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ketoacidosis treatment

Sérgio Azevedo, Joana Saraiva, Francisco Caramelo, Lúcia Fadiga, Luísa Barros, Carla Baptista, Miguel Melo, Leonor Gomes, Francisco Carrilho
INTRODUCTION: The use of continuous subcutaneous insulin infusion therapy in type 1 diabetes mellitus has increased due to its benefits on glycemic control and on the lifestyle flexibility. The aim of this study was to assess the impact of continuous subcutaneous insulin infusion therapy on glycemic control, body mass index, total daily dose of insulin and complications associated with this therapy, during 20 years of experience in Centro Hospitalar e Universitário de Coimbra. MATERIAL AND METHODS: This retrospective study included patients with type 1 diabetes mellitus who started continuous subcutaneous insulin infusion therapy up until 2005, followed at Centro Hospitalar e Universitário de Coimbra...
February 1, 2019: Acta Médica Portuguesa
P Choudhary, S de Portu, A Delbaere, J Lyon, J C Pickup
AIMS: To develop a novel interactive budget impact model that assesses affordability of diabetes treatments in specific populations, and to test the model in a hypothetical scenario by estimating cost savings resulting from reduction in HbA1c from ≥69 mmol/mol (8.5%) to a target of 53 mmol/mol (7.0%) in adults with Type 1 diabetes in the UK. METHODS: A dynamic, interactive model was created using the projected incidence and progression over a 5-year horizon of diabetes-related complications (micro- and macrovascular disease, severe hypoglycaemia and diabetic ketoacidosis) for different HbA1c levels, with flexible input of population size, complications and therapy costs, HbA1c distribution and other variables...
February 2, 2019: Diabetic Medicine: a Journal of the British Diabetic Association
Rachel J Perry, Aviva Rabin-Court, Joongyu D Song, Rebecca L Cardone, Yongliang Wang, Richard G Kibbey, Gerald I Shulman
Sodium-glucose transport protein 2 (SGLT2) inhibitors are a class of anti-diabetic agents; however, concerns have been raised about their potential to induce euglycemic ketoacidosis and to increase both glucose production and glucagon secretion. The mechanisms behind these alterations are unknown. Here we show that the SGLT2 inhibitor (SGLT2i) dapagliflozin promotes ketoacidosis in both healthy and type 2 diabetic rats in the setting of insulinopenia through increased plasma catecholamine and corticosterone concentrations secondary to volume depletion...
February 1, 2019: Nature Communications
Wei-Yu Chou, Yan-Rong Li, Wai Kin Chan, Szu-Tah Chen
BACKGROUND: This study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy. METHODS: A total of 825 individuals aged ≤ 20 years with T1DM, using either basal-bolus or premixed insulin regimens, were retrospectively recruited from 2001 to 2015. Rates of DKA after diagnosis, severe hypoglycemia, and the level of glycated hemoglobin A1c (HbA1c) improvement during the follow-up period were analyzed...
December 2018: Biomedical Journal
Awadhesh Kumar Singh, Ambika G Unnikrishnan, Abdul H Zargar, Ajay Kumar, Ashok K Das, Banshi Saboo, Binayak Sinha, Kalyan Kumar Gangopadhyay, Pradeep G Talwalkar, Samit Ghosal, Sanjay Kalra, Shashank Joshi, Surendra Kumar Sharma, Usha Sriram, Viswanathan Mohan
The current diabetes management strategies not only aim at controlling glycaemic parameters but also necessitate continuous medical care along with multifactorial risk reduction through a comprehensive management concept. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of evolving antidiabetic agents that have the potential to play a pivotal role in the comprehensive management of patients with diabetes due to their diverse beneficial effects. SGLT2i provide moderate glycaemic control, considerable body weight and blood pressure reduction, and thus have the ability to lower the risk of macrovascular and microvascular complications...
January 31, 2019: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Wei You, Jianming Yang, Yanqun Liu, Wen Wang, Li Zhu, Wei Wang, Jun Yang, Fangyuan Chen
RATIONALE: Fulminant type 1 diabetes mellitus (FT1DM) is a new subtype of type 1 diabetes mellitus that was first proposed by the Japanese scholar Imagawa in 2000. In the 2 patient cases described in this study, gastrointestinal symptoms were the first symptoms reported, and the initial blood glucose levels were very high. However, the glycosylated hemoglobin (HbA1c) levels were not very high, the islet β-cell function was almost completely lost in a short time, and the metabolic disorder was severe; the patients' islet β cells demonstrated complete and irreversible functional damage, and the prognosis was poor...
February 2019: Medicine (Baltimore)
Alice Gallo de Moraes, Salim Surani
Diabetes affects approximately 30 million persons in the United States. Diabetes ketoacidosis is one of the most serious and acute complications of diabetes. At the time of presentation and during treatment of diabetic ketoacidosis (DKA), several metabolic and electrolyte derangements can ultimately result in respiratory compromise. Most commonly, hypokalemia, hypomagnesemia and hypophosphatemia can eventually lead to respiratory muscles failure. Furthermore, tachypnea, hyperpnea and more severely, Kussmaul breathing pattern can develop...
January 15, 2019: World Journal of Diabetes
Victoria Byrd, Attila Nemeth
Epidermolysis bullosa acquisita is a rare autoimmune bullous disease involving the skin and mucosa, most commonly treated with systemic corticosteroids. This case illustrates the importance of counseling patients on medication side effects and ensuring close physician follow-up during an extended course of steroids. A 46-year-old man presented to the emergency department with weakness, fatigue, dizziness and polyuria in the setting of eight weeks of prednisone therapy for a flare-up of his bullous disease...
November 19, 2018: Curēus
June James
Death is an inevitable part of living. There are undoubtedly clinical and psychological challenges when any individual is passing from life to death. For a person with a long-term condition such as diabetes, these challenges can be compounded and impact on the care and experience of both the individual and their families and carers. It is estimated that about 500,000 people die each year in the United Kingdom; of these approximately 75,000 will have diabetes. The vast majority of people with diabetes who die do not do so as a result of a metabolic diabetes emergency such as diabetic ketoacidosis or hyperosmolar hyperglycaemic state...
January 17, 2019: Annals of Palliative Medicine
Stephan Siebel, Alfonso Galderisi, Neha S Patel, Lori R Carria, William V Tamborlane, Jennifer L Sherr
OBJECTIVE: We have shown that "euglycemic DKA" in patients with type 1 diabetes receiving a sodium-glucose cotransporter 2-inhibitor (SGLT2i) is due to normal increases in rates of ketogenesis but blunted increases in plasma glucose levels. In this analysis, we assessed whether rescue treatment of early ketoacidosis with insulin is altered by SGLT2i use. RESEARCH DESIGN AND METHODS: Participants received 0.2 U/kg of aspart insulin after two 6-h interruptions of basal insulin that increased beta-hydroxybutyrate (BHB) by 1...
January 28, 2019: Diabetes Technology & Therapeutics
Sang Mok Yeo, Hayeon Park, Jin Hyuk Paek, Woo Yeong Park, Seungyeup Han, Sung Bae Park, Kyubok Jin
RATIONALE: Dapagliflozin (a sodium-glucose cotransporter-2 [SGLT2] inhibitor) represents the most recently approved class of oral medications for the treatment of type 2 diabetes. Dapagliflozin lowers plasma glucose concentration by inhibiting the renal reuptake of glucose in the proximal renal tubules. In 2015, the US Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis in patients taking this medication. PATIENT CONCERNS: We present the case of a 23-year-old woman with type 2 diabetes treated with dapagliflozin (10 mg, once a day) for 2 years who presented to the emergency department with abdominal pain...
January 2019: Medicine (Baltimore)
S Picard, E Bonnemaison-Gilbert, E Leutenegger, P Barat
BACKGROUND: The impact of 7-day real-time continuous glucose monitoring (RT-CGM) on type 1 diabetes (T1D) management remains unknown in youths with suboptimal control by multiple daily injections (MDI). The DIACCOR Study aimed to describe treatment decisions and glucose outcomes after a short-term RT-CGM sequence in real-life conditions. METHODS: This French multicenter longitudinal observational study included T1D youths with HbA1c>7.5% or a history of severe hypoglycemia (SH) or recurrent documented hypoglycemia...
January 12, 2019: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Deepashree Gupta, Anju Prasad, Faisal Siddiqui, Sujata Sitaula, Stewart G Albert
AIMS: Although diabetic ketoacidosis (DKA) commonly presents as a pure diabetic ketoacidosis (PDKA), up to 30% of cases may be associated with a mixed hypochloremic metabolic alkalosis (HMA). It is unknown whether there is a difference in treatment outcomes between these two entities. We evaluated an insulin infusion protocol (IIP), previously validated for hyperglycemia management in ICU's, for the management of PDKA and HMA. MATERIALS AND METHODS: A retrospective case series/cohort study of 41 DKA admissions was further characterized as having PDKA or HMA...
January 2019: Diabetes & Metabolic Syndrome
Shannon M Fernando, Sean M Bagshaw, Bram Rochwerg, Daniel I McIsaac, Kednapa Thavorn, Alan J Forster, Alexandre Tran, Peter M Reardon, Erin Rosenberg, Peter Tanuseputro, Kwadwo Kyeremanteng
PURPOSE: There is wide variation in the utilization of Intensive Care Unit (ICU) beds for treatment and monitoring of adult patients with Diabetic Ketoacidosis (DKA). We sought to compare the outcomes and hospital costs of adult DKA patients admitted to ICUs as compared to those admitted to step-down units. MATERIALS AND METHODS: We included consecutive adult patients from two hospitals with a diagnosis of DKA. Patients were either admitted to the ICU, or a step-down unit, which has a nurse-to-patient ratio of 2:1, but does not have capability for mechanical ventilation or administration of vasoactive agents...
December 25, 2018: Journal of Critical Care
Ja Young Jeon, Soo-Kyung Kim, Kyung-Soo Kim, Sun Ok Song, Jae-Seung Yun, Bo-Yeon Kim, Chul-Hee Kim, Seok O Park, Seongbin Hong, Hea Seo, Ji A Seo, Jung Hyun Noh, Dae Jung Kim
AIM: - This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors. METHODS: - Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Based on their history of medications taken before admission, subjects were classified as either users or non-users of SGLT2 inhibitors and their clinical characteristics of DKA were compared...
January 9, 2019: Diabetes & Metabolism
Fortunato Lombardo, Stefano Passanisi, Albino Gasbarro, Giovanni Tuccari, Antonio Ieni, Giuseppina Salzano
BACKGROUND: Hepatic glycogenosis is characterized by excessive glycogen accumulation in hepatocytes and represents a complication of poor controlled type 1 diabetes. It can be caused by excessive insulin doses or recurrent ketoacidosis episodes. Mauriac's syndrome is a rare disease, which includes short stature, growth maturation delay, dyslipidemia, moon facies, protuberant abdomen, hepatomegaly with transaminase elevation. It has become even less common after the emergence of advances on diabetes treatment, but still exists...
January 7, 2019: Italian Journal of Pediatrics
K K Dhatariya, K Parsekar, C Skedgel, V Datta, P Hill, R Fordham
AIMS: Adolescents with Type 1 diabetes commonly experience episodes of ketoacidosis. In 2014, we conducted a nationwide survey on the management of diabetic ketoacidosis in young people. The survey reported how individual adolescents with diabetes were managed. However, the costs of treating diabetic ketoacidosis were not reported. METHODS: Using this mixed population sample of adolescents, we took a 'bottom-up' approach to cost analysis aiming to determine the total expense associated with treating diabetic ketoacidosis...
January 6, 2019: Diabetic Medicine: a Journal of the British Diabetic Association
Ruchi Gaba, Paras Mehta, Ashok Balasubramanyam
Patients presenting with diabetic ketoacidosis (DKA) who lack the classic phenotype of autoimmune type 1 diabetes have become increasingly identified in recent decades. This has led to the recognition of heterogeneous syndromes of 'ketosis-prone diabetes' (KPD). Evaluation and optimal management of KPD differs from that of 'typical' type 1 or type 2 diabetes. Awareness of these differences and a systematic approach to diagnosis and treatment can improve glycemic control and prevent both acute and chronic complications of diabetes...
January 2019: Expert Review of Endocrinology & Metabolism
Suzanne Cao, NhuChi Dao, Kristina Roloff, Guillermo J Valenzuela
Background  Although rare, familial hypertriglyceridemia can cause acute and life-threatening complications in pregnancy. Cases  The first patient's pregnancy was complicated by multiple admissions for pancreatitis due to hypertriglyceridemia and noncompliance with gemfibrozil. In her second pregnancy, she was compliant with gemfibrozil and only experienced pancreatitis episodes toward the end of pregnancy. The second patient had diabetes mellitus and familial hypertriglyceridemia. She required multiple hospitalizations for diabetic ketoacidosis secondary to insulin noncompliance...
October 2018: American Journal of Perinatology Reports
Tasnim Islam, Khalid Sherani, Salim Surani, Abhay Vakil
Diabetic ketoacidosis (DKA) is a complication seen in patients with both type 1 and type 2 diabetes. Due to its large, growing economic impact with associated morbidity, closer look at proper management is important. Factors involved in appropriate management involves fluid resuscitation, insulin regimen, and electrolyte replacement including types of fluid and insulin treatment. The caveat with generalized protocol is application to special populations such as renal or heart failure patients the sequelae of complications due to pathophysiology of the disease processes...
December 15, 2018: World Journal of Diabetes
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