Ketoacidosis Due to Empagliflozin, a Paradigm Shift: Case Report and Review of Literature

Hernández-Quiles, Carlos; Ramírez‐Duque, Nieves; Acosta-Delgado, Domingo

doi:10.2174/1573399814666180726114044

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…Extra insulin (in users) and/or a lower intensity cool-down after intense activities may be used to reduce postexercise glucose elevations, although no treatment is needed in most cases (140). Importantly, diabetic ketoacidosis, which normally is the result of hyperglycemia and elevated ketones, may occur with euglycemia or only moderate hyperglycemia in adults with T2D taking oral sodium-glucose-co-transporter-2 inhibitors to manage blood glucose (142). Given these potential confounders, PA should only be undertaken when individuals with elevated blood glucose, even without overt ketosis, are feeling well.…”

Section: Management Of Acute and Chronic Health Complications With Pamentioning

confidence: 99%

Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine

Kanaley

Colberg

Corcoran³

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

238

153

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This consensus statement is an update of the 2010 American College of Sports Medicine position stand on exercise and type 2 diabetes. Since then, a substantial amount of research on select topics in exercise in individuals of various ages with type 2 diabetes has been published while diabetes prevalence has continued to expand worldwide. This consensus statement provides a brief summary of the current evidence and extends and updates the prior recommendations. The document has been expanded to include physical activity, a broader, more comprehensive definition of human movement than planned exercise, and reducing sedentary time. Various types of physical activity enhance health and glycemic management in people with type 2 diabetes, including flexibility and balance exercise, and the importance of each recommended type or mode are discussed. In general, the 2018 Physical Activity Guidelines for Americans apply to all individuals with type 2 diabetes, with a few exceptions and modifications. People with type 2 diabetes should engage in physical activity regularly and be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks. Any activities undertaken with acute and chronic health complications related to diabetes may require accommodations to ensure safe and effective participation. Other topics addressed are exercise timing to maximize its glucose-lowering effects and barriers to and inequities in physical activity adoption and maintenance.

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Section: Management Of Acute and Chronic Health Complications With Pamentioning

confidence: 99%

Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine

Kanaley

Colberg

Corcoran³

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

238

153

View full text Add to dashboard Cite

show abstract

“…The paradoxical increase in endogenous glucose production (EGP) is a concern, as it diminishes the efficacy of glucosuria-stimulating therapy [ 3 ]. An additional drawback of SGLT2i is the increased incidence of ketoacidosis and the emergence of rare euglycemic diabetic ketoacidosis [ [10] , [11] , [12] , [13] , [14] ]. The rise in ketone body levels results from their increased production rather than decreased renal clearance [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

SGLT2 is not expressed in pancreatic α- and β-cells, and its inhibition does not directly affect glucagon and insulin secretion in rodents and humans

Chae

Augustin

Gatineau

et al. 2020

Molecular Metabolism

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Objective Sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i), or gliflozins, are anti-diabetic drugs that lower glycemia by promoting glucosuria, but they also stimulate endogenous glucose and ketone body production. The likely causes of these metabolic responses are increased blood glucagon levels, and decreased blood insulin levels, but the mechanisms involved are hotly debated. This study verified whether or not SGLT2i affect glucagon and insulin secretion by a direct action on islet cells in three species, using multiple approaches. Methods We tested the in vivo effects of two selective SGLT2i (dapagliflozin, empagliflozin) and a SGLT1/2i (sotagliflozin) on various biological parameters (glucosuria, glycemia, glucagonemia, insulinemia) in mice. mRNA expression of SGLT2 and other glucose transporters was assessed in rat, mouse, and human FACS-purified α- and β-cells, and by analysis of two human islet cell transcriptomic datasets. Immunodetection of SGLT2 in pancreatic tissues was performed with a validated antibody. The effects of dapagliflozin, empagliflozin, and sotagliflozin on glucagon and insulin secretion were assessed using isolated rat, mouse and human islets and the in situ perfused mouse pancreas. Finally, we tested the long-term effect of SGLT2i on glucagon gene expression. Results SGLT2 inhibition in mice increased the plasma glucagon/insulin ratio in the fasted state, an effect correlated with a decline in glycemia. Gene expression analyses and immunodetections showed no SGLT2 mRNA or protein expression in rodent and human islet cells, but moderate SGLT1 mRNA expression in human α-cells. However, functional experiments on rat, mouse, and human (29 donors) islets and the in situ perfused mouse pancreas did not identify any direct effect of dapagliflozin, empagliflozin or sotagliflozin on glucagon and insulin secretion. SGLT2i did not affect glucagon gene expression in rat and human islets. Conclusions The data indicate that the SGLT2i-induced increase of the plasma glucagon/insulin ratio in vivo does not result from a direct action of the gliflozins on islet cells.

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Empagliflozin/metformin

2019

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Ketoacidosis Due to Empagliflozin, a Paradigm Shift: Case Report and Review of Literature

Abstract: DKA in patients treated with SGLT2 inhibitors can be presented as euglycemic and moderated hyperglycemia. This special presentation poses a physician's challenge.

Cited by 4 publications

References 12 publications

Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine

Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine

SGLT2 is not expressed in pancreatic α- and β-cells, and its inhibition does not directly affect glucagon and insulin secretion in rodents and humans

Empagliflozin/metformin

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