Low carbohydrate diet while taking dapagliflozin: A case report and review of literature

Paul, Namrata; Jonklaas, Jacqueline

doi:10.1016/j.dsx.2021.01.016

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…However, the human diet even with diabetes is considerably higher in simple sugar and starch (35+%) ( Gray and Threlkeld, 2019 ) than the equine on restricted metabolic syndrome diets (less than 10%). The combination of a low carbohydrate diet and SGLT2 inhibitors in humans was reported to induce diabetic ketoacidosis ( Paul and Jonklass, 2021 ) and there is also a published case of hypertriglyceridemia in a human on SGLT2 inhibitor therapy who was on a low carbohydrate diet ( Senoo et al , 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors

Kellon¹,

Gustafson²

2023

Open Vet J

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Background: Sodium-Glucose CoTransporter-2 [SGLT2] inhibitors, the -flozin group of drugs, which block glucose reuptake in the renal proximal tubule, are being increasingly used off-label to treat horses with refractory hyperinsulinemia. After two years of use by animals in our group, a horse on canagliflozin was incidentally noted to be hyperlipemic. Case Description: We have been following a cohort of equines (n=20) treated with SGLT2 inhibitors due to refractory hyperinsulinemia. The animals are owned by members of the Equine Cushing’s and Insulin Resistance Group (ECIR) and treated by their attending veterinarians. The index case was a 23 year old gelding with a 2 year history of recurring laminitis that began canagliflozin therapy to control hyperinsulinemia which was no longer responsive to metformin. Between 6-10 weeks post therapy, significant weight loss was noticed. Two days later he was hospitalized with colic symptoms and hyperlipemia but was bright, alert and eating well throughout. Canagliflozin was discontinued and triglycerides returned to normal reference values within 10 days. Subsequent study of 19 other horses on SGLT2 inhibitors revealed varying degrees of hypertriglyceridemia, all asymptomatic. Conclusion: While this class of drugs holds great promise for cases of refractory hyperinsulinemia and laminitis that do not respond to diet or metformin therapy, hypertriglyceridemia is a potential side effect. In our experience, animals remained asymptomatic and eating well. Further study of hypertriglyceridemia in horses on SGLT2 inhibitors and the possible mitigating effect of diet is indicated. To our knowledge, this is the first published report of hypertriglyceridemia with SGLT2 inhibitor treatment in equines.

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Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors

Kellon¹,

Gustafson²

2023

Open Vet J

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“…It is important that ketone formation is affected by many factors including low insulin/glucagon ratio, dietary carbohydrate content and stressful event promoting catabolism. There is a high risk of developing ketosis with a low-carbohydrate diet 26 and a state of acute stress that can promote ketone production under SGLT2i. 3,4 Although this study showed no apparent correlation between carbohydrate intake and ketone levels before and after starting SGLT2is, the risks of lowcarbohydrate diets were not examined at all and need to be well explained and precautions taken before starting SGLT2is.…”

Section: Discussionmentioning

confidence: 99%

Younger patients and low c‐peptide immunoreactivity index but not nutritional states affect fasting blood ketone levels in Japanese with type 1 diabetes after sodium‐glucose cotransporter 2 inhibitor administration

Nakajima,

Okada,

Yoshimura

et al. 2023

Diabetes Obesity Metabolism

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AimSodium‐glucose cotransporter 2 inhibitors (SGLT2is) are available for individuals with type 1 diabetes, but appropriate use is recommended to prevent ketosis or ketoacidosis. This study aimed to evaluate the risk of ketosis in people with type 1 diabetes, focusing on the relationship between nutritional assessment, glycaemic status, c‐peptide immunoreactivity (CPR) index and body composition.Materials and MethodsIn total, 46 Japanese patients with type 1 diabetes were included, and dietary assessment from food photographs and ketone levels were evaluated before and after taking SGLT2is. The effect of diet on morning ketone levels was also investigated.ResultsAll patients had an increase in mean ketone concentrations after taking SGLT2is (before 0.12 ± 0.06 mmol/L, after 0.23 ± 0.16 mmol/L). A significant negative correlation was found between average morning ketone levels and age (r = −0.514, p < .001) and the CPR index (r = −0.523, p = .038) after taking SGLT2is. Using a mixed‐effects model based on the results before starting the inhibitors, it was noted that both patient‐to‐patient and age, or patient‐to‐patient and capacity of insulin secretion, influenced the ketone levels. Multiple regression analysis showed that factors associated with the risk of increasing ketone levels after taking SGLT2is were younger age (β = −0.504, p = .003) and a low ratio of basal to bolus insulin (β = −0.420, p = .005).ConclusionsWhen administering SGLT2is to patients with a low CPR index or younger patients with type 1 diabetes, adequate instructions to prevent ketosis should be given.

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Dapagliflozin/metformin/semaglutide

2023

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Low carbohydrate diet while taking dapagliflozin: A case report and review of literature

Cited by 3 publications

References 6 publications

Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors

Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors

Younger patients and low c‐peptide immunoreactivity index but not nutritional states affect fasting blood ketone levels in Japanese with type 1 diabetes after sodium‐glucose cotransporter 2 inhibitor administration

Dapagliflozin/metformin/semaglutide

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