scholarly journals MON-675 Ziprasidone Induced Diabetic Ketoacidosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Varshitha Thanikonda ◽  
Fatima Jalil ◽  
Vitaly Kantorovich
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Sugar Content ◽  
Dry Mouth ◽  
Close Monitoring ◽  
Antipsychotic Therapy ◽  
Increased Risk

Abstract Introduction: Atypical antipsychotics are known to cause increased risk of type 2 Diabetes Mellitus (DM2), dyslipidemia, and weight gain (metabolic syndrome). Clozapine, a commonly used anti-psychotic, is known to cause Diabetic Ketoacidosis (DKA), but literature has rarely shown an association of DKA with Ziprasidone. Case: A 42-year-old African American female presented with two weeks of polyuria, polydipsia, 23-pound weight loss, blurriness of vision, and dry mouth. Before the presentation, she had been drinking several drinks with high sugar content. Her medications included Ziprasidone (Geodon), Trileptal, and Cogentin for her bipolar disorder. She was started on Ziprasidone in 2007, changed to Brand name Geodon in 2014. Except for dry mouth, her exam was unremarkable. Labs were significant for blood glucose of 1114 mg/dL, bicarbonate of 18mmol/L, beta-hydroxybutyrate of 3.33 mmol/L, serum osmolality of 334 mOsm/kg. She was diagnosed with new-onset diabetes mellitus presenting as diabetic ketoacidosis. Her mother was diagnosed with DM2 in her 40s. She ha difficult to control blood sugars despite aggressive hydration and required regular insulin drip for 3 days for her anion gap to close. Managing her BGs was challenging. Discussion: Clozapine and olanzapine are the common atypical antipsychotics that can cause DKA1, 2. To our knowledge, Ziprasidone is associated with hyperglycemia within days of starting the drug and HHS but not with DKA. For atypical antipsychotic associated DKA, risk factors include the duration of antipsychotic therapy, polypharmacy with multiple antipsychotic agents, non-Caucasians, obesity and pre-diabetes2, 3. Proposed mechanisms include peripheral insulin resistance, alteration of pancreatic beta-cell function by inhibiting 5-HT1A/2A/2C and alpha 2 adrenergic receptors1-3. However, there is no explanation of why few people develop complications while others do not. There is hypothesis regarding leptin gene polymorphisms of receptors that may play a role4. While starting patients on Ziprasidone, close monitoring of blood glucose is necessary before initiation and regular follow up thereafter3. 1. Henderson DC. Atypical antipsychotic-induced diabetes mellitus: How strong is the evidence? CNS Drugs. 2002. 2. Vuk A. Diabetic ketoacidosis associated with antipsychotic drugs: Case reports and a review of literature. Psychiatr Danub. 2017. 3. Schwenkreis P. Atypical antipsychotics and diabetes mellitus. World J Biol Psychiatry. 2004. 4. 1. Reynolds GP. Metabolic side effects of antipsychotic drug treatment - pharmacological mechanisms. Pharmacol Ther. 2010.

scholarly journals Unusual high blood glucose in ketoacidosis as first presentation of type 1 diabetes mellitus

2018 ◽  
Vol 2018 ◽  
Author(s):  
Sebastian Hörber ◽  
Sarah Hudak ◽  
Martin Kächele ◽  
Dietrich Overkamp ◽  
Andreas Fritsche ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Atypical Antipsychotics ◽  
List Type ◽  
High Blood Glucose ◽  
Increased Risk ◽  
New Onset

Summary Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus. It usually occurs in patients with type 1 diabetes where it is typically associated with only moderately increased blood glucose. Here, we report the case of a 52-year-old female patient who was admitted to the emergency unit with severely altered mental status but stable vital signs. Laboratory results on admission revealed very high blood glucose (1687 mg/dL/93.6 mmol/L) and severe acidosis (pH <7) with proof of ketone bodies in serum and urine. Past history revealed a paranoid schizophrenia diagnosed 10 years ago and for which the patient was treated with risperidone for many years. Acute treatment with intravenous fluids, intravenous insulin infusion and sodium bicarbonate improved the symptoms. Further laboratory investigations confirmed diagnosis of autoimmune type 1 diabetes. After normalization of blood glucose levels, the patient could soon be discharged with a subcutaneous insulin therapy. Learning points: Diabetic ketoacidosis as first manifestation of type 1 diabetes can occur with markedly elevated blood glucose concentrations in elder patients. Atypical antipsychotics are associated with hyperglycemia and an increased risk of new-onset diabetes. First report of risperidone-associated diabetic ketoacidosis in new-onset type 1 diabetes. Patients treated with atypical antipsychotics require special care and regular laboratory examinations to detect hyperglycemia and diabetic ketoacidosis. In cases when the diagnosis is in doubt, blood gas analysis as well as determination of C-peptide and islet autoantibodies can help to establish the definite diabetes type.

Perioperative Management of Diabetes Mellitus Type 1 and 2

2018 ◽  
Author(s):  
Vidya T. Raman
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Dietary Intake ◽  
Diabetic Ketoacidosis ◽  
Perioperative Management ◽  
Diabetes Management ◽  
Diabetes Mellitus Type 1 ◽  
Close Monitoring ◽  
Increased Risk

Diabetes management offers unique challenges in children and adolescents versus adults especially in the perioperative environment. The obvious challenges of monitoring dietary intake plus possible communication barriers with increased risk of diabetic ketoacidosis and hypoglycemia. Adding the catabolic stressors from surgery also add challenges to the perioperative physician managing the patient’s glycemic control. It is important to work with endocrinology in order to manage their diabetes. Lengthier procedures also complicate glycemic control. It involves sometimes close monitoring of not only glucose but electrolytes and blood and urine ketones.

scholarly journals Effect of atypical antipsychotics on blood glucose levels and HbA1c in patients of schizophrenia and bipolar disorder.

2021 ◽  
Vol 28 (02) ◽  
pp. 158-164
Author(s):  
Abdul Hafeez Bughio ◽  
Shafak Ansari ◽  
Rajesh Kumar ◽  
Muhammad Hassan Sheikh ◽  
Tarachand Devrajani
Keyword(s):  
Diabetes Mellitus ◽  
Bipolar Disorder ◽  
Blood Glucose ◽  
Atypical Antipsychotics ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Bipolar Disorders ◽  
Antipsychotic Agents ◽  
Antipsychotic Therapy ◽  
Glucose Levels

Objectives: To evaluate the effect of atypical antipsychotics on serum glucose levels and HbA1C in patients of schizophrenia and bipolar disorder. Study Design: Quasi-experimental study. Setting: Department of Neurology and Sir C. J Institute of Psychiatry LUMHS Jamshoro/Hyderabad. Period: Dec 2018-Dec 2019. Material & Methods: Total 360 participants of age more than 15 years of either gender presenting with psychiatric illness i.e. schizophrenia and bipolar disorder and prescribed same brand of antipsychotic drugs were included in the study. Fasting blood glucose (FBS), random blood glucose (RBS) and glycosylated hemoglobin (HbA1c) were measured at baseline and 6th months after treatment with atypical antipsychotic agents. SPSS version 23 was used to analyze data. Results: A total of 360 patients were enrolled in the study duration, among them 338 patients were followed up till 6 months, while 22 patients were lost to follow up. The mean age of the study sample was reported as 39.33±8.83 years. At baseline mean FBS, RBS and HbA1c were reported as 92.52±9 mg/dl, 143.21±14.91, 5.83±0.37 which significantly increase after treatment with antipsychotics at 6 months (p<0.05). About 23.6% developed diabetes mellitus and 21.3% developed hyperglycemia at the end of 6 months. Conclusion: Non-diabetic treatment naïve schizophrenia and bipolar disorders patients have higher chances developing side-effects on the glucose regulations after initiation of antipsychotic therapy. Overall, the early identification and diagnosis of antipsychotic-induced diabetes mellitus and hyperglycemia requires proper evaluation, reporting, and physician and patient awareness.

scholarly journals Associations of markers of arterial stiffness and remodeling with new-onset type 2 diabetes mellitus

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
F Ahmadizar ◽  
K Wang ◽  
F Mattace Raso ◽  
MA Ikram ◽  
M Kavousi
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Arterial Stiffness ◽  
Wall Stress ◽  
Lipid Lowering ◽  
Circumferential Wall Stress ◽  
Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background. Arterial stiffness/remodeling results in impaired blood flow and, eventually, decreased glucose disposal in peripheral tissues and increased blood glucose. Besides, increased arterial stiffness/remodeling may lead to hypertension, as a potential reciprocal risk factor for type 2 diabetes mellitus (T2D). We, therefore, hypothesized that increased arterial stiffness/remodeling is associated with an increased risk of T2D. Purpose. To study the associations between arterial stiffness/remodeling and incident T2D. Methods. We used the prospective population-based Rotterdam Study. Common carotid arterial properties were ultrasonically determined in plaque-free areas. Aortic stiffness was estimated by carotid-femoral pulse wave velocity (cf_PWV), carotid stiffness was estimated by the carotid distensibility coefficient (carDC). Arterial remodeling was estimated by carotid artery lumen diameter (carDi), carotid intima-media thickness (cIMT), mean circumferential wall stress (CWSmean), and pulsatile circumferential wall stress (CWSpuls). Cox proportional hazard regression analysis was used to estimate the associations between arterial stiffness/remodeling and the risk of incident T2D, adjusted for age, sex, cohort, mean arterial pressure (MAP), antihypertensive medications, heart rate, non- high-density lipoprotein (HDL)-cholesterol, lipid-lowering medications, and smoking. We included interaction terms in the fully adjusted models to study whether any significant associations were modified by sex, age, blood glucose, or MAP. Spearman correlation analyses were applied to examine the correlations between measurements of arterial stiffness/remodeling and glycemic traits. Results. We included 3,055 individuals free of T2D at baseline (mean (SD) age, 67.2 (7.9) years). During a median follow-up of 14.0 years, 395 (12.9%) T2D occurred. After adjustments, higher cf_PWV (hazard ratio (HR),1.18; 95%CI:1.04-1.35), carDi (1.17; 1.04-1.32), cIMT (1.15; 1.01-1.32), and CWSpuls (1.28; 1.12-1.47) were associated with increased risk of incident T2D. After further adjustment for the baseline glucose, the associations attenuated but remained statistically significant. Sex, age, blood glucose, or MAP did not modify the associations between measurements of arterial stiffness/remodeling, and incident T2D. Among the population with prediabetes at baseline (n = 513) compared to the general population, larger cIMT was associated with a greater increase in the risk of T2D. Most measurements of arterial stiffness/remodeling significantly but weakly correlated with baseline glycemic traits, particularly with blood glucose.  Conclusions. Our study suggests that greater arterial stiffness/remodeling is independently associated with an increased risk of T2D development. Blood glucose and hypertension do not seem to play significant roles in these associations. Further studies should disentangle the underlying mechanism that links arterial stiffness/remodeling and T2D.

Association of Acrochordons with Diabetes Mellitus - A Hospital based Case Control Study

2021 ◽  
Vol 4 (1) ◽  
pp. 51-60
Author(s):  
Sunita Karki ◽  
Anjan Rai ◽  
Manish Pradhan
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Postprandial Glucose ◽  
Early Screening ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Increased Risk ◽  
Skin Tags ◽  
And Gender ◽  
Control Study

Introduction Acrochordons or skin tags are common benign cutaneous tumors that occur especially over the neck and major flexures. A possible association between diabetes mellitus and dyslipidemia is observed in numerous past studies with varying results. We aim to find out the association of diabetes mellitus with acrochordons Methods: One hundred patients were enrolled in our study. Among them, 50 (27 males and 23 females) with skin tags were selected as cases and 50 with other dermatologic diseases after matching age and gender were taken as controls. Blood glucose levels including both fasting and postprandial glucose levels were determined for both cases and controls and compared. Results: There was a higher frequency of Diabetes Mellitus and impaired glucose tolerance in patients with skin tags in comparison to controls (p<0.001). Moreover, there were higher odds of acquiring skin tags in patient with abnormal blood glucose levels. Conclusions: There is an increased risk of developing DM in patients with skin tags. It is highly recommended that suspicion for Diabetes Mellitus is to be done in patients with skin tags for early screening and diagnosis of Diabetes.

scholarly journals Evaluation of type-2 diabetes mellitus patients for dyslipidemia in a tertiary care centre

2020 ◽  
Vol 7 (4) ◽  
pp. 586
Author(s):  
Janak G. Chokshi ◽  
Apal P. Gandhi ◽  
Ishvarlal M. Parmar ◽  
Dipen R. Damor
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Total Cholesterol ◽  
Plasma Glucose ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Diabetic Patients ◽  
Low Density ◽  
Increased Risk

Background: Diabetes mellitus (DM) is a syndrome consisting of metabolic, vascular and neuropathic components that are interrelated. Diabetes mellitus is associated with a considerably increased risk of premature atherosclerosis, particularly coronary heart disease (CHD) and peripheral arterial disease. Dyslipidemia is a common feature of diabetes. There is an association between atherosclerotic cardiovascular disease and serum cholesterol and triglyceride levels in both type 1 and type 2 diabetes.Methods: The study was done on 50 adult diabetes mellitus (T2) patients from IPD of General Medicine wards at SMS Hospital, Ahmedabad, Gujarat. 50 healthy age and sex matched healthy volunteers were taken as control. They were evaluated for lipid profile i.e., Total Cholesterol (TC),Triglyceride (TG), Low-density lipoprotein (LDL), High density lipoprotein (HDL), Very low density lipoprotein (VLDL) and glycemic status i.e., Fasting blood glucose (FBS), Postprandial 2 hours blood glucose (PP2BS) & Glycosylated haemoglobin(HbA1C).Results: Diabetic cases had statistically highly significant (p<0.001) elevated levels of total Cholesterol, Triglycerides and VLDL as compared to controls. Serum TG, serum TC, LDL-C and VLDL-C had positive correlation with the postprandial plasma glucose, fasting plasma glucose and HbA1c.Conclusions: Significant correlations between HbA1c levels and lipid levels point towards the usefulness of HbA1c for screening high-risk diabetic patients. High TC, TG, LDL-C and HbA1c with normal or low HDL-C is seen in almost all diabetic patients either alone or in combinations.

scholarly journals COVID-19 Infection with Refractory Diabetic Ketoacidosis- A case Report

2021 ◽  
Vol 7 (2) ◽  
pp. 54-56
Author(s):  
Reshmi Mishra ◽  
◽  
Jyoti Ranjan Behera ◽  
P. Ramkumar ◽  
Mukesh Kumar Jain ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Vital Organ ◽  
Increased Risk ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
New Onset

Diabetic ketoacidosis is an acute life-threatening complication of type 1 diabetes. Sometimes it is the first presentation in an undiagnosed child. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) and diabetes mellitus are very much interrelated as diabetes mellitus is associated with an increased risk of severe COVID19 at the same time, many cases of new-onset diabetes had been diagnosed. Hyperglycemia, metabolic acidosis, and ketonemia are classical presentations. It is essential to correct the acidosis and fluid correction and insulin therapy in these patients, leading to vital organ dysfunction. In refractory metabolic acidosis, renal replacement therapy may help

Euglycemic Diabetic Ketoacidosis Associated With Sodium–Glucose Cotransporter Type 2 Inhibitors in Patients With Type 2 Diabetes Mellitus Receiving Oral Therapy

2017 ◽  
Vol 32 (2) ◽  
pp. 240-243 ◽  
Author(s):  
Ryan B. Dull ◽  
Mikayla L. Spangler ◽  
Emily L. Knezevich ◽  
Britney M. Lau
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Case Reports ◽  
Serious Adverse Events ◽  
Type 2 Dm ◽  
Sodium Glucose Cotransporter ◽  
Increased Risk

Introduction and Objective: Postmarketing reports and warnings of serious adverse events such as diabetic ketoacidosis (DKA) have raised concern regarding the safety of sodium–glucose cotransporter 2 inhibitors (SGLT2i). This report describes 2 cases of symptomatic SGLT2i-associated euglycemic DKA (euDKA) leading to hospitalization in patients with type 2 diabetes mellitus (DM) previously well controlled on oral medications. Case Reports: Subject 1 is a 55-year-old female admitted with euDKA precipitated by infection and managed with intravenous insulin. This case was notable for a delayed diagnosis of euDKA and lack of clinical improvement despite withholding dapagliflozin. Subject 2 is a 62-year-old male admitted with euDKA precipitated by infection. His clinical condition improved rapidly and euDKA responded to withdrawal of empagliflozin alone. Discussion: Applying the Naranjo adverse medication reaction probability scale to each case (subject 1 score = 3 points; subject 2 score = 4 points) suggests these are possible adverse reactions to SGLT2i. Data from randomized controlled trials suggest DKA events in adults with type 2 DM receiving SGLT2i are rare and similar to placebo. However, data from a large cohort suggest these events occur more frequently and are associated with a 2-fold increased risk of DKA. Conclusion: This class of medications may be associated with a higher real-world risk of DKA in adults with type 2 DM than previously reported. Patients prescribed these medications should receive vigilant assessment for features of traditional DKA as well as euDKA.

FAMILY HISTORY OF DIABETES IS ASSOCIATED WITH INCREASED RISK OF RECURRENT DIABETIC KETOACIDOSIS IN PEDIATRIC PATIENTS

2020 ◽  
Vol 26 (3) ◽  
pp. 305-311
Author(s):  
Janaki D. Vakharia ◽  
Sungeeta Agrawal ◽  
Janine Molino ◽  
Lisa Swartz Topor
Keyword(s):  
Diabetes Mellitus ◽  
Family History ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Incidence Rate Ratio ◽  
Family History Of Diabetes ◽  
Increased Risk ◽  
History Of

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM). Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM. Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household. Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus

scholarly journals Immune checkpoint inhibitors and type 1 diabetes mellitus: a case report and systematic review

2019 ◽  
Vol 181 (3) ◽  
pp. 363-374 ◽  
Author(s):  
Jeroen M K de Filette ◽  
Joeri J Pen ◽  
Lore Decoster ◽  
Thomas Vissers ◽  
Bert Bravenboer ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Diabetic Ketoacidosis ◽  
Immune Checkpoint ◽  
Health Care Professionals ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Autoimmune Diabetes ◽  
Acid Decarboxylase ◽  
Close Monitoring

Objective To better define the rare adverse event (AE) of diabetes mellitus associated with immune checkpoint inhibitors (ICIs). Design and methods We report the case of a lung cancer patient with diabetic ketoacidosis (DKA) and autoimmune thyroiditis during pembrolizumab treatment. We provide a systematic review of all published cases (PubMed/Web of Science/Cochrane, through November 2018) of autoimmune diabetes mellitus related to blockade of the cytotoxic T-lymphocyte antigen 4 (CTLA-4)-, programmed cell death 1 (PD-1) receptor or its ligand (PD-L1) or combination (ICI) therapy. Results Our literature search identified 90 patient cases (our case excluded). Most patients were treated with anti-PD-1 or anti-PD-L1 as monotherapy (79%) or in combination with CTLA-4 blockade (15%). On average, diabetes mellitus was diagnosed after 4.5 cycles; earlier for combination ICI at 2.7 cycles. Early-onset diabetes mellitus (after one or two cycles) was observed during all treatment regimens. Diabetic ketoacidosis was present in 71%, while elevated lipase levels were detected in 52% (13/25). Islet autoantibodies were positive in 53% of patients with a predominance of glutamic acid decarboxylase antibodies. Susceptible HLA genotypes were present in 65% (mostly DR4). Thyroid dysfunction was the most frequent other endocrine AE at 24% incidence in this patient population. Conclusion ICI-related diabetes mellitus is a rare but often life-threatening metabolic urgency of which health-care professionals and patients should be aware. Close monitoring of blood glucose and prompt endocrine investigation in case of hyperglycemia is advisable. Predisposing factors such as HLA genotype might explain why some individuals are at risk.

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