Complications of H1N1 infection include severe pneumonia, empyema, ARDS, seizures, encephalitis and myocarditis(1). We report a 11 year old female, diagnosed to have H1N1 infection by RT-PCR, in whom a routine random blood sugar showed hyperglycemia (240 mg/dL). Child had high fasting (149,109,172 mg/dL) and postprandial blood sugar (258,160,192 mg/dL), respectively on day 1, 2 and 3 of testing. However, 4th day onwards, for three consecutive days, child had normal fasting and postprandial sugar. HbA1C was normal (6.3%) suggesting this was a transient hyperglycemia. Urine and serum ketones were negative on all 6 days. Urine Sugar was 1+ positive for the first 3 days when blood sugar was high and negative once blood sugar normalized. Child was receiving oseltamivir only during the illness.

It is thought that influenza causes an increase in IL-6 levels which may lead to increased cortisol levels, followed by a pronounced dose-dependent increase in blood glucose. It is also postulated that systemic hypercytokinemia in influenza causes hyperglycemia and that the glucose levels reflect the degree of pathogenicity(2). Literature search revealed hyperglycemia as a complication associated with higher mortality in H5N1 cases(2) and in few critically ill children with influenza encephalo-pathy(3). Another speculation was whether the hyperglycemia was related to administration of oseltamivir, a complication of this drug, hitherto undescribed. However, only rare aggravation of pre-existing diabetes has been described with oseltamivir(4), and not transient hyperglycemia.