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Diabetic Ketoacidosis Treatment

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Management Of Diabetic Ketoacidosis In Severe Insulin Resistance

Syndromes of severe insulin resistance (IR) include mutations of or autoantibodies to the insulin receptor and lipodystrophy (1). Diabetic ketoacidosis (DKA), although rare, can occur in these patients, even in the context of hyperinsulinemia, due to impaired insulin signaling. DKA can be extremely challenging to treat, and few clinicians are experienced or comfortable in using the high doses of insulin required. We describe aggressive management of DKA in three patients with syndromic severe IR. CASE 1 An 18-year-old man with compound heterozygous mutation of the insulin receptor presented with DKA. He had poorly controlled diabetes (A1C 14% [130 mmol/mol]) treated with U-500 insulin (1,500 units/day), metreleptin (recombinant human methionyl leptin as an experimental drug), and metformin (2 g/day). Two weeks prior, he underwent a root canal for an abscessed tooth but did not take the prescribed antibiotics. Antibiotics were subsequently initiated. One day after discharge, he developed abdominal pain, nausea, vomiting, and worsening jaw pain and swelling. Two days later, he developed fatigue, malaise, and Kussmaul respirations. He presented to an outside hospital with DKA with a p Continue reading >>

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Popular Questions

  1. Karan Sharma

    Diabetes

    Medical Conditions and Diseases

    Medicine and Healthcare



    What are the first complications of diabetes?




    1 Answer







    There are a number of complications that can develop in long term diabetics.
    One of the earliest complication that can be seen in an Undiagnosed Type I diabetic is Diabetic Ketoacidosis (DKA)[1].
    In diabetics on treatment, hypoglycaemia is also a common complication that can occur.
    Footnotes
    [1] Causes, Symptoms and Treatment of DKA

    168 Views · 1 Upvote








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