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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.

Ketosis And Diabetic Ketoacidosis In Response To Sglt2 Inhibitors: Basic Mechanisms And Therapeutic Perspectives

Probing SGLT2 as a therapeutic target for diabetes: Basic physiology and consequences The mechanisms and therapeutic potential of SGLT2 inhibitors in diabetes mellitus Lowering Plasma Glucose Concentration by Inhibiting Renal SodiumGlucose CoTransport SGLT2 inhibitors in the treatment of type 2 diabetes Pharmacodynamics, efficacy and safety of sodiumglucose cotransporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus Renal hemodynamic effect of sodiumglucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus Sodiumglucose cotransporter 2 inhibition and glycemic control in type 1 diabetes: Results of an 8week openlabel proofofconcept trial SGLT2 inhibitors may predispose to ketoacidosis Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes Empagliflozin and progression of kidney disease in type 2 diabetes Physiological roles of ketone bodies as substrates and signals in mammalian tissues Fukao, T; Mitchell, G; Sass, JO; Hori, T; Orii, K; Aoyama, Y Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes A focused review of the role of ketone bodies in health and disease Transport o Continue reading >>

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Popular Questions

  1. DemZee

    does caffeine take you out of ketosis? and does aspartame take you out of ketosis? i want to know because my preworkout has alot of caffeine and i need it because on this diet i feel tired and i have a lack of energy in the gym also i enjoy a coke zero from time to time and i want to know if this will take me out of ketosis?

  2. Targash

    does caffeine take you out of ketosis? and does aspartame take you out of ketosis?
    Read the faq. Carbs take you out of ketosis and a large excess of protien.
    on this diet i feel tired and i have a lack of energy
    Follow the electrolyte guidelines in the faq.

  3. DemZee

    thanks for the info but caffeine and aspartame are very controversial so i wanted the opinion of the reddit community not just the faq

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Dr. Tom Elliott from BCDiabetes discusses the value of SGLT2 inhibitors for people with diabetes in BC and the fact pharmacare does not cover this class of medication. Sign our petition at https://www.change.org/p/bcpharmacare...

Euglycemic Ketosis In Patients With Type 2 Diabetes On Sglt2-inhibitor Therapy-anemerging Problem And Solutions Offered By Diabetes Technology.

1. Endocrine. 2017 Apr;56(1):212-216. doi: 10.1007/s12020-017-1264-y. Epub 2017 Mar 17. Euglycemic ketosis in patients with type 2 diabetes on SGLT2-inhibitor therapy-anemerging problem and solutions offered by diabetes technology. Pftzner A(1), Klonoff D(2), Heinemann L(3), Ejskjaer N(4), Pickup J(5). (1)Pftzner Science & Health Institute, Mainz, UK. [email protected] (2)Mills Peninsula Healthcare Services, San Mateo, USA. (4)Department of Endocrinology, Clinical Institute, Aalborg University, Aalborg University Hospital, Aalborg, UK. (5)Division of Diabetes and Nutritional Sciences, King's College London, Guy's Hospital, London, UK. Diabetic ketoacidosis is an infrequent but life-threatening acute complication ofdiabetes, affecting predominantly patients with type 1 diabetes, children, andpregnant women, where ketosis is usually associated with marked hyperglycemia.Recently, an increasing number of cases have been reported of euglycemic diabeticketoacidosis in patients with type 2 diabetes receiving sodium-glucosecotransporter 2 inhibitor treatment in routine practice. There is a minor, butnot negligible diabetic ketoacidosis risk associated with this drug c Continue reading >>

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  1. Mark Simpson

    (edit: it's worth pointing out that "Ketosis " on it's own is not a bad thing, but Diabetic ketoacidosis is. I assume this is the point of the question)
    Diabetic Ketoacidosis comes from High (hyper) Blood Sugar not Low (Hypo). They could happen together, if you had high blood sugar for too long, the Ketoacidosis happened then you over treated the high and it went low. In this case you'd have 2 separate problems. Hypoglaycemia and Ketoacidosis. Low blood sugar will make you pass out and go into a coma eventually. Ketoacidosis is very painful and horrible to be part of. But I wouldn't say they increase each others danger very much.
    (i am a diabetic, not a medical professional)

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  2. Dennis Kitainik

    I'm not a doctor, but from what I know of diabetic conditions, both of these can be dangerous, and especially if they occur together (especially since ketosis would probably indicate serious hypoglycemia).

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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 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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Popular Questions

  1. carlitos1982

    http://nutrition.about.com/library/blwatercalculator.htm
    It turns out that I have been severely under-drinking my water intake. at a mere 50% or less. I was drinking about 5 bottles of water (16oz size) and thought I was hydrated. For a big guy like me (350lbs) this is less than 50% of the required water for my body type to be hydrated.
    Plug in your numbers and see if you are coming near the suggested amount.
    This gives me hope that if I continue to follow my plan, and now drink enough water, I should get better results.

  2. tsarz

    That water calculator thinks that someone who is 399 pounds and doesn't exercise should drink 6 liters of water. That seems excessive to me.
    .
    Here's an article that was just posted that goes over some of the scientific literature on water intake:
    http://authoritynutrition.com/how-much-water-should-you-drink-per-day
    .
    I've seen a lot of anecdotal evidence, especially here, that more water helps people with weight loss and helps people move through a stall. That article may back this up slightly. Here are a couple of quotes:
    Drinking water can cause mild, temporary increases in metabolism and drinking it about a half hour before meals can make people automatically eat fewer calories.
    One study showed that dieters who drank 500 ml of water before meals lost 44% more weight over a period of 12 weeks, compared to those who didn’t

  3. carlitos1982

    very cool article, thanks for sharing!

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