Diabetic euglycemic ketoacidosis in newly diagnosed type 1 diabetes mellitus during Ramadan fasting

Baş, Veysel Nijat; Uytun, Salih; Torun, Yasemin Altuner

doi:10.1515/jpem-2013-0497

Cited by 18 publications

(8 citation statements)

References 9 publications

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“…Although the majority of patients present with plasma glucose levels > 250 mg/dL, some patients exhibit only mild elevations in plasma glucose levels (termed ‘euglycemic DKA’) 80 . This phenomenon has been reported during pregnancy, in patients with prolonged starvation, alcohol intake, pregnancy, partially treated patients receiving insulin, and more recently in the setting of SGLT-2 inhibitor use 59,81,82 .…”

Section: Diagnosis Of Dkamentioning

confidence: 72%

Management of Hyperglycemic Crises

Fayfman

Pasquel

Umpiérrez

2017

Medical Clinics of North America

171

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Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most serious and life-threatening hyperglycemic emergencies in diabetes. DKA is more common in young people with type 1 diabetes and HHS in adult and elderly patients with type 2 diabetes. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Both are characterized by insulinopenia and severe hyperglycemia. Early diagnosis and management are paramount. Treatment is aggressive rehydration, insulin therapy, electrolyte replacement, and treatment of underlying precipitating events. This article reviews the epidemiology, pathogenesis, diagnosis, and management of hyperglycemic emergencies.

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Section: Diagnosis Of Dkamentioning

confidence: 72%

Management of Hyperglycemic Crises

Fayfman

Pasquel

Umpiérrez

2017

Medical Clinics of North America

171

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“…Bas VN et al case emphasizes the importance of evaluation of acid–base state, urine glucose, and ketone values in all type 1 diabetic patients during Ramadan. [18]. Another case of DKA during Ramadan was reported Friedrich I et al who concluded that omitting doses during fasting as well as dehydration predispose patients to develop DKA.…”

Section: Discussionmentioning

confidence: 99%

A prospective multi-country observational trial to compare the incidences of diabetic ketoacidosis in the month of Ramadan, the preceding month, and the following month (DKAR international)

Abdelgadir

Hassanein

Bashier

et al. 2016

J Diabetes Metab Disord

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Background1.7 billion Muslims worldwide obey divine commands of fasting for a month. This may increase the probability of the acute complications of diabetes during the fasting period.Design and methodsWe primarily aimed to compare the incidences and duration of Diabetic ketoacidosis (DKA) admissions during Ramadan compared to the month before (Shaaban) and the month after (Shawal) as well as the average pre-Ramadan six months' admissions. Our secondary objective was to assess the different incidence of DKA between Ramadan and the other months regarding precipitating factors, fasting practices in people admitted with DKA and gender differences.This was a prospective study that included all Muslims who were admitted with DKA to major hospitals in the United Arab Emirates, Sudan, Tunisia and Morocco during the pre-Ramadan month, Ramadan and post-Ramadan month, in addition to the average monthly admissions during the last six months before Ramadan. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points.ResultsOne hundred seventy patients were admitted during the study duration, 56 were admitted during Ramadan and 63 in Shawal. Six months before Ramadan showed an average admission of 56 + 7 per month. All those admitted during Ramadan were people with type1 diabetes. 29.8 % of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Non-compliance to medications represented the commonest cause for admission in the whole study period. Hospital stay was comparable through different months, but the duration of acidosis was longest during Ramadan month.ConclusionIn concordance with DKAR1, DKAR international showed higher rates of DKA during Ramadan when compared to preceding Lunar month (Shaaban). In Shawal, however, the rates of DKA admission were higher than the average monthly DKA admissions. The duration of acidosis was longer in Ramadan group and positively correlated with duration of diabetes. Many patients did not receive structured education about diabetes and fasting Ramadan. Our study calls for formal pre-Ramadan education and enforces the need for advice against fasting in patients who already experienced DKA in the months preceding Ramadan.

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“…Cocaine use, pancreatitis, pregnancy, and Ramadan fasting had previously been suspected as contributing to EDK etiology [9][10][11][12]. Recently, data concerning SGLT-2 inhibitors suggest EDK occurs in both type-1 and type-2 diabetes patients with the concomitant use of these drugs.…”

Section: Discussionmentioning

confidence: 99%