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Euglycemic Dka

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Euglycemic Diabetic Ketoacidosis: A Potential Complication Of Treatment With Sodiumglucose Cotransporter 2 Inhibition

Objective Sodiumglucose cotransporter 2 (SGLT-2) inhibitors are the most recently approved antihyperglycemic medications. We sought to describe their association with euglycemic diabetic ketoacidosis (euDKA) in hopes that it will enhance recognition of this potentially life-threatening complication. Research Design and Methods Cases identified incidentally are described. Results We identified 13 episodes of SGLT-2 inhibitorassociated euDKA or ketosis in nine individuals, seven with type 1 diabetes and two with type 2 diabetes, from various practices across the U.S. The absence of significant hyperglycemia in these patients delayed recognition of the emergent nature of the problem by patients and providers. Conclusions SGLT-2 inhibitors seem to be associated with euglycemic DKA and ketosis, perhaps as a consequence of their noninsulin-dependent glucose clearance, hyperglucagonemia, and volume depletion. Patients with type 1 or type 2 diabetes who experience nausea, vomiting, or malaise or develop a metabolic acidosis in the setting of SGLT-2 inhibitor therapy should be promptly evaluated for the presence of urine and/or serum ketones. SGLT-2 inhibitors should only be used with grea Continue reading >>

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  1. iderpthereforeiherp

    Hi Keto-ers, i'm in ketosis, have been back in it for 3 weeks after a break for a vacation, and quite frankly i effing love this diet :)
    however today i slept in for work, and didn't have breakfast or make a lunch, yet i have had no hunger pains, been drinking my 500ml water per hour and just had a pepperami and a babybel.
    one of my friends is telling me how my metabolism must be overly slow for me not to have a hunger pang... and that this means if i have a kebab or anything like that it will show pretty quickly.
    how can i defend this diet of the gods??
    thanks!

  2. Casao

    General public perception of "slowing your metabolism" or "going into starvation mode" is bullshit, that is the #1 thing to keep in mind.
    In most people, the metabolism does not substantially change until around 1 week of fasting. You can skip meals, load up on meals, whatever you want - your metabolism will not slow down.
    What's happening here is you're solidly in ketosis. The current trend is to get your energy from carbohydrates, becoming glucose in the blood (blood sugar) and powering things that way. Glucose is short lived in a working body, which means that you'll get a burst of energy, and then it will go away. This is why you feel a sugar crash sometimes, and why people recommend eating 5 small meals instead of 3 big ones. As a result of this, your body will release horomones triggering hunger as your blood sugar drops.
    In a state of ketosis, your body is burning fat and releasing ketones. Once you've adapted to using ketones as your primary form of energy (I believe I've seen 2-3 weeks quoted for this), your body has a constant supply of ready energy, as it can burn fat as long as you have some. In this case, your body does not need to eat as much, and will release the hunger horomone less often. As long as you're getting the nutrients you need (which come from meats and vegetables much more easily than grains), you don't need to worry about forcing yourself to eat if you're not hungry.
    tl;dr: Your body is currently an efficient fat-burning machine, and that's why you're not hungry.

  3. iderpthereforeiherp

    thanks for the replies! my next question... the little amount i eat, is this dangerous in terms of slowing down weightloss? i always thought i should always have a breakfast? but i find myself forcing myself to eat it.

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Euglycemic Diabetic Ketoacidosis: A Diagnostic And Therapeutic Dilemma

Prashanth Rawla1, Anantha R Vellipuram2, Sathyajit S Bandaru3 and Jeffrey Pradeep Raj4[1] Department of Internal Medicine, Memorial Hospital of Martinsville and Henry County, Martinsville, Virginia, USA [2] Texas Tech University Health Sciences Center, El Paso, Texas, USA [3] Senior Research Associate, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA [4] Department of Pharmacology, St John’s Medical College, Bangalore, India Summary Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus, a high clinical suspicion is warranted, and other diagnosis ruled out. Here, we present two patients on regular insulin treatment who were admitted with a diagnosis of EDKA. The first patient had insulin pump failure and the second patient had urinary tract infection and nausea, thereby resulting in starvation. Both of them were aggressively treated with intravenous fluids and insulin drip as per the protocol for the blood gluco Continue reading >>

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  1. atcgirl

    I started 5:2 in september and initially tried to spread my 500 calories accross the day, but I lost no weight and couldn’t cope with the hunger pangs. Then I started just having all my 500 calories at dinner, with zero calories during the day (just a green tea in the morning for the caffeine), and I started losing a pound a week. I figure that my body needed to go into ketosis to actually shift the pounds.
    I am sick of green tea, I actually hate it. Black coffee isn’t an option because it gives me bad breath, so I’m going to need to go back to black tea with milk (no sugar). I figure semi skimmed is better than skimmed because having more fat in it leave less room for lactose and I only have a splash of milk, but will this bring me out of ketosis for any significant period?
    I know that my body will use some of the lactose as energy, I figure it can’t be for that long, but it’s going to try and do that as efficiently as possible; I don’t know enough about the science behind all this.
    Body building forums state all sorts of numbers from 10 calories to 50 and most of my googling has been fruitless. Anyone know?
    Thanks

  2. Pot-bellied Heron

    My understanding is that you won’t get into ketosis on the 5:2 though I haven’t really looked into it.

  3. atcgirl

    Some sites I’ve read suggest ketosis starts 8 to 12 hours after your last meal, others suggest it’s actually much longer – 48 hours. Which had me confused anyway.
    Normally i’d just experiment but I have a month until my love handles need to not show under my wedding dress and would prefer not to delay further weightloss
    It’s so little milk I have to believe it won’t make a difference! Also hoping it won’t affect IGF-1 levels but I think lots of people on here have already proved that it doesn’t because their levels have dropped even though they spread the calories out during the day.

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Susan Cornell, PharmD, CDE, FAPhA, FAADE, describes the risks for ketoacidosis and serious urinary tract infection associated with use of SGLT2 inhibitors. This video was recorded at APhA's 2016 Annual Meeting and Exposition in Baltimore, Maryland.

Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, And Preventable Safety Concern With Sglt2 Inhibitors

The Case At Hand Recently, the U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication that warns of an increased risk of diabetic ketoacidosis (DKA) with uncharacteristically mild to moderate glucose elevations (euglycemic DKA [euDKA]) associated with the use of all the approved sodium–glucose cotransporter 2 (SGLT2) inhibitors (1). This Communication was based on 20 clinical cases requiring hospitalization captured between March 2013 and June 2014 in the FDA Adverse Event Reporting System database. The scarce clinical data provided suggested that most of the DKA cases were reported in patients with type 2 diabetes (T2D), for whom this class of agents is indicated; most likely, however, they were insulin-treated patients, some with type 1 diabetes (T1D). The FDA also identified potential triggering factors such as intercurrent illness, reduced food and fluid intake, reduced insulin doses, and history of alcohol intake. The following month, at the request of the European Commission, the European Medicines Agency (EMA) announced on 12 June 2015 that the Pharmacovigilance Risk Assessment Committee has started a review of all of the three approved SGLT2 inhibitors Continue reading >>

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  1. BruisedxEm0ti0ns

    What are the dos and don'ts of a Keto Pregnancy?

  2. sellyberry

    DO:
    Drink water and get the salts, you'll be peeing a lot, stay hydrated and get electrolytes. You'll know you aren't if you get leg cramps at night.
    Eat what you crave. Maybe not a whole tin of cashews in one sitting, but if you're craving something there is probably a reason for it. Here is a handy chart
    Eat a serving of dates each day in the 3rd trimester. This one is backed by some science and personal experience. Not only are they fibrous they are sweet enough to stave off other cravings of sweets (not real pregnancy cravings, but I could eat a house kind of cravings) and delicious! I also used them to gross out my husband because the big tub I bought looked a bit like candied cockroaches...
    Don't:
    Don't try to eat a caloric deficit. You are not trying to lose weight right now, you are trying to not gain too much weight, and you're growing another person while you do it. If you have morning sickness and can only keep down oyster crackers and ginger ale then DO IT!
    If you are eating plenty and are just not hungry then that's fine, but don't go hungry, and don't worry about gaining weight. It's one of the few times in your life it's not only acceptable, but also healthy and expected.
    Don't worry about the rate at which you gain (or don't gain) you may read that you should be gaining at a certain rate, but it's an average. To gain 25 pounds in 9 months you need to gain 2.77777 pounds per month.... but that isn't how it works. You might actually lose weight in the beginning and then gain 15, but then stall out for 3 months, and then gain 5 pounds in week 37.
    Don't worry about losing weight until you're 2 months PP. Don't 'diet'. Just rest, heal, enjoy your new baby. Try to remember to eat!!! If you're breastfeeding and eating 2,000 calories a day it's more like 1,500, because that milk is calories leaving your body.

  3. Bancer705

    Thank you for asking this question. We just recently started trying for our first baby, and I plan on staying on keto throughout when I do get pregnant.
    Hope we get some responses... :-)

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