We are reporting a timely case of atypical euglycemic diabetic ketoacidosis in a type 1 diabetic patient treated with sodium-glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin. The clinical history, physical examination findings and laboratory values are described. Other causes of acidosis such as salicylate toxicity or alcohol intoxication were excluded. Ketoacidosis resolved after increasing dextrose and insulin doses supporting the hypothesis that SGLT-2 inhibitors may lead to hypoinsulinemia. Euglycemic ketoacidosis did not recur in our patient after discontinuing canagliflozin. We recommend reserving SGLT2 inhibitor therapy to type 2 diabetics, discontinuing medication and treating patients presenting with ketoacidosis due to SGLT-2 inhibitors with higher concentrations of dextrose with appropriate doses of insulin to help resolve acidosis.
Background Diabetes affects many people across the world. Diabetes education plays a critical role in helping people with diabetes to perform diabetes self-management at home. Intervention We explored whether serious games can be used as a supplementary tool for diabetes education. Two online video games- the “Diabetic Dog” game and “Carb Counting with Lenny the Lion” game, were used for the study. Methods Fourteen patients with Type II diabetes were recruited from the Norman Diabetes Center by personal invitations. After initial training, the patients played the games a minimum of four times per week during the two-week study duration. Pre- and post-assessments of patients' diabetes knowledge and self-efficacy in diabetes self-management behaviors were performed using questionnaires, and an interview was conducted at the end to gauge the effectiveness of the game intervention. Results The results from the questionnaires show a general trend of improvement in patient diabetes knowledge and self-efficacy in diabetes self-management. A general trend of improvements in patients’ self-efficacy in controlling blood sugar level, handling abnormal blood sugar levels, taking insulin, and complying with a diabetes diet was observed. The interview results showed that the patients reinforced their diabetes knowledge and became more aware of their own lifestyles by playing diabetes educational games. They perceived the games as fun and easy to play. They also provided suggestions for the game design for diabetes education. Conclusion The study showed that serious game intervention had good potential to be a useful supplement to clinic-based diabetes education in improving patient diabetes knowledge and increasing patient self-efficacy in diabetes self-management behavior.
IMPORTANCEIntense interest exists in novel ω-3 formulations with high bioavailability to reduce blood triglyceride (TG) levels. OBJECTIVE To determine the phase 3 efficacy and safety of a naturally derived krill oil with eicosapentaenoic acid and docosahexaenoic acid as both phospholipid esters (PLs) and free fatty acids (FFAs) (ω-3-PL/FFA [CaPre]), measured by fasting TG levels and other lipid parameters in severe hypertriglyceridemia. DESIGN, SETTING, AND PARTICIPANTS This study pooled the results of 2 identical randomized, double-blind, placebo-controlled trials.
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A 67-year-old female taking Nivolumab for melanoma developed a hyperglycemic emergency requiring hospital admission. She was referred to our endocrinology clinic post-discharge where she was diagnosed with new-onset Type 1 diabetes mellitus. Severe hyperglycemia and immune-mediated diabetes mellitus are extremely rare but potentially life-threatening side effects of Nivolumab.
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