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ketoacidosis treatment

TeriSue Smith-Jackson, Mary V Brown, Matthew Flint, Merilee Larsen
AIMS: This study examined delayed type one diabetes (T1D) diagnosis, along with the associated severity markers, in the United States. Qualitative reflection was explored to add depth of understanding. METHODS: 975 parents of a minor child with T1D were recruited through snowball, social media requests to complete a 55-question online survey on the experience of diagnosis. RESULTS: 34% of children with T1D had a delayed diagnosis. When compared to those without a delayed diagnosis, these children were more likely to have an Emergency Room diagnosis (39...
August 14, 2018: Journal of Diabetes and its Complications
Andrew Smith, Chelsea Harris
There is considerable benefit of tight glucose control in patients with type 1 diabetes mellitus. Tight blood glucose control dramatically decreases the incidence of microvascular and macrovascular complications. Although glycemic goals should be individualized, most nonpregnant adults should strive for an A1C level less than 7%. Greater frequency of glucose monitoring and continuous glucose monitoring are both associated with lower A1C levels. The choice to monitor glucose levels via multiple daily capillary blood samples or continuous glucose monitoring is based on cost and patient preference...
August 1, 2018: American Family Physician
Takeshi Kawashita, Mikio Nakajima, Richard H Kaszynski, Masamitsu Shirokawa, Tomotsugu Nakano, Koji Ochiai, Yoshitaka Inoue, Hideaki Goto
A 28-year-old man with type 1 diabetes mellitus was admitted for shock and coma due to diabetic ketoacidosis. Despite aggressive treatment and management of the patient's underlying clinical issues, the patient remained in a comatose state. Further investigations revealed an excess consumption of psychotropic agents; however, there was no evidence of an insulin overdose. Physicians should be aware that, in patients who are highly dependent upon insulin, an overdose of psychotropic agents can lead to hypoxic-ischemic brain injury...
September 12, 2018: Internal Medicine
Harriet Warnes, Rebecca Helliwell, Sam Matthew Pearson, Ramzi A Ajjan
Despite advances in insulin therapies, patients with type 1 diabetes (T1DM) have a shorter life span due to hyperglycaemia-induced vascular disease and hypoglycaemic complications secondary to insulin therapy. Restricting therapy for T1DM to insulin replacement is perhaps an over-simplistic approach, and we focus in this work on reviewing the role of adjuvant therapy in this population. Current data suggest that adding metformin to insulin therapy in T1DM temporarily lowers HbA1c and reduces weight and insulin requirements, but this treatment fails to show a longer-term glycaemic benefit...
September 12, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Igor Alexander Harsch, Peter Christopher Konturek
The therapy with immune checkpoint inhibitors (Programmed cell death-1 and programmed cell death-ligand-1 inhibitors) is a novel and promising approach in cancer treatment. The mode of action can cause serious adverse advents, mainly immune-related ones. The case of a 65 year old caucasian female is reported. She suffers from hepatocellular carcinoma since 2012. She underwent several surgeries, was treated with sorafenib and had transcatheter arterial chemoembolizations. As part of an individual healing trial, the patient was treated with nivolumab every 2 or 3 weeks since September 2017 and has no recurrence of the tumor ever since...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Majid Alfadhel, Amir Babiker
Inborn errors of metabolism (IEM) are heterogeneous group of disorders that might present in the clinics or emergency departments in different phenotypes, and one of these is a diabetes scenario. Diabetes is the most common endocrine disorder among children. The mechanism of how IEM could lead to diabetes is unclear; however, the postulated pathogenesis consists of three mechanisms: 1) accumulation of toxic substance in the gland, ruining structure and normal functionality, 2) disturbing energy availability required for hormone synthesis and 3) defect of complex molecules...
2018: Sudanese Journal of Paediatrics
Katie Wynne, Benedict Devereaux, Anne Dornhorst
Diabetes of the exocrine pancreas (DEP) is a form of diabetes that occurs due to pancreatic disease. It is far more common than has been previously considered, with a recent study showing 1.8% of adults with new-onset diabetes should have been classified as DEP. The majority is misdiagnosed as type 2 diabetes mellitus (T2DM). Patients with DEP exhibit varying degrees of exocrine and endocrine dysfunction. Damage to the islet of Langerhans effects the secretion of hormones from the β, α and PP cells; the combination of low insulin, glucagon and pancreatic polypeptide contributes to rapid fluctuations in glucose levels...
August 27, 2018: Journal of Gastroenterology and Hepatology
Osman Yesilbas, Ela Cem, Emine Ayca Cimbek
No abstract text is available yet for this article.
August 21, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
Halis Kaan Akturk, Aimon Alkanani, Zhiyuan Zhao, Liping Yu, Aaron W Michels
Context: Immune checkpoint inhibitors, including monoclonal antibodies directed against programmed cell death protein 1 (PD-1) and its ligand (PD-L1), have emerged as beneficial cancer immunotherapies. These therapies are known to cause immune-related side effects; however, their role in patients with a preexisting autoimmune disease is not clear. Case Description: We describe two cases of anti-PD-1 immune-related adverse events. A 52-year-old male with longstanding type 1 diabetes (T1D), long-term stable kidney transplant, and hypothyroidism received two separate anti-PD-1 monoclonal antibodies for metastatic melanoma...
August 14, 2018: Journal of Clinical Endocrinology and Metabolism
Eliza Sharma, Suyash Dahal, Pratibha Sharma, Dipesh Kc Ghimire, Sumit Dahal
Diabetic ketoacidosis (DKA) is regularly associated with hyperkalemia that results in well-described changes on the electrocardiogram (EKG). However, ST-segment elevations on EKG mimicking acute myocardial infarction have rarely been described in the setting of DKA. Here we present a case of a 43-year-old male with DKA who had pseudoinfarction pattern of ST-segment elevation on EKG that resolved with treatment of DKA and discuss the diagnostic and therapeutic dilemma around the condition.
August 2018: Cardiology Research
Vinod Kumar, Sushant M Nanavati, Gabriel Melki, Mira Upadhyaya, Raman Dhillon, Sandra Gibiezaite, Patrick Michael, Monisha Singhal
Diabetic Ketoacidosis commonly presents with hyponatremia, but hypernatremia is a rare entity. We report a unique case of a 50-year-old woman admitted with altered sensorium with blood glucose 979 milligrams/deciliter, serum osmolarity 363 mOsm/kilograms, and serum sodium 144 milliequivalents/liter. Patient was given initial bolus of isotonic saline and continued on half isotonic saline for correction of hypernatremia along with insulin infusion therapy. Patient was successfully treated with intravenous fluids, insulin infusion, and the altered sensorium was resolved without any sequelae...
2018: Case Reports in Endocrinology
Joanne Blair, Andrew McKay, Colin Ridyard, Keith Thornborough, Emma Bedson, Matthew Peak, Mohammed Didi, Francesca Annan, John W Gregory, Dyfrig Hughes, Carrol Gamble
BACKGROUND: The risk of developing long-term complications of type 1 diabetes (T1D) is related to glycaemic control and is reduced by the use of intensive insulin treatment regimens: multiple daily injections (MDI) (≥ 4) and continuous subcutaneous insulin infusion (CSII). Despite a lack of evidence that the more expensive treatment with CSII is superior to MDI, both treatments are used widely within the NHS. OBJECTIVES: (1) To compare glycaemic control during treatment with CSII and MDI and (2) to determine safety and cost-effectiveness of the treatment, and quality of life (QoL) of the patients...
August 2018: Health Technology Assessment: HTA
Chien-Yu Huang, Yaoh-Shiang Lin, Yu-Hsi Liu, Sheng-Chiao Lin, Bor-Hwang Kang
BACKGROUND: The development of a hyperglycemic crisis in platinum-based chemotherapy-treated head and neck cancer patients, such as hyperosmolar hyperglycemic state (HHS), has been reported. Hyperglycemic crises are associated with a high risk of comorbidity and may delay cancer treatment if not promptly managed. METHODS: This is a retrospective study using cancer registry data from a tertiary medical center. Head and neck cancer patients who had been treated with platinum-based chemotherapy from January 2014 to December 2015 were enrolled for review...
August 9, 2018: Journal of the Chinese Medical Association: JCMA
Daisuke Yabe, Atsutaka Yasui, Linong Ji, Moon-Kyu Lee, Ronald Ching Wan Ma, Tien-Jyun Chang, Tomoo Okamura, Cordula Zeller, Stefan Kaspers, Jisoo Lee, Sven Kohler, Yutaka Seino
AIMS/INTRODUCTION: We investigated the safety and tolerability of empagliflozin (EMPA) in East Asian patients with type 2 diabetes (T2D). MATERIALS AND METHODS: Data were pooled from participants with T2D evenly randomized to placebo, EMPA 10 mg, or EMPA 25 mg in 15 Phase I-III trials. Adverse events (AEs) were analyzed in the subgroup of trial participants from East Asian countries/regions. RESULTS: In total, 709, 724 and 708 East Asian trial participants with T2D received placebo, EMPA 10 mg and EMPA 25 mg, respectively; total exposure was 953, 1072, and 1033 patient-years in these groups, respectively...
August 12, 2018: Journal of Diabetes Investigation
Ting Chen, Dandan Zhang, Zhenjiang Bai, Shuiyan Wu, Haiying Wu, Rongrong Xie, Ying Li, Fengyun Wang, Xiuli Chen, Hui Sun, Xiaoyan Wang, Linqi Chen
Neonatal diabetes mellitus (NDM) is a rare monogenic disorder presenting as uncontrolled hyperglycemia during the first 6 months of life. Hyperglycemic hyperosmolar state (HHS) is quite rare in NDM patients, and reported experience with this condition is limited. Continuous renal replacement therapy (CRRT) is frequently used as a mode of dialytic treatment in critically ill patients with acute renal failure, but has seldom been used in patients with diabetic ketoacidosis (DKA) and HHS. We report the case of a 2-month-old infant admitted to our hospital presenting with dyspnea and lethargy...
August 9, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Sungeeta Agrawal, Grayson L Baird, Jose Bernardo Quintos, Steven E Reinert, Geetha Gopalakrishnan, Charlotte M Boney, Lisa Swartz Topor
OBJECTIVE: Studies of hyperglycemic emergencies with hyperosmolality, including hyperglycemic hyperosmolar state (HHS) and "mixed presentation" with features of diabetic ketoacidosis (DKA) and HHS, are lacking in children. Objectives were to determine the incidence of DKA, HHS, and mixed presentation in a pediatric population, to characterize complications, and to assess accuracy of associated diagnosis codes. METHODS: Retrospective cohort study of 411 hyperglycemic emergencies in pediatric patients hospitalized between 2009 and 2014...
August 2018: Endocrine Practice
Dimitrios Patoulias, Konstantinos Imprialos, Konstantinos Stavropoulos, Vasilios Athyros, Michael Doumas
BACKGROUND: Sodium - glucose cotransporter 2 (SGTL-2) inhibitors are a new class of antidiabetics, which have been approved for the treatment of patients with type 2 diabetes mellitus (T2DM). Besides their beneficial metabolic effects, they exert favourable results in cardiovascular events and risk factors along with renoprotection. However, SGLT-2 inhibitors have not been yet approved as adjunct therapy to insulin in patients with type 1 diabetes mellitus (T1DM). This review aims at presenting both clinical and experimental data that reinforce the role of SGLT-2 inhibitors as adjunctive treatment in patients with T1DM along with the main restrictions of their use, namely diabetic ketoacidosis (DKA)...
August 7, 2018: Current Clinical Pharmacology
Kishan J Padalia, Arjun J Padalia, Milind G Parikh
There have been over 80 documented cases of swallow syncope-a rare form of reflex or neurally mediated syncope-with most cases associated with an underlying esophageal disorder. Here, we describe the first reported case of swallow syncope or presyncope caused by an infectious esophagitis. Our 65-year-old patient initially developed dysphagia, odynophagia, and presyncope with swallowing. This lead to nutrition and medication avoidance behavior, which was followed by the development of diabetic ketoacidosis. The diagnosis of swallow presyncope was confirmed with a provocative swallow study demonstrating 8 s sinus arrest, and an underlying cause of Candida esophagitis was found by upper endoscopy...
July 30, 2018: Dysphagia
Aleksandra Cieluch, Aleksandra Uruska, Bogusz Falkowski, Magdalena Błońska, Paweł Niedźwiecki, Karolina Balawajder, Aleksandra Araszkiewicz, Dorota Zozulińska-Ziółkiewicz
Introduction Diabetic ketoacidosis is a life-threatening condition that requires prompt management. Objectives We aimed to assess the impact of adherence to potassium replacement protocol according to the guidelines of Diabetes Poland on the duration of diabetic ketoacidosis (DKA) treatment. Patients and methods This retrospective analysis included 242 adults (median age, 27 years; range, 21-38 years). Nonadherence to potassium replacement protocol was assessed, along with the relationship between nonadherence and duration of DKA management...
August 31, 2018: Polish Archives of Internal Medicine
Juan Li, Xingping Shen
BACKGROUND: Diabetes is a common metabolic state during ageing, and one in five elderly individuals suffers from diabetes. However, few studies have been performed in elderly diabetic patients, and large randomized clinical trials in this population are rare. The purpose of this study was to investigate changes in serum leptin levels in elderly patients with diabetic ketoacidosis (DKA) before and after treatment and assess its relationship with oxidative stress parameters. MATERIALS AND METHODS: Serum leptin levels, plasma superoxide dismutase (SOD) activity, plasma malondialdehyde (MDA) levels, plasma total antioxidant capacity (TAC) and plasma 8-iso-prostaglandin F2α (8-iso-PGF2α ) levels were measured in elderly patients aged 81...
July 27, 2018: European Journal of Clinical Investigation
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