Title PageManuscript Title:Indomethacin-Associated Transient Hyperglycemia in a Well-Controlled Type 2 Diabetic Patient: A Self-Controlled Observational Case ReportAuthor:Dr. Parisa Damirchi, MD – OtolaryngologistAffiliation:Private ENT Clinic, Tehran, IranCorresponding Author:Dr. Parisa DamirchiEmail: parisa.damirchi.md@gmail.comKeywords:Indomethacin, Hyperglycemia, Type 2 Diabetes, NSAIDs, Case ReportRunning Title:Indomethacin-Induced Hyperglycemia in T2DMKey Clinical MessageClinicians should be aware of the potential glycemic impact of indomethacin, even in stable type 2 diabetic patients. Monitoring blood glucose in such patients may help identify unexpected side effects early and avoid unnecessary escalation in diabetes treatment.IntroductionType 2 diabetes mellitus (T2DM) is a chronic metabolic condition requiring consistent glycemic control to prevent long-term complications. Many T2DM patients regularly use nonsteroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal issues. While NSAIDs like ibuprofen and naproxen have been studied for their metabolic effects, evidence regarding indomethacin remains limited. This case report presents a self-controlled observation of transient hyperglycemia associated with short-term indomethacin use in a well-controlled diabetic patient.Case History / ExaminationA 45-year-old male with a 7-year history of T2DM and prior coronary artery bypass grafting (CABG) was managed with stable doses of metformin (500 mg BID) and Glorenta (10/5 mg QD), alongside cardiovascular medications. He maintained a low-carbohydrate, low-fat diet, regular physical activity, and self-monitored blood glucose three times daily.Baseline laboratory values were:HbA1c: 6.1%BUN: 21.4 mg/dLCreatinine: 0.95 mg/dLALT: 57 IU/LAST: 36 IU/LALP: 160 IU/LDifferential Diagnosis, Investigations and TreatmentThe patient was prescribed indomethacin 25 mg BID for six days due to trigger finger pain. On day 2 of treatment, he experienced polyuria. Glucose logs showed a consistent increase in fasting, post-breakfast, and post-lunch blood sugar levels. No signs of infection, dietary deviation, or other potential causes were present. Upon discontinuing indomethacin, glucose levels returned to baseline within three days.Conclusion and Results (Outcome and Follow-up)This case shows a temporal relationship between indomethacin use and transient hyperglycemia in a self-controlled setting. No lasting effects or complications were noted. Figure 1 illustrates the glucose trend:FBS: from 120.5 to 126.2 mg/dL, post-treatment 113.22hpp: from 102.5 to 109.2, post-treatment 96.7Post-lunch: from 94.2 to 117.5, post-treatment 106.7Figure 1 caption: Blood glucose trends before, during, and after indomethacin therapy.Patient ConsentWritten informed consent was obtained from the patient for publication of this case report and any accompanying data or figure.DiscussionThis case emphasizes a possible reversible hyperglycemic effect of indomethacin. Given the absence of other factors and the pattern of return to baseline post-treatment, a metabolic side effect is likely. Potential mechanisms include interference with insulin signaling or hepatic glucose output via COX inhibition. Although rare, this observation supports the need for glycemic monitoring in T2DM patients prescribed indomethacin.Author ContributionDr. Parisa Damirchi was solely responsible for the conception of the case, data collection, interpretation, manuscript writing, and final approval.References1. Wallace JL. Physiol Rev. 2008;88(4):1547–1565.2. Helmers RA, et al. J Pharmacol Exp Ther. 2003;306(3):1081–1086.3. Misra P, Kumar A. Int J Diabetes Dev Ctries. 2013;33(4):182–189.