DIABETIC KETOACIDOSIS FOLLOWING SGLT2 INHIBITOR THERAPY IN DM2
AACE ePoster Library. Chaudhry F. 05/14/15; 97736; 203
Dr. Foiqa Chaudhry
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Abstract
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OBJECTIVES: To describe two cases of diabetic ketoacidosis developing after utilization of SGLT2 inhibitor therapy in patients with pre-existing DM2.
CASE DESCRIPTION:
An 18 year old female, with history DM2 and no previous DKA episodes, presented with persistent vomiting and abdominal pain occurring within the preceeding 24 hrs. She had a diagnosis of DM2 since age 8 with negative antibodies and had never been on insulin. She was taking metformin 1g BID and canagliflozin was initiated three weeks earlier. She was advised to increase the dose from 100mg to 300mg one week prior to admission when seen by PCP. She had also recently been treated for vaginitis and had completed a course of flagyl. She was afebrile, normotensive, tachypneic and tachycardic. BMI was 31 kg/m2. She appeared lethargic with dry mucous membranes, had mild abdominal tenderness and normal pelvic exam. Labs notable for A1c of 12.9%, glucose 300 mg/dL, positive urinary ketones, leukocytosis, serum bicarbonate 5 mmol/L (22-30 mmol/L) and ABG pH 6.95. She was treated with insulin drip and aggressive IVF; no focus of infection was found. She was discharged on basal bolus insulin regimen and advised to continue metformin.
A 55 year old male diagnosed with DM2 at age 49 with most recent A1c of 12.1% presented with dizziness and near syncope while working in his yard. He had been taking metformin 1g bid and glipizide XR 5mg daily for the past 3 months and dapagliflozin 5mg daily was added one month earlier. He was afebrile with BP 102/66 and HR 102. His BMI was 21.7 kg/m2 and physical exam was unremarkable. Labs notable for serum glucose 344 mg/dL, positive serum ketones and AG of 16. Neuroimaging was negative for any acute pathology. He was treated for mild DKA and ultimately discharged on basal insulin with metformin.
DISCUSSION
SGLT2 inhibitors are a new class of diabetes medications affecting the renal handling of glucose and approved for use in DM2. Beneficial affects of A1c lowering as well as modest weight loss and improvement in BP is noted via the glycosuric affect. In our two cases however, it is concerning if an excessive degree of dehydration while on this class of medications was partly responsible for the development of DKA. Furthermore, safety of re-initiating SGLT2 therapy after an episode of DKA warrants further study.
CASE DESCRIPTION:
An 18 year old female, with history DM2 and no previous DKA episodes, presented with persistent vomiting and abdominal pain occurring within the preceeding 24 hrs. She had a diagnosis of DM2 since age 8 with negative antibodies and had never been on insulin. She was taking metformin 1g BID and canagliflozin was initiated three weeks earlier. She was advised to increase the dose from 100mg to 300mg one week prior to admission when seen by PCP. She had also recently been treated for vaginitis and had completed a course of flagyl. She was afebrile, normotensive, tachypneic and tachycardic. BMI was 31 kg/m2. She appeared lethargic with dry mucous membranes, had mild abdominal tenderness and normal pelvic exam. Labs notable for A1c of 12.9%, glucose 300 mg/dL, positive urinary ketones, leukocytosis, serum bicarbonate 5 mmol/L (22-30 mmol/L) and ABG pH 6.95. She was treated with insulin drip and aggressive IVF; no focus of infection was found. She was discharged on basal bolus insulin regimen and advised to continue metformin.
A 55 year old male diagnosed with DM2 at age 49 with most recent A1c of 12.1% presented with dizziness and near syncope while working in his yard. He had been taking metformin 1g bid and glipizide XR 5mg daily for the past 3 months and dapagliflozin 5mg daily was added one month earlier. He was afebrile with BP 102/66 and HR 102. His BMI was 21.7 kg/m2 and physical exam was unremarkable. Labs notable for serum glucose 344 mg/dL, positive serum ketones and AG of 16. Neuroimaging was negative for any acute pathology. He was treated for mild DKA and ultimately discharged on basal insulin with metformin.
DISCUSSION
SGLT2 inhibitors are a new class of diabetes medications affecting the renal handling of glucose and approved for use in DM2. Beneficial affects of A1c lowering as well as modest weight loss and improvement in BP is noted via the glycosuric affect. In our two cases however, it is concerning if an excessive degree of dehydration while on this class of medications was partly responsible for the development of DKA. Furthermore, safety of re-initiating SGLT2 therapy after an episode of DKA warrants further study.
OBJECTIVES: To describe two cases of diabetic ketoacidosis developing after utilization of SGLT2 inhibitor therapy in patients with pre-existing DM2.
CASE DESCRIPTION:
An 18 year old female, with history DM2 and no previous DKA episodes, presented with persistent vomiting and abdominal pain occurring within the preceeding 24 hrs. She had a diagnosis of DM2 since age 8 with negative antibodies and had never been on insulin. She was taking metformin 1g BID and canagliflozin was initiated three weeks earlier. She was advised to increase the dose from 100mg to 300mg one week prior to admission when seen by PCP. She had also recently been treated for vaginitis and had completed a course of flagyl. She was afebrile, normotensive, tachypneic and tachycardic. BMI was 31 kg/m2. She appeared lethargic with dry mucous membranes, had mild abdominal tenderness and normal pelvic exam. Labs notable for A1c of 12.9%, glucose 300 mg/dL, positive urinary ketones, leukocytosis, serum bicarbonate 5 mmol/L (22-30 mmol/L) and ABG pH 6.95. She was treated with insulin drip and aggressive IVF; no focus of infection was found. She was discharged on basal bolus insulin regimen and advised to continue metformin.
A 55 year old male diagnosed with DM2 at age 49 with most recent A1c of 12.1% presented with dizziness and near syncope while working in his yard. He had been taking metformin 1g bid and glipizide XR 5mg daily for the past 3 months and dapagliflozin 5mg daily was added one month earlier. He was afebrile with BP 102/66 and HR 102. His BMI was 21.7 kg/m2 and physical exam was unremarkable. Labs notable for serum glucose 344 mg/dL, positive serum ketones and AG of 16. Neuroimaging was negative for any acute pathology. He was treated for mild DKA and ultimately discharged on basal insulin with metformin.
DISCUSSION
SGLT2 inhibitors are a new class of diabetes medications affecting the renal handling of glucose and approved for use in DM2. Beneficial affects of A1c lowering as well as modest weight loss and improvement in BP is noted via the glycosuric affect. In our two cases however, it is concerning if an excessive degree of dehydration while on this class of medications was partly responsible for the development of DKA. Furthermore, safety of re-initiating SGLT2 therapy after an episode of DKA warrants further study.
CASE DESCRIPTION:
An 18 year old female, with history DM2 and no previous DKA episodes, presented with persistent vomiting and abdominal pain occurring within the preceeding 24 hrs. She had a diagnosis of DM2 since age 8 with negative antibodies and had never been on insulin. She was taking metformin 1g BID and canagliflozin was initiated three weeks earlier. She was advised to increase the dose from 100mg to 300mg one week prior to admission when seen by PCP. She had also recently been treated for vaginitis and had completed a course of flagyl. She was afebrile, normotensive, tachypneic and tachycardic. BMI was 31 kg/m2. She appeared lethargic with dry mucous membranes, had mild abdominal tenderness and normal pelvic exam. Labs notable for A1c of 12.9%, glucose 300 mg/dL, positive urinary ketones, leukocytosis, serum bicarbonate 5 mmol/L (22-30 mmol/L) and ABG pH 6.95. She was treated with insulin drip and aggressive IVF; no focus of infection was found. She was discharged on basal bolus insulin regimen and advised to continue metformin.
A 55 year old male diagnosed with DM2 at age 49 with most recent A1c of 12.1% presented with dizziness and near syncope while working in his yard. He had been taking metformin 1g bid and glipizide XR 5mg daily for the past 3 months and dapagliflozin 5mg daily was added one month earlier. He was afebrile with BP 102/66 and HR 102. His BMI was 21.7 kg/m2 and physical exam was unremarkable. Labs notable for serum glucose 344 mg/dL, positive serum ketones and AG of 16. Neuroimaging was negative for any acute pathology. He was treated for mild DKA and ultimately discharged on basal insulin with metformin.
DISCUSSION
SGLT2 inhibitors are a new class of diabetes medications affecting the renal handling of glucose and approved for use in DM2. Beneficial affects of A1c lowering as well as modest weight loss and improvement in BP is noted via the glycosuric affect. In our two cases however, it is concerning if an excessive degree of dehydration while on this class of medications was partly responsible for the development of DKA. Furthermore, safety of re-initiating SGLT2 therapy after an episode of DKA warrants further study.
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