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ketosis diabet

Hiroyuki Hirai, Sanae Midorikawa, Shinichi Suzuki, Hironobu Sasano, Tsuyoshi Watanabe, Hiroaki Satoh
We herein present the findings of a 42-year-old woman with either adrenal pheochromocytoma or intraadrenal paraganglioma that simultaneously secreted somatostatin, thus mimicking insulin-dependent diabetes mellitus. Pheochromocytoma was clinically diagnosed based on scintigraphy, elevated catecholamine levels, and finally a histopathological analysis of resected specimens. The patient had diabetic ketosis, requiring 40 U insulin for treatment. Following laparoscopic adrenalectomy, insulin therapy was discontinued and the urinary c-peptide levels changed from 5...
2016: Internal Medicine
Tory J Andrews, Robert D Cox, Christina Parker, James Kolb
BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitor medications are a class of antihyperglycemic agents that increase urinary glucose excretion by interfering with the reabsorption of glucose in the proximal renal tubules. In May of 2015, the U.S. Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis and ketosis in patients taking these medications. CASE REPORT: We present a case of a 57-year-old woman with type 2 diabetes mellitus taking a combination of canagliflozin and metformin who presented with progressive altered mental status over the previous 2 days...
October 4, 2016: Journal of Emergency Medicine
Didier Raboisson, Maxime Barbier, Elise Maigné
Decreasing the use of antimicrobials has become a primary objective for both human and veterinary medicine in many countries. Medical prevention and good nutrition are seen as key parameters for reducing antimicrobial use. However, little consideration has been given to how metabolic diseases may influence the use of antimicrobials in humans and animals through limiting the prevalence and severity of infectious diseases. To quantify this relationship using the example of a common metabolic disease in dairy cows (subclinical ketosis, SCK), we constructed a stochastic model reporting the total quantity of curative antimicrobials for a given population with the prevalence of cows at risk for SCK...
2016: PloS One
Nora Luethi, Luca Cioccari, Marco Crisman, Rinaldo Bellomo, Glenn M Eastwood, Johan Mårtensson
BACKGROUND: It is uncertain whether liberal glucose control in critically ill diabetic patients leads to increased ketone production and ketoacidosis. Therefore, we aimed to assess the prevalence of ketosis, ketonuria and ketoacidosis in critically ill diabetic patients treated in accordance with a liberal glycemic control protocol. METHODS: We performed a prospective observational cohort study of 60 critically ill diabetic patients with blood and/or urine ketone bodies tested in ICU...
2016: Critical Care: the Official Journal of the Critical Care Forum
Ivan Kruljac, Miroslav Ćaćić, Petra Ćaćić, Vedran Ostojić, Mario Štefanović, Aljoša Šikić, Milan Vrkljan
Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department...
September 3, 2016: Endocrine
Naoto Tani, Tomomi Michiue, Jian-Hua Chen, Shigeki Oritani, Takaki Ishikawa
A severely malnourished, Japanese female in her twenties was found dead in her apartment. On autopsy, most of the findings from the internal examination were suggestive of hypothermia. Postmortem biochemistry, however, showed severely increased levels of glycated hemoglobin (HbA1c) and blood and urine glucose levels. Levels of acetone, 3-hydroxybutyric acid, and acetoacetate in various body fluids were also highly increased, indicating ketosis. The serum insulin and c-peptide levels were severely low, and subsequent testing was positive for anti-GAD antibodies...
September 2016: Legal Medicine
Alla K Ovsyannikova, Oksana D Rymar, Elena V Shakhtshneider, Vadim V Klimontov, Elena A Koroleva, Natalya E Myakina, Mikhail I Voevoda
Maturity-onset diabetes of the young (MODY) is a heterogeneous group of diseases associated with gene mutations leading to dysfunction of pancreatic β-cells. Thirteen identified MODY variants differ from each other by the clinical course and treatment requirement. Currently, MODY subtypes 1-5 are best-studied, descriptions of the other forms are sporadic. This article reports a MODY12 clinical case, caused by a mutation in the gene of the ATP-binding cassette transporter sub-family C member 8 (ABCC8), encoding sulfonylurea receptor 1...
September 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Chantal Mathieu, Bernard Zinman, Joanna Uddén Hemmingsson, Vincent Woo, Peter Colman, Erik Christiansen, Martin Linder, Bruce Bode
OBJECTIVE: To investigate whether liraglutide added to treat-to-target insulin improves glycemic control and reduces insulin requirements and body weight in subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS: A 52-week, double-blind, treat-to-target trial involving 1,398 adults randomized 3:1 to receive once-daily subcutaneous injections of liraglutide (1.8, 1.2, or 0.6 mg) or placebo added to insulin. RESULTS: HbA1c level was reduced 0...
October 2016: Diabetes Care
Po-Chung Cheng, Shang-Ren Hsu, Yun-Chung Cheng
Objective. This study examined the association between serum albumin concentration and ketosis risk in hospitalized individuals with type 2 diabetes mellitus (T2DM). Methods. A retrospective cross-sectional study was conducted at a medical center in Taiwan. Inclusion criteria were endocrinology ward inpatients exceeding 21 years of age, with preexisting diagnosis of T2DM, and blood glucose above 13.9 millimoles per liter (mmol/L) at admission. Individuals without measurement of serum albumin, urine ketone, or hemoglobin A1C, or harboring active infection, myocardial infarction, cerebrovascular event, cirrhosis, malignancy, or overt proteinuria were excluded...
2016: Journal of Diabetes Research
Bo Ahrén, Irl B Hirsch, Thomas R Pieber, Chantal Mathieu, Fernando Gómez-Peralta, Troels Krarup Hansen, Areti Philotheou, Sune Birch, Erik Christiansen, Thomas Jon Jensen, John B Buse
OBJECTIVE: To investigate the efficacy and safety of liraglutide added to capped insulin doses in subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS: A 26-week, placebo-controlled, double-blind, parallel-group trial enrolling 835 subjects randomized 3:1 receiving once-daily subcutaneous liraglutide (1.8, 1.2, and 0.6 mg) or placebo added to an individually capped total daily dose of insulin. RESULTS: Mean baseline glycated hemoglobin (HbA1c) (8...
October 2016: Diabetes Care
Nitesh D Kuhadiya, Husam Ghanim, Aditya Mehta, Manisha Garg, Salman Khan, Jeanne Hejna, Barrett Torre, Antoine Makdissi, Ajay Chaudhuri, Manav Batra, Paresh Dandona
CONTEXT: It is imperative that novel approaches to treatment of type 1 diabetes (T1D) are devised. OBJECTIVE: The objective of the study was to investigate whether addition of dapagliflozin to insulin and liraglutide results in a significant reduction in glycemia and body weight. DESIGN: This was a randomized clinical trial. SETTING: The study was conducted at a single academic medical center. PARTICIPANTS: Participants included T1D patients on liraglutide therapy for at least last 6 months...
September 2016: Journal of Clinical Endocrinology and Metabolism
A Messaaoui, S Tenoutasse, H Dorchy
Maturity Onset Diabetes of the Young (MODY) is a monogenic form of diabetes with onset in patients aged less than 25 years. It is a heterogeneous disorder due to heterozygous monogenic mutations with an autosomal dominant transmission. It could represent 2 to 5% of diabetes but is often under-diagnosed. We report three different cases of MODY, two without associated abnormalities and one with renal disorder. Mutations concern genes that are directly involved in the beta-cell function. In patients with non-syndromic diabetes, more than 99% of MODY result from mutations in hepatocyte nuclear factor-1-alpha (HNF-1-alpha ; formerly MODY 3), glucokinase (MODY 2), or HNF-4-alpha (MODY 1)...
March 2016: Revue Médicale de Bruxelles
Pete J Cox, Tom Kirk, Tom Ashmore, Kristof Willerton, Rhys Evans, Alan Smith, Andrew J Murray, Brianna Stubbs, James West, Stewart W McLure, M Todd King, Michael S Dodd, Cameron Holloway, Stefan Neubauer, Scott Drawer, Richard L Veech, Julian L Griffin, Kieran Clarke
Ketosis, the metabolic response to energy crisis, is a mechanism to sustain life by altering oxidative fuel selection. Often overlooked for its metabolic potential, ketosis is poorly understood outside of starvation or diabetic crisis. Thus, we studied the biochemical advantages of ketosis in humans using a ketone ester-based form of nutrition without the unwanted milieu of endogenous ketone body production by caloric or carbohydrate restriction. In five separate studies of 39 high-performance athletes, we show how this unique metabolic state improves physical endurance by altering fuel competition for oxidative respiration...
August 9, 2016: Cell Metabolism
Ken Yajima, Yoichi Oikawa, Kentaro Ogata, Akinori Hashiguchi, Akira Shimada
The loss of insulin-producing pancreatic β-cells in Type 1 diabetes mellitus (DM) is presumably the result of a T cell-mediated process. In general, CD8(+) T cells are the predominant lymphocytes in the insulitis lesions, and CD4(+) T cell-dominant insulitis is very rare. We present a case of a 72-year-old woman presented with excessive thirst and a 3-month history of weight loss. She was in a state of ketosis, and her plasma glucose concentration and HbA1c value were elevated. Moreover, anti-islet autoantibodies were positive, thus acute-onset Type 1 DM was diagnosed...
July 5, 2016: Endocrine Journal
Hala Hussein, Fidaa Ibrahim, Eugène Sobngwi, Jean François Gautier, Philippe Boudou
OBJECTIVES: Zinc transporter 8 (ZnT8) is specifically expressed in the pancreatic β-cell and is more restricted in its tissue distribution than other auto-antigens as glutamic acid decarboxylase 65 (GAD65) and insulinoma-associated antigen-2 (IA2). ZnT8 autoantibodies (ZnT8A) assessment allows identifying rapid progression to clinical onset of the disease. We evaluated the prevalence of ZnT8A in adults of different ethnic and phenotypic groups and analyzed its potential utility as additional marker of autoimmunity in daily practice...
June 27, 2016: Clinical Biochemistry
J-L Nguewa, E Lontchi-Yimagou, F Agbelika, M AitDjoudi, P Boudou, S Choukem, E Sobngwi, J-F Gautier
BACKGROUND AND OBJECTIVES: Peripheral tissue resistance to insulin action is a characteristic of type 2 diabetes mellitus (T2DM). It has also been reported that some chronic viral infections can contribute to insulin resistance. Human herpesvirus (HHV)-8 infection has been detected in T2DM patients in previous studies. Our study investigated whether the presence of the virus is associated with insulin resistance in patients with ketosis-prone type 2 diabetes (KPD), as reported with other viruses...
June 1, 2016: Diabetes & Metabolism
Cristian Palmiere, Camilla Tettamanti, Marc Augsburger, Sandra Burkhardt, Sara Sabatasso, Christelle Lardi, Dominique Werner
Significantly increased blood ketone body levels can be occasionally observed in the forensic setting in situations other than exposure to cold, diabetic or alcoholic ketoacidosis. Though infrequent, these cases do occur and deserve thorough evaluation in order to establish appropriate differential diagnoses and quantify the role that hyperketonemia may play in the death process. Starvation ketoacidosis is a rare cause of metabolic acidosis and is a phenomenon that occurs normally during fasting, as the body switches from carbohydrate to lipid energy sources...
August 2016: Journal of Forensic and Legal Medicine
Peter M Calhoun, Bruce A Buckingham, David M Maahs, Irene Hramiak, Darrell M Wilson, Tandy Aye, Paula Clinton, Peter Chase, Laurel Messer, Craig Kollman, Roy W Beck, John Lum
BACKGROUND: We developed a system to suspend insulin pump delivery overnight when the glucose trend predicts hypoglycemia. This predictive low-glucose suspend (PLGS) system substantially reduces nocturnal hypoglycemia without an increase in morning ketosis. Evaluation of hypoglycemia risk factors that could potentially influence the efficacy of the system remains critical for understanding possible problems with the system and identifying patients that may have the greatest benefit when using the system...
May 20, 2016: Journal of Diabetes Science and Technology
Anar Modi, Abhinav Agrawal, Farah Morgan
INTRODUCTION: Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. It is characterised by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L) and ketosis. Rarely these patients can present with blood glucose (BG) levels of less than 200 mg/dl, which is defined as euglycemic DKA. The possible etiology of euglycemic DKA includes the recent use of insulin, decreased caloric intake, heavy alcohol consumption, chronic liver disease and glycogen storage disorders...
April 21, 2016: Current Diabetes Reviews
M B Abraham, J A Nicholas, T T Ly, H C Roby, N Paramalingam, J Fairchild, B R King, G R Ambler, F Cameron, E A Davis, T W Jones
INTRODUCTION: Innovations with sensor-augmented pump therapy (SAPT) to reduce hypoglycaemia in patients with type 1 diabetes are an ongoing area of research. The predictive low glucose management (PLGM) system incorporates continuous glucose sensor data into an algorithm and suspends basal insulin before the occurrence of hypoglycaemia. The system was evaluated in in-clinic studies, and has informed the parameters of a larger home trial to study its efficacy and safety in real life. METHODS AND ANALYSIS: The aim of this report is to describe the study design and outcome measures for the trial...
2016: BMJ Open
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