Prolonged diabetic ketoacidosis and glycemic fluctuations associated with dapagliflozin: a case report
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CASE REPORT
Prolonged diabetic ketoacidosis and glycemic fluctuations associated with dapagliflozin: a case report Seher Kir 1
&
İbrahim Tiken 1
Received: 14 November 2019 / Accepted: 21 April 2020 / Published online: 18 May 2020 # Research Society for Study of Diabetes in India 2020
Abstract Aim Sodium-glucose co-transporter 2 inhibitors (SGLT-2I) are oral anti-diabetic drugs. We aimed to raise awareness by presenting a difficult and long-lasting DKA case that developed after the addition of dapagliflozin to the treatment. Case presentation We report a case of a 40-year-old woman who developed diabetic ketoacidosis (DKA) after 2 weeks use of dapagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT-2I). She had complaints of nausea, vomiting, loss of consciousness, fever, and shortness of breath. DKA was detected in her laboratory results despite the absence of marked hyperglycemia. The patient had metabolic acidosis episodes accompanied by ketonuria on the 5th (mild) and 9th (severe) day despite discontinuation of dapagliflozin. Sudden fluctuations in blood glucose levels of the patient lasted for 10 days and made it difficult to switch to routine basal-bolus insulin treatment. Conclusion Prolonged DKA may be a result of SGLT-2 inhibition and individualized treatment and follow-up should be performed instead of standard DKA treatment. Also, we suggest that we need to evaluate endogenous insulin reserves of the patients before starting a SGLT-2I treatment. We believe that in order to raise awareness, these cases should be reported. Keywords Diabetic ketoacidosis . Dapagliflozin . SGLT-2 inhibitors
Introduction Sodium-glucose co-transporter 2 inhibitors (SGLT-2I) are oral anti-diabetic drugs that have been in use for the past few years in the treatment of diabetes mellitus (DM). They reduce the reabsorption of glucose by 30–50% by inhibiting SGLT-2, which is present in the S1 segment of the renal proximal tubule and is responsible for the reabsorption of 90% of the urine glucose [1]. They can be used at any stage of DM as they provide a decrease in blood glucose levels independent of insulin levels. They provide an average drop of 0.4–1.1% in HbA1c levels and have advantages such as weight loss, drop in blood pressure, and low risk of hypoglycemia [2, 3]. In SGLT-2I users, diabetic ketoacidosis (DKA) cases with slightly increased or normal blood glucose levels are reported with increasing numbers [4–6]. Therefore, it is necessary to follow preventive approaches for DKA development when starting * Seher Kir [email protected] 1
Internal Medicine Department, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
SGLT-2I and their follow-up. In this case report, we aimed to present a difficult and long-lasting DKA case that developed after the addition of dapagliflozin to the treatment of a patient with type 1 DM and to raise awareness on this issue.
Case presentation A 40-year-old female patient was admitted to the emergency department with complaints of nausea, vomiting, loss of consciousness, fe
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