scholarly journals Diabetic ketoacidosis following PEG-asparaginase therapy

2018 ◽  
Vol 2018 ◽  
Author(s):  
Miriam Hinaa Ahmad ◽  
Ismat Shafiq
Keyword(s):  
Diabetic Ketoacidosis ◽  
Pediatric Population ◽  
Lymphoblastic Leukemia ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Physician Education ◽  
List Type ◽  
African American Female ◽  
Treatment Protocols ◽  
Frequent Blood Glucose Monitoring

Summary We report a case of a 21-year-old African American female with history of pre-diabetes, and a diagnosis of a rare leukemia, blastic-plasmacytoid dendritic neoplasm (BPDCN), who developed diabetic ketoacidosis (DKA) after the third dose of PEG-asparaginase infusion. She was successfully treated with insulin. Asparaginase is a vital part of treatment protocols for acute lymphoblastic leukemia (ALL) in combination with other chemotherapeutic drugs. Asparaginase therapy has been reported to cause hyperglycemia especially when used in conjunction with glucocorticoids for the treatment of ALL in the pediatric population. Multiple mechanisms for hyperglycemia have been hypothesized which include decreased insulin secretion, impaired insulin receptor function and excess glucagon formation. Hyperglycemia is usually self-limiting but can deteriorate to diabetic ketoacidosis. DKA is a rare adverse effect with asparaginase therapy with an incidence rate of about 0.8%. Learning points: DKA is a rare finding following asparaginase therapy. Hyperglycemia is most commonly seen with asparaginase treatment when used along with glucocorticoid. Frequent blood glucose monitoring and prompt initiation of insulin treatment with hyperglycemia can prevent severe complications. Patients and physician education on this complication can reduce morbidity due to DKA.

scholarly journals Perioperative Management of Patients with Diabetes

2017 ◽  
Vol 10 ◽  
pp. 117863291773507 ◽  
Author(s):  
Vivien Leung ◽  
Kristal Ragbir-Toolsie
Keyword(s):  
Glucose Control ◽  
Preoperative Evaluation ◽  
Glucose Monitoring ◽  
Perioperative Period ◽  
Blood Glucose Monitoring ◽  
Effective Strategies ◽  
Uncontrolled Diabetes ◽  
Patients With Diabetes ◽  
Management Recommendations ◽  
Frequent Blood Glucose Monitoring

Hyperglycemia has long been recognized to have detrimental effects on postoperative outcomes in patients undergoing surgery. The manifestations of uncontrolled diabetes are manifold and can include risk of hyperglycemic crises, postoperative infection, poor wound healing, and increased mortality. There is substantial literature supporting the role of diligent glucose control in the prevention of adverse surgical outcomes, but considerable debate remains as to the optimal glucose targets. Hence, most organizations advocate the avoidance of hypoglycemia while striving for adequate glucose control in the perioperative period. These objectives can be accomplished with careful preoperative evaluation, clear patient instructions the day of surgery, frequent blood glucose monitoring during the perioperative period, and use of effective strategies for insulin initiation and titration. This article highlights the major issues concerning patients with diabetes undergoing surgery and reviews the management recommendations put forth by general consensus guidelines and expert opinion.

scholarly journals A case of pembrolizumab-induced severe DKA and hypothyroidism in a patient with metastatic melanoma

2019 ◽  
Vol 2019 ◽  
Author(s):  
Osamah A Hakami ◽  
Julia Ioana ◽  
Shahzad Ahmad ◽  
Tommy Kyaw Tun ◽  
Seamus Sreenan ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Cancer Treatment ◽  
Metastatic Melanoma ◽  
Checkpoint Inhibitors ◽  
Advanced Melanoma ◽  
Blood Glucose Monitoring ◽  
Thyroid Peroxidase ◽  
List Type ◽  
Treatment Protocols ◽  
Cancer Treatment Protocols

Summary Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy and improved outcomes for patients with advanced disease. Pembrolizumab, a monoclonal antibody that acts as a programmed cell death 1 (PD-1(PDCD1)) inhibitor, has been approved for the treatment of advanced melanoma and other solid tumours. Immune-related adverse events (irAEs) including endocrinopathies have been well described with this and other PD-1 inhibitors. While hypothyroidism and hyperthyroidism, and less commonly hypophysitis, are the most common endocrinopathies occurring in patients treated with pembrolizumab, the incidence of type 1 diabetes mellitus (T1DM) was low in clinical trials. We report a case of pembrolizumab-induced primary hypothyroidism and T1DM presenting with severe diabetic ketoacidosis (DKA). A 52-year-old male patient was treated with pembrolizumab for metastatic melanoma. He presented to the emergency department with a 1-day history of nausea and vomiting 2 weeks after his seventh dose of pembrolizumab, having complained of polyuria and polydipsia for 2 months before presentation. He had been diagnosed with thyroid peroxidase (TPO) antibody-negative hypothyroidism, requiring thyroxine replacement, shortly after his fifth dose. Testing revealed a severe DKA (pH: 6.99, glucose: 38.6 mmol/L, capillary ketones: 4.9 and anion gap: 34.7). He was treated in the intensive care unit as per the institutional protocol, and subsequently transitioned to subcutaneous basal-bolus insulin. After his diabetes and thyroid stabilised, pembrolizumab was recommenced to treat his advanced melanoma given his excellent response. This case highlights the importance of blood glucose monitoring as an integral part of cancer treatment protocols composed of pembrolizumab and other ICIs. Learning points: The incidence of T1DM with pembrolizumab treatment is being increasingly recognised and reported, and DKA is a common initial presentation. Physicians should counsel patients about this potential irAE and educate them about the symptoms of hyperglycaemia and DKA. The ESMO guidelines recommend regular monitoring of blood glucose in patients treated with ICIs, a recommendation needs to be incorporated into cancer treatment protocols for pembrolizumab and other ICIs in order to detect hyperglycaemia early and prevent DKA.

Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

2019 ◽  
Vol 37 (1) ◽  
pp. 31-35
Author(s):  
Ahmed Aljabri ◽  
Stephen Perona ◽  
Mohannad Alshibani ◽  
Moteb Khobrani ◽  
Daniel Jarrell ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Severe Hypoglycaemia ◽  
Glucose Monitoring ◽  
Regular Insulin ◽  
Blood Glucose Monitoring ◽  
High Incidence ◽  
Reduction Coefficient ◽  
Frequent Blood Glucose Monitoring ◽  
Glucose Reduction ◽  
Intravenous Dextrose

BackgroundDextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin.MethodsThis was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction.ResultsA total of 90 patients were included. The median blood glucose change over 6 hours was −24 mg/dL (IQR −53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient −0.36, 95% CI −0.55 to −0.18, p<0.001).ConclusionsThe extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring.

scholarly journals Hyperglycemic Crises in Patients with Covid-10

2020 ◽  
Vol 5 (3) ◽  
pp. 01-03
Author(s):  
Nasser Mikhail
Keyword(s):  
Mortality Rate ◽  
Diabetic Ketoacidosis ◽  
Case Reports ◽  
English Literature ◽  
Glucose Monitoring ◽  
Volume Overload ◽  
Blood Glucose Monitoring ◽  
Nursing Time ◽  
Manual Search ◽  
Step Down

Background: It is unclear whether the 2 hyperglycemic crises, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS) have different characteristics in patients with COVID-19. Objective: to describe prevalence, outcomes, and management of hyperglycemic crisis specifically in patients with COVID-19. Methods: English literature search of electronic databases supplemented by manual search up to July 31st, 2020. Search terms included hyperglycemic crises, diabetic ketoacidosis, COVID-19, ARDS, dexamethasone, mortality, safety. Since no randomized trials are available, all pertinent observational studies, case reports and major organization guidelines were reviewed. Results: DKA occurs in 0.45 to 3.4% of patients with COVID-19 admitted to the hospital, and results in approximately 50% mortality rate. Excessive intravenous hydration should be avoided in patients at risk or having acute respiratory distress syndrome (ARDS) to avoid volume overload. In patients presenting with hyperglycemic crisis and COVID-19 requiring oxygen or on mechanical ventilation, dexamethasone may be given after resolution of hyperglycemic crisis. Insulin doses need to be increased by 50-100% to control dexamethasone-induced hyperglycemia. Selected patients with non-complicated both DKA and COVID-19 may be safely managed by subcutaneous rapid-acting insulin in a step-down unit with blood glucose monitoring every 2 hours. This strategy may spare beds in the intensive care unit (ICU) and personal protective equipment (PPE), and decrease nursing time at bedside. Conclusions: Hyperglycemic crises with COVID-19 are uncommon but carry high mortality rate. Uncomplicated cases may be managed ia step-down unit. Dexamethasone can be given after resolution of hyperglycemic crisis.

Approach to Management

1990 ◽  
Vol 16 (5) ◽  
pp. 401-406 ◽  
Author(s):  
Diana W Guthrie ◽  
Richard A. Guthrie
Keyword(s):  
Blood Glucose ◽  
Patient Education ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Self Management ◽  
Sliding Scale ◽  
Logic Approach ◽  
Catch Up ◽  
Frequent Blood Glucose Monitoring

This paper describes a physio logic approach to diabetes management called pattern therapy and compares it with the sliding scale or "catch-up" type of management. Pattern therapy differs from the sliding scale approach in that it anticipates rather than reflects insulin needs, and it relies heavily on intensive patient education and intelligent self-management. Frequent blood glucose monitoring is also a key aspect of pattern therapy.

941-P: Frequency of Blood Glucose Monitoring in Relation to Medical Cost and Glycemic Control in Hospitalized Patients with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 941-P
Author(s):  
LEI ZHANG ◽  
YAN GU ◽  
YUXIU YANG ◽  
NA WANG ◽  
WEIGUO GAO ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Medical Cost ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Blood Glucose Monitoring
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