Invokana Euglycemic Dka

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Risk of Diabetic Ketoacidosis after Initiation of an SGLT2 Inhibitor Inhibitors of sodiumglucose cotransporter 2 (SGLT2) decrease plasma glucose by blocking the reabsorption of glucose at the proximal tubule.1,2 Case reports have suggested that SGLT2 inhibitors may be associated with an increased risk of diabetic ketoacidosis, which led to a warning from the Food and Drug Administration (FDA) in May 2015.3,4 The objective of our study was to assess the risk of diabetic ketoacidosis after the initiation of an SGLT2 inhibitor. https://www.youtube.com/channel/UCsqm...

Adverse Effects Of Canagliflozin, An Sglt2 Inhibitor

Adverse Effects of Canagliflozin, an SGLT2 Inhibitor Allan S. Brett, MD reviewing Peters AL et al. Diabetes Care 2015 Sep . The FDA has expressed concern about diabetic ketoacidosis and fractures in users of sodiumglucose cotransporter 2 inhibitors. The sodiumglucose cotransporter 2 (SGLT2) inhibitors (canagliflozin [Invokana], empagliflozin [Jardiance], and dapagliflozin [Farxiga]) increase urinary excretion of glucose. These drugs are approved for use in type 2 diabetes, but anecdotal reports suggest that off-label prescribing to type 1 diabetic patients is increasing. In May 2015, the FDA noted a possible association between SGLT2 inhibitors and diabetic ketoacidosis (DKA) . Now, several endocrinologists describe 13 cases of euglycemic DKA in 9 diabetic patients (7 patients with type 1, and 2 patients with type 2) who were taking canagliflozin in addition to insulin. The designation euglycemic DKA refers to presentations with anion-gap acidosis and ketosis but serum glucose levels only in the 100 to 200 mg/dL range. The absence of substantial hyperglycemia tended to delay recognition and treatment. Some of the cases were preceded by moderate alcohol intake or low intake of food Continue reading >>

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  1. obviousdscretion

    Just curious if any of the benefits of keto work if I'm eating high fat med protein but more than 20g carb/day?

  2. [deleted]

    I've been averaging about 60g carbs per day. Sometimes up to 80, sometimes as low as 20. In a month I've dropped 10 pounds (186 - 175) that wouldn't come off before even though I run and play soccer. Just switching to low carb, almost keto levels, has helped me lose weight and drop a pant size. You need to know your own body though, I've always known that carbs were my fastest way to put on weight, so cutting them back was a no brainer for me when I realized I wanted to lose weight.

  3. spanishgianni

    I did about 100 grams of carbs/day over a 4 month period. High fat. Lost 20 pounds, energy was good. And I got to eat so much fucking yogurt, I miss it so much...have to plan my day around a small bowl of Greek yogurt now, it's bullshit
    So yeah, weight loss and dairy are the benefits

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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

Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma 1Department of Internal Medicine, Memorial Hospital of Martinsville and Henry County, Martinsville, Virginia, USA, 2Texas Tech University Health Sciences Center, El Paso, Texas, USA, 3Senior Research Associate, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, 4Department of Pharmacology, St Johns Medical College, Bangalore, India, Received 2017 Jul 18; Accepted 2017 Aug 4. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License . 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 Continue reading >>

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  1. fadisaleh

    People always say that running helps you lose weight, and my understanding is that it simply helps you burn more calories, adding to your deficit, and it's as simple as that. But I wanted to see what you all thought. Especially because I'm eating at the minimum calories before losing muscle (according to keto calculator).
    When I tell keto calculator that I'm running (sedentary to lightly active) my calories are already so low that it tells me to eat more so I don't lose muscle. So I end up with the same net calories on days I run vs days I don't.
    My question is: past calories burned, how does running help you lose weight?
    My current guesses: It doesn't, if you have the same net calories. It helps keep insulin levels more stable, helping burn fat more efficiently regardless of calorie deficit (in the same sense as eating fewer carbs).

  2. FXOjafar

    Cardio is catabolic so if you're worried about losing muscle, switch to weights and limit cardio to a nice walk outside or 30s Hiit to keep Cortisol down. Muscle will help burn more fat even when you're sitting on the couch so what's not to love? :)

  3. elliebellrox

    I've only recently gotten into running and keto. I'm only losing 1 kg a week and that's regardless of whether I run or not.
    It do believe it's influencing the outline of my legs and ass though, if not helping with weight loss. Just having a bit more definition looks very different.
    Also doing cardio tells your body to increase the ventilation to your lungs so your oxygen/co2 exchange improves. That's always a nice benefit. And the lower heart rate long term... (My sauce is my lecture content but I can probably go find it in relevant physiology book if you want)
    Basically, choose an exercise you think you can maintain and make part of your lifestyle. And reap the physiological benefits that will help you look and feel better because your internal mechanics will be much improved :)

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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.

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Deepali Dixit, PharmD, BCPS, is a Clinical Assistant Professor at Ernest Mario School of Pharmacy and a Clinical Critical Care Pharmacist in the Medical Intensive Care Unit at Robert Wood Johnson University Hospital. Dr. Dixit has been involved in multiple committees and in leadership positions in regional and national pharmacy and organizations. Dr. Dixit's research interests include sedation and delirium in the critically ill, infectious disease, alcohol withdrawal syndrome, chronic obstructive pulmonary disease, and patient safety. This article was collaboratively written with Shannon Anthony, PharmD Candidate. In May 2015, the FDA issued a warning about the risk of developing diabetic ketoacidosis while using SGLT2 inhibitors. That December, the FDA updated the drugs’ labels to include warnings about developing ketoacidosis even with near-normal blood glucose levels.1 SGLT2 inhibitors lower blood glucose levels by decreasing renal glucose reabsorption, which increases urinary glucose excretion.2 Three drugs in this class are currently available in the United States: canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).1 These medications are approv Continue reading >>

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  1. Fapacwl

    After listening to the latest Tim Ferriss podcast (great listen for KETO people!) he mentioned that supplementing ketones is a great way to ease into ketosis, or create ketosis for a short period of time. I then googled ketone supplements and only saw "raspberry ketone for weight loss" which seemed sketchy. Ferris describes taking ketones as drinking jet fuel, so idk if his stuff is for the faint of heart, but I was wondering if anyone takes ketone supplements and where did they get them.
    Thanks for any advice, I am asking about this because I'm lazy and he made it seem like this is an easy way to do ketosis..
    Edit: link to podcast

  2. simsalabimbam

    Some people get caught up with all kinds of weight loss nonsense, supplementing keto salts is nonsense for weight-loss.
    Ketones don't cause weight-loss. Having ketones is the biomarker that you are:
    making glucose
    predominantly metabolising fat
    Under these conditions ketones are produced as a necessary and beneficial by-product.
    Taking keto salts or MCT oil will give you ketones without the benefits associated with nutritional ketosis. Ketone supplementation on top of a ketogenic diet is mostly useful for people with intractable epilepsy suffering dozens of seizures per day.

  3. super_toilet

    Far from expert, but the whole point of keto is that your body will burn fat and make all the ketones it needs from that fat. If you're taking ketones that meas you're body isn't burning fat to make them. These businesses aren't interested in helping you burn fat as much as they are interested in helping you burn cash.

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