Ketoacidosis without significantly hyperglycaemia - is it possible?

Michał Budzyński, Joanna Pekar, Justyna Magdalena Skolarczyk, Monika Tadla, Katarzyna Skórzyńska-Dziduszko

Abstract


Introduction and aim of the study. Currently only minimal information is available regarding ketoacidosis without significant hyperglycemia. Some study describe that the sodium –glucose cotransporters (SGLT) may alter the normal balance between gluconeogenesis and ketogenesis.Aim of the study is to present the problem of the occurrence of ketoacidosis without hyperglycemia.

Results. Phlorizen, the sodium –glucose cotransporters SGLT inhibitor was recognized to increase acetoacetate reabsorption and to induce hyperketonemia to an extent comparable to that seen with insulin deficiency. SGLT2 is expressed on the α -cells of the pancreatic islets, functioning in their glucose-sensing mechanism, so that earlier reports of SGLT2 inhibition-induced hyperglucagonemia. Episodes of diabetic ketoacidosis with SGLT2 inhibitors use were characterized by lower blood glucose levels. Drugs as ipragliflozin, dapagliflozin and tofogliflozin (SGLT inhibitors) may increase ketogenesis. Ipragliflozin increases lipolysis and both fatty acid oxidation and ketogenesis. In trials of tofogliflozin hyperketonemia and ketonuria were reported, with dose-related increases both in β-hydroxybutyrate and acetoacetate.

Conclusions. Ketoacidosis may cause by phlorizen – SGLT inhibitor with slightly / moderately elevated levels of blood glucose.


Keywords


SGLT2 inhibitors; ketoacidosis

Full Text:

PDF (Polski)

References


http://www.who.int/mediacentre/factsheets/fs312/en/.

Przybysławski B, Karbowiak P, Rzeszotarski J, Walasek L. Inhibitory kotransportera glukozowo-sodowego 2 (SGLT2): nowa grupa doustnych leków przeciwcukrzycowych. Diabetologia Kliniczna Diabetologia Kliniczna. 2013; 2(5): 191-197.

Mizerski G, Kicinski P, Jaroszynski A. Flozins, inhibitors of type 2 renal sodium-glucose co-transporter – not only antihyperglycemic drugs. Curr. Issues Pharm. Med. Sci., 2015, 28(3): 155-158, DOI: https://doi.org/10.1515/cipms-2015-0063.

Otto-Buczkowska E. Inhibitory sodozależnego kotransportera 2 glukozy — nowa grupa leków w leczeniu cukrzycy. Forum Medycyny Rodzinnej, 2014; 8(5): 238–241.

Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę 2015. Diabetologia Kliniczna 2015; 4(A): 1-73, ISSN 2084–4441.

Misra S, Oliver NS. Diabetic ketoacidosis in adults. BMJ, 2015; 351: h5660 DOI: 10.1136/bmj.h5660.

Ciechanowska M, Starzyk J. Kwasica ketonowa w przebiegu cukrzycy typu 1 u dzieci. Rozpoznanie i leczenie chorego w pierwszej dobie hospitalizacji. Endokrynologia, Otyłość i Zaburzenia Przemiany Materii 2009; 5(1): 28-35.

Peters AL, Buschur EO, Buse JB, Cohan P, Diner CJ, Hirsch IB. Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium–Glucose Cotransporter 2 Inhibition. Diabetes Care, 2015; 38(9): 1687–1693, DOI: 10.2337/dc15-0843.

Rosenstock J, Ferrannini E. Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, and Preventable Safety Concern With SGLT2 Inhibitors. Diabetes Care, 2015; 38(9): 1638–1642, DOI: 10.2337/dc15-1380.

Bloomgarden ZT. Sodium–glucose cotransporter 2 inhibitors and diabetic ketoacidosis. Journal of diabetes, 2016; 8(2), 175-176, DOI: 10.1111/1753-0407.12353.

Burke KR, Schumacher CA, Harpe SE. SGLT2 inhibitors: a systematic review of diabetic ketoacidosis and related risk factors in the primary literature. Pharmacotherapy, 2017; 37(2): 187-194.

Ostergaard JA, Laugesen E, Leslie RD. Should there be concern about autoimmune diabetes in adults? Current evidence and controversies. Curr Diab Rep, 2016, 16(9): 82.

Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85(1): 109–17.

Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB. Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium–Glucose Cotransporter 2 Inhibition, Diabetes Care. 2015; 38(9): 1687-1693.

Ogawa W, Sakaguchi K. Euglycemic diabetic ketoacidosis induced by SGLT2 inhibitors: possible mechanism and contributing factors. J Diabetes Investig. 2016, 7(2): 135-138 DOI: 10.1111/jdi.12401.

Jazi M, Porfiris G. Euglycemic diabetic ketoacidosis in type 2 diabetes treated with a sodium-glucose cotransporter-2 inhibitor. Can Fam Physician. 2016; 62(9): 722-724.




DOI: http://dx.doi.org/10.5281/zenodo.804619

Refbacks

  • There are currently no refbacks.




Copyright (c) 2017 Michał Budzyński, Joanna Pekar, Justyna Magdalena Skolarczyk, Monika Tadla, Katarzyna Skórzyńska-Dziduszko

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616

POL-index 2011 - 2014

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655

BASE 2011 - 2014

https://www.base-search.net/Search/Results?lookfor=Journal+of+Health+Sciences+%28Radom%29&type=all&oaboost=1&ling=1&name=&thes=&refid=dcrespl&newsearch=1

http://elibrary.ru/contents.asp?titleid=37467

http://journal.rsw.edu.pl/index.php/JHS/issue/archive

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844

Find a library that holds this journal: http://worldcat.org/issn/23918306

Journal Language(s): English 

PBN Poland

https://pbn.nauka.gov.pl/sedno-webapp/journals/49068

POL-index

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4

BASE

https://www.base-search.net/Search/Results?join=AND&bool0[]=AND&lookfor0[]=2391-8306&type0[]=all&page=11&l=pl&oaboost=1&refid=dcpagepl

Redaction, Publisher and Editorial Office

Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2  www.ukw.edu.pl Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy http://ojs.ukw.edu.pl/index.php/johs  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

SIC Science citation index (calculated on the basis of TCI and Page Rank) 0

Russian Impact factor 0.16

Indexed in Index Copernicus Journals Master List.

http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase Index.com.

Website: www.infobaseindex.com

Universal Impact Factor 1.78 for year 2012. (http://www.uifactor.org/AppliedJournals.aspx)

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski

(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)