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Euglycaemic Diabetic Ketoacidosis In A Patient With Type 2 Diabetes Started On Empagliflozin

Euglycaemic diabetic ketoacidosis in a patient with type 2 diabetes started on empagliflozin 1Aga Khan University, Karachi, Sindh, Pakistan 2Department of Endocrinology, The Aga Khan University Hospital, Karachi, Sindh, Pakistan Correspondence to Dr Owais Rashid, owais.rashid{at}aku.edu Diabetes ketoacidosis (DKA) is largely associated with type 1 diabetes and has hyperglycaemia as a cardinal feature. We discuss the case of a 42-year-old man, a patient with type 2 diabetes, who presented to the emergency room, with nausea, vomiting and abdominal pain. He had recently changed his diabetes medications and started on an SGLT2 inhibitor (empagliflozin) along with metformin, pioglitazone, liraglutide and self-adjusted exogenous insulin. DKA was suspected in the wake of clinical examination and lab findings but glucose levels were below the cut-off for DKA; therefore, he was diagnosed with euglycaemic DKA. He was successfully managed with intravenous hydration and insulin infusion. We discuss the link of SGLT2 inhibitors with DKA and the pathophysiology behind euglycaemic DKA. The full text of all Editor's Choice articles and summaries of every article are free without registration The Continue reading >>

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  1. Kodah007

    I'm new here and may be too late for this discussion. Our 8 year old husky was in diabetic ketoacidosis 4 days ago. 3 nights on fluid at vet, started insulin, steroids and pain meds. She cannot walk on her own, like her hind legs are totally numb. She's also been going potty on herself at vet. I'm really worried she won't get better and I don't have the time to be carrying her around and/or cleaning up messes. How long can I expect this yo last? Do all dogs recover?

  2. k9diabetes

    I decided to copy your question to a thread of your own... so sorry such a scary experience brings you here.
    If she can get past the ketoacidosis, whatever leg problems and incontinence coming from neuropathy should gradually diminish with better blood sugar.
    Most dogs I've seen have fully recovered from neuropathy. Sometimes a dog has other spinal issues also involved and in those cases the problems associated with neuropathy go away so things get better.
    So, yes, chances are very good she can get back to normal. Beaming her Get Well wishes.... hang in there.

  3. Rubytuesday

    Hi there,
    If the sole cause of weakness in the backend is diabetic neuropathy, and it could well be, they can recover and go on to be healthy diabetics. Surviving diabetic ketoacidosis can take quite a toll on them and I would not judge her condition now as long as she isn't suffering. weakness isn't a lot of fun for either of you but they can get back to normal.
    I will attach some info about a key role a specific form of B-12 (methylcobalimin) plays in recovery.
    Many dogs here have struggled with hind end weakness. Has the B-12 helped in these cases? I don't know, but it hasn't hurt.
    The single most important thing you can do now is to find the best dose to manage her diabetes. This can be a trying process. To tell the truth this was the best place I found for getting the best information about how to go about that. My dog wasn't an easy diabetic and frankly my vets didn't know what to do to make our situation better. Folks here helped us tremendously. The collective knowledge and creativity was a godsend.
    I found that I couldn't rely on just the guidance from my vet and some stories I have heard have been downright scary. The best advice I can give is read a lot from the home page and threads, ask a bunch of questions and if at all possible give home testing a try. Doing your own home testing not only saves you money and keeps your dog safe, but it will help you progess through the regulation process a bit quicker.
    I will go grab the home page link for you and the b-12 info. Just don't want to lose this post. The ipad sometimes doesn't like me switching around.

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Diluting Your Sugar | Sinaiem

By Jeff Nusbaum | Pearl of the Day | Comments are Closed | 15 August, 2016 | 0 Last week, we closed out the week by discussing the dischargable, benign sugars, but what about when you have the legit sugars. Were talking about DKA. While the algorithm for DKA is fairly straight forward fluids, insulin, replete lytes prn, admit / ICU consult, there are some often under appreciated subtleties we neglect in the ED. Lets start with fluid choice. Most clinicians empirically start volume resuscitation with 0.9% saline or normal saline. As weve all heard, there is very little truly normal about normal saline. Specifically in the context of DKA, one should worry about giving an acidic solution (with a pH of ~5.5) to an already acidotic patient. Other, perhaps more savvy clinicians reach for isolyte / plasmalyte. With a more physiologic pH, logically this makes sense, however one must be weary of giving potassium to a patient population that is typically hyperkalemic (often due to normal fluid shifts of acid base balance). So lets review some of the most commonly used ED fluids: This is clearly a complicated question, so what do the experts do. Uptodate recommends resuscitation with 0.9% sa Continue reading >>

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  1. Lauraa83

    The ones you use on the atkins diet?

  2. Mummyvicky

    I asked at Boots Pharmacy for a friend who was doing it, it was about £4 for 50 strips.

  3. Normsnockers

    Message withdrawn

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Management Of Diabetic Ketoacidosis In Adults

Management of diabetic ketoacidosis in adults Management of diabetic ketoacidosis in adults Insulin (blue dots) promotes glucose uptake in the liver and muscles, controlling blood sugar. Feeding/transition to subcutaneous insulin The first mealtime after the acidosis has resolved and the patient feels that he or she can tolerate food is the time to begin feeding the patient. Subcutaneous insulin should be started simultaneously. Dosing of subcutaneous insulin is given in basal/bolus fashion calculated first as total daily dose (TDD), which is based on insulin therapy the patient received at home prior to losing control. Alternatively, TDD may be estimated at 0.5 to 0.8 units/kg/day in an individual who has not previously been treated with insulin.3 Total daily insulin requirements may be significantly elevated for a few days following the resolution of DKA due to persistently elevated counter-regulatory hormone concentrations. These elevations predispose the patient to going back into acidosis if insulin levels are inadequate or stress levels increase further. Basal/bolus insulin therapy is generally broken down into long- and short-acting insulin as 50% basal and 50% bolus spread Continue reading >>

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  1. GaresTaylan

    My first 2 weeks on Keto.

    Hey everyone. Just finished my carb up after the 2nd week of keto. The first week, I lost 4.7lbs (which I figured a lot of was water weight). I came down with a cold my 3rd day in, so exercise was rather limited.
    I have not strayed from my diet a single time. I have been at a -700 calorie deficit; 1 gallon of water or slightly less per day; and I have been very strict at staying around 65/30/5. I use fitday to track everything, and I weigh and measure *everything.*
    On my 2nd week, I lost a whopping .4lbs. By default, at a deficit, shouldnt I have lost at LEAST another 1lb? Something doesnt seem right. Now, I will admit, I normally weigh on Sunday but since I would be carbing up I weighed Friday night before I started my carb up.
    -Fats/proteins include: Sausage, bacon, pepperoni, cheese, steak, chicken, almonds, natural pb, hot dogs (minimal), ranch dressing
    -Carbs include: Cheese, natural pb, almonds, broc****, green beans, bell pepper, romaine lettuce
    During my 2nd week, I had 3 weight training days (Mon/Weds/Fri) and 3 cardio days (Sun/Tues/Fri). On Thurs and Friday, I did weights and cardio both. Saturday was my rest day since I figured I would feel bad.
    Can anyone see what I am doing wrong? I will admit, I could have had a few more veggies in there per day. I would average about 1-1.5 cups of veggies per day. My carbs have never been over 25g and usually around 15-20g. Is it a fluke because I weighed in so late in the day? I tested myself twice with ketostix, and I had traces each time.

  2. anabolicangel

    From a diet standpoint, you might still be holding onto some water since some of the foods you have listed contain a lot of sodium (hot dogs, cheese, pepperoni, bacon, sausage, etc), and if these make up the majority of your daily intake that could possibly cause some water retention... thus, making you look like you're holding onto weight.
    Also, sometimes peanut butter can be a problem for people on keto... there have been those that said when they drop it altogether, weight loss begins again.
    More importantly, you should pay more attention to your measurements/mirror/clothes to see your progress. The scale may not show a loss for weeks but you'll be losing fat and thus, your measurements will go down, you'll see more definition, and your clothes will fit better.
    You're only two weeks in... don't get hung up on it unless it continues to be a problem and the indicators mentioned above aren't yielding positive results.
    Good luck!

  3. rbdwarf

    The late weighing is almost definitely a factor. Try to weigh yourself in the morning after you hit the bathroom but before breakfast - that will give you the truest indication. If you weigh yourself at the end of the day you have a variable amount of food and water in your system.

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