Rare Movement Disorder Linked to Diabetic Ketosis Resolved with Insulin Therapy in Elderly Man

A 70-year-old man with 15 years of poorly controlled type 2 diabetes developed subacute, involuntary choreiform movements of his right limbs, a rare condition known as hemichorea-hemiballism. In a case report from the Department of Endocrinology and Metabolism at the Affiliated Hospital of Qingdao University, clinicians describe how the movement disorder emerged in the setting of diabetic ketosis. The patient also experienced foot pain, significant weight loss, and showed evidence of multiple diabetic complications.

Hemichorea-hemiballism associated with ketotic hyperglycemia is a rare movement disorder, and the authors note that this case occurred in an elderly patient with longstanding inadequate glucose control. The involuntary movements affected one side of the body, involving the right arm and leg, and appeared alongside the metabolic disturbances of ketosis.

What makes this case notable is what the brain imaging did not show. Despite the patient’s clear clinical presentation of right-sided choreiform movements during diabetic ketosis, his MRI revealed no classic striatal T1 hyperintensity. The authors emphasize that diabetic ketosis can trigger hemichorea-hemiballism in elderly patients even in the absence of typical imaging findings.

Treatment in this case centered on correcting the underlying metabolic disturbance. The patient received intensive insulin therapy combined with short-term symptomatic treatment. The response was rapid: ketonuria resolved quickly, blood glucose stabilized, and the involuntary movements improved markedly.

At a three-month follow-up visit, the patient remained free of choreiform movements. The authors present this outcome as underscoring the central role of prompt glycemic optimization in managing the condition.

As a single-patient case report, the findings cannot establish how commonly ketosis triggers this movement disorder, nor can they predict outcomes for other patients. The report is limited to the individual described, an elderly man with a specific history of poorly controlled type 2 diabetes and multiple diabetic complications.

Nevertheless, the report documents that hemichorea-hemiballism can occur during diabetic ketosis even when the hallmark imaging sign is missing. This observation may be relevant for clinicians evaluating older diabetic patients who present with new-onset one-sided involuntary movements, since the diagnosis in this case rested on the clinical picture and metabolic context rather than on characteristic MRI changes.

The case report, accepted by Frontiers in Endocrinology in the Clinical Diabetes section, was authored by Wennan Zhang, Lili Xu, Xinzhi Fu, Fengyao Sun, and Yangang Wang. Its central message, as stated by the authors, is that diabetic ketosis can trigger hemichorea-hemiballism in elderly patients even without typical imaging findings, and that prompt glycemic optimization played the central role in the resolution of the movement disorder in this patient.

Subject of Research: Hemichorea-hemiballism associated with diabetic ketosis in an elderly patient with poorly controlled type 2 diabetes

Article Title: Case Report: Diabetic ketosis-associated hemichorea-hemiballism in an elderly patient with longstanding poorly controlled type 2 diabetes mellitus

Article References: Zhang, W., Xu, L., Fu, X., Sun, F., & Wang, Y. (2026). Case Report: Diabetic ketosis-associated hemichorea-hemiballism in an elderly patient with longstanding poorly controlled type 2 diabetes mellitus. Frontiers in Endocrinology, 17, Article 1991954. https://doi.org/10.3389/fendo.2026.1991954

Image Credits: AI Generated

DOI: 10.3389/fendo.2026.1991954

Keywords: hemichorea-hemiballism, diabetic ketosis, type 2 diabetes mellitus, case report, movement disorder, insulin therapy, brain MRI, endocrinology, glycemic control, ketonuria, Case, Report