CONSIDERATIONS FOR SODIUM-GLUCOSE TRANSPORTER 2 INHIBITOR THERAPY RESULTING IN EUGLYCEMIC DIABETIC KETOACIDOSIS

Introduction: With the incredibly high incidence of Type 2 Diabetes in the current population of emergency department patients, it is critical for clinicians to understand the possible complications of the treatment of this disease. Medication like canagliflozin are more common to encounter on patient’s home medication lists and clinicians should be aware of how these medications, alone or combined with dietary modifications, can result in significant pathology and even mortality if not appropriately treated. Case Report: We report a case of a patient with type II diabetes mellitus who presented with euglycemic diabetic ketoacidosis in the setting of concurrent use of canagliflozin, a sodium-glucose transporter-2 (SGLT-2) inhibitor, and strict adherence to a low-carbohydrate ketogenic diet for weight control. Discussion: Euglycemic ketoacidosis has previously been observed in both diabetic and non-diabetic patients following strict ketogenic diets, as well as in diabetic patients being treated with SGLT-2 inhibitors. Conclusion: As more patients choose ketogenic diets for weight control and diabetes management, clinicians should be aware of this potentially life-threatening complication in patients concurrently taking SGLT-2 inhibitors.

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Periprocedural Euglycemic Diabetic Ketoacidosis Associated With Sodium–Glucose Cotransporter 2 Inhibitor Therapy During Colonoscopy

Diabetes Care ◽

10.2337/dc20-1244 ◽

2020 ◽

Vol 43 (11) ◽

pp. e181-e184

Author(s):

Emily J. Meyer ◽

Edward Mignone ◽

Anthony Hade ◽

Venkatesan Thiruvenkatarajan ◽

Robert V. Bryant ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Inhibitor Therapy ◽

Sodium Glucose Cotransporter ◽

Euglycemic Diabetic Ketoacidosis

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Euglycemic Diabetic Ketoacidosis in a Diabetic Patient Treated with SGLT2 Inhibitor

10.26420/austinendocrinoldiabetescaserep.2021.1018 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Lavrynenko O ◽

◽

Santos H ◽

Garza A ◽

Qazi R ◽

...

Keyword(s):

Metabolic Acidosis ◽

Diabetic Ketoacidosis ◽

Glucose Transporter ◽

Sglt2 Inhibitor ◽

Anion Gap ◽

Laboratory Evaluation ◽

Intravenous Insulin ◽

Glucose Transporter 2 ◽

Life Threatening ◽

History Of

Diabetic Ketoacidosis (DKA) is a life - threatening complication and must be diagnosed and treated promptly and aggressively. The classic triad of DKA is hyperglycemia (Blood Glucose (BG) >250mg/dl; anion gap metabolic acidosis (pH <7.30 and bicarbonate <18mEq/L); and ketonemia. With Food and Drug Administration (FDA) approval of the sodium - glucose transporter 2 inhibitors (SGLT2i), DKA can occur with BG levels below 200mg/dl and has been defined as Euglycemic DKA (EuDKA). Due to the absence of hyperglycemia, the diagnosis of EuDKA is challenging and often delayed. This 60-year-old diabetic male, treated with Empagliflozin and pioglitazone, presented with diarrhea and abdominal pain, which started 20 days ago. He was admitted with dehydration and diagnosis of colitis. On admission laboratory evaluation revealed metabolic acidosis with elevated anion gap of 18mEq/L, bicarbonate of 19mEq/L, and BG of 146mg/dL. There was no history of ingestion of alcohol, salicylates, methanol, ethylene glycol and nothing to suggest lactic acidosis. The plasma creatinine was 0.79mg/dl. On the following day, he developed an increase in the anion gap to 22mEq/L and further decrease in bicarbonate to 13mEq/L, and serum ketones were detected. The patient was treated for EuDKA in ICU with intravenous insulin, dextrose (to prevent hypoglycemia), and normal saline with resolution of his symptoms and EuDKA in 3 days. With the widespread use of SGLT2i, physicians need to have a high suspicion of EuDKA in patients who present with an unexplained anion gap acidosis without or only modest elevation in BG concentration.

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A Case Report of Diabetic Ketoacidosis With Combined Use of a Sodium Glucose Transporter 2 Inhibitor and Hybrid Closed-Loop Insulin Delivery

Journal of Diabetes Science and Technology ◽

10.1177/1932296819838875 ◽

2019 ◽

Vol 13 (3) ◽

pp. 605-606 ◽

Cited By ~ 1

Author(s):

Sukhmani Singh ◽

Robert J. Rushakoff ◽

Aaron B. Neinstein

Keyword(s):

Case Report ◽

Diabetic Ketoacidosis ◽

Closed Loop ◽

Glucose Transporter ◽

Insulin Delivery ◽

Glucose Transporter 2 ◽

Combined Use

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Prevalence of Incretin-mimetic and Sodium-Glucose-Transporter-2-Inhibitor Therapy in Hospitalized Type-2-Diabetics following Myocardial Revascularization: an Observational Study

10.21203/rs.3.rs-52203/v1 ◽

2020 ◽

Author(s):

Rainer U. Pliquett ◽

Linda Golle ◽

Andreas Wienke ◽

Matthias Girndt

Keyword(s):

Observational Study ◽

Glucose Transporter ◽

Inhibitor Therapy ◽

Glucose Transporter 2 ◽

Type 2 Diabetics ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Background: We hypothesized that the recommended incretin-mimetic therapy associates with a better outcome (1-year mortality after discharge, rehospitalizations within 12 months) and with less hypoglycemic events in type − 2 diabetics following myocardial revascularization. Methods: Hospitalized type-2 diabetics of the Departments of Cardiology and Cardiothoracic Surgery (University Hospital Halle), who had percutaneous coronary intervention (29.4%) or coronary artery bypass graft (70.6%) in 2016, were included in this observational study: Group 1 (incretin-mimetic therapy), Group 2 (insulin therapy without incretin mimetics) or Group 3 (oral diabetes medication without incretins or insulin). They were asked to mail in a questionnaire on medical therapy, number of hypoglycemic episodes and rehospitalizations 2 years following discharge. In non-responders, the vital status was obtained by local registries 2.4 years after discharge. Results: 204 patients were recruited in this prospective observational study. At discharge, only 3.9% of all type-2 diabetics had an incretin mimetic, 39.7% were on insulin, and 56.4% on oral medication. In all patient groups together, the prevalence of incretin-mimetic therapy did not change (3.9% at discharge, 2.9% at follow-up). The prevalence of sodium glucose transporter-2–inhibitor therapy slightly increased from 6.8% at discharge to 9.2% at follow-up. However, 85 out of 173 patients (49.1%) did not provide follow-up questionnaires. In hospital mortality (Group 1: 0%, Group 2: 0%, Group 3: 5.2%; p = 0.092), 1-year mortality after discharge ( Group 1: 12.5%, Group 2: 13.6%, Group 3: 11.9%; p = 0.944), and number of rehospitalizations within 12 months after discharge (Group 1: 1.0 per capita, Group 2: 1.0, Group 3: 1.1; p = 0.697) were similar among groups. Hypoglycemic events 6 months prior to follow-up were highest in Group 2 (0.9 ± 2.3) in comparison to Group 1 (0 ± 0) and Group 3 (0.1 ± 0.3; p = 0.017). Conclusion: Even after adjusting for surviving patients not sending back questionnaires, the adherence to the recommendations regarding incretin-mimetic and sodium-glucose transporter-2–inhibitor therapy was poor. With the limitation of a low patient number, both 1-year mortality after discharge and rehospitalizations were similar among groups. Self-reported hypoglycemic events occurred more often in insulin-treated diabetics than in the ones without.

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