, the patient was on Humalog 75/25, 30 units twice a day. Upon completion of his treatments, the patient experienced an episode of hypoglycemia that required hospitalization. His insulin regimen was decreased from 30 to 25 units BID. His A1C at the time of diagnosis was 8.7% and after insulin adjustments declined to 8.1%. We are reviewing a list of type II diabetic patients with bladder cancer who were treated with BCG and analyzing blood sugars before and after BCG exposure. We hypothesize that BCG vaccination precipitated the improvement in his blood sugars. Conclusion - Additional studies on BCG vaccinated, diabetic, bladder cancer patients are needed for confirmation of this effect. Our case illustrates a probable reduction in blood sugars attributable to his BCG vaccinations. Research suggests that intradermal BCG switches cellular metabolism from oxidative phosphorylation to early aerobic glycolysis. Another effect of BCG is the increasing levels of tumor necrosis factor (TNF) that leads to elimination of self-reactive white blood cells and inducing regulatory T cells. More research is needed to confirm whether intravesical administration of BCG has the same effect as intradermal BCG vaccination, which would have a potential impact on the clinical management of both type 1 and type 2 diabetic patients.