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1.
BMC Endocr Disord ; 22(1): 148, 2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-1902378

ABSTRACT

INTRODUCTION: Diabetic ketoacidosis (DKA) is a complication of diabetes presenting with high anion gap metabolic acidosis. Methanol poisoning, on the other hand, is a toxicology emergency which presents with the same feature. We present a case of methanol poisoning who presented with DKA. CASE PRESENTATION: A 28-year-old male was referred to us with blurred vision and loss of consciousness three days after ingestion of 1.5 L of an unknown mixture of bootleg alcoholic beverage. He had history of insulin-dependent diabetes and had neglected his insulin shots on the day prior to hospital admission due to progressive loss of consciousness. Vital signs were normal and venous blood gas analysis showed severe metabolic acidosis and a methanol level of 10.2 mg/dL. After eight hours of hemodialysis, he remained unresponsive. Diabetic ketoacidosis was suspected due to positive urine ketone and blood sugar of 411 mg/dL. Insulin infusion was initiated which was followed by full awakening and extubation. He was discharged completely symptom-free after 4 weeks. CONCLUSIONS: Diabetic ketoacidosis and methanol poisoning can happen simultaneously in a diabetic patient. Given the analogous high anion gap metabolic acidosis, physicians should pay particular attention to examination of the diabetic patients. Meticulous evaluation for both conditions is highly recommended.


Subject(s)
Acidosis , Diabetes Mellitus , Diabetic Ketoacidosis , Acidosis/chemically induced , Acidosis/complications , Adult , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/therapy , Humans , Insulin/therapeutic use , Male , Methanol , Unconsciousness/complications
2.
Endocr Pract ; 28(8): 787-794, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1873032

ABSTRACT

BACKGROUND/OBJECTIVE: Coronavirus disease 2019 (COVID-19) is thought to contribute to diabetic ketoacidosis (DKA) and worse outcomes in patients with diabetes. This study compared the cumulative insulin dose required to achieve DKA resolution in the intensive care unit among patients with type 2 diabetes and COVID-19 infection versus without COVID-19 infection. METHODS: This retrospective cohort study evaluated 100 patients-50 patients with COVID-19 in cohort 1 and 50 patients without COVID-19 in cohort 2-treated with insulin infusions for DKA at a tertiary care teaching hospital. The primary outcome was to compare the cumulative insulin dose required to achieve DKA resolution in each cohort. The secondary outcomes included time to DKA resolution, mean insulin infusion rate, and mean weight-based cumulative insulin infusion dose required to achieve DKA resolution. All endpoints were adjusted for confounders. RESULTS: The mean cumulative insulin dose was 190.3 units in cohort 1 versus 116.4 units in cohort 2 (P = .0038). Patients receiving steroids had a mean time to DKA resolution of 35.9 hours in cohort 1 versus 15.6 hours in cohort 2 (P = .0014). In cohort 1 versus cohort 2, the mean insulin infusion rate was 7.1 units/hour versus 5.3 units/hour (P = .0025), whereas the mean weight-based cumulative insulin infusion dose was 2.1 units/kg versus 1.5 units/kg (P = .0437), respectively. CONCLUSION: COVID-19-infected patients required a significantly larger cumulative insulin dose, longer time to DKA resolution, higher insulin infusion rate, and higher weight-based insulin infusion dose to achieve DKA resolution versus non-COVID-19-infected patients with type 2 diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Diabetic Ketoacidosis , COVID-19/complications , COVID-19/drug therapy , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/drug therapy , Diabetic Ketoacidosis/epidemiology , Humans , Hypoglycemic Agents , Insulin , Insulin, Regular, Human/therapeutic use , Retrospective Studies
3.
J Diabetes Investig ; 13(7): 1290-1292, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1714218

ABSTRACT

The epidemic of coronavirus disease-2019 (COVID-19) is the major public health issue in the world. COVID-19 vaccines are one of the most effective strategies against COVID-19. Here we report a 36-year-old female patient who had thirst, polydipsia, polyuria, palpitations, loss of appetite, and fatigue 3 days after the first dose of COVID-19 RNA-based vaccines without a prior history of diabetes. Ten days after vaccination, she visited our hospital with diabetic ketoacidosis and was diagnosed with type 1 diabetes. Hyperglycemia (501 mg/dL), anion gap metabolic acidosis and ketonuria were observed. The glycated hemoglobin level was 7.0%. Islet-related autoantibodies were all negative. The glucagon tolerance test revealed attenuated secretion of insulin. Human leukocyte antigen was haplotype DRB1*0405-DQB1*0401, which was associated with type 1 diabetes in Japan. The present case suggests that COVID-19 RNA-based vaccines might trigger the onset of type 1 diabetes, even in subjects without prior histories of diabetes.


Subject(s)
COVID-19 Vaccines , COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Adult , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Diabetes Mellitus, Type 1/chemically induced , Diabetic Ketoacidosis/chemically induced , Female , Humans
4.
Thorac Cancer ; 13(8): 1220-1223, 2022 04.
Article in English | MEDLINE | ID: covidwho-1685174

ABSTRACT

We describe a case of diabetic ketoacidosis (DKA) shortly after the SARS-CoV-2 (COVID-19) vaccination in a 65-year-old woman with non-small-cell lung cancer under a combination treatment of programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors. She had no history of diabetic mellitus. A few days after the second shot of COVID-19 vaccination, she developed DKA. We speculate that the immune-related adverse event and immunogenicity of vaccination synergistically induced DKA.


Subject(s)
COVID-19 , Carcinoma, Non-Small-Cell Lung , Diabetes Mellitus , Diabetic Ketoacidosis , Lung Neoplasms , Aged , COVID-19 Vaccines/adverse effects , CTLA-4 Antigen/therapeutic use , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/drug therapy , Diabetic Ketoacidosis/chemically induced , Female , Humans , Immune Checkpoint Inhibitors , Lung Neoplasms/complications , Lung Neoplasms/drug therapy , Programmed Cell Death 1 Receptor/therapeutic use , SARS-CoV-2 , Vaccination/adverse effects
5.
J Med Case Rep ; 16(1): 17, 2022 Jan 04.
Article in English | MEDLINE | ID: covidwho-1608781

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors are among the new-generation oral antihyperglycemic agents that have been used in the treatment of type 2 diabetes mellitus. With the recent coronavirus disease 2019 pandemic and rise of cases in the third wave, diagnosis of life-threatening euglycemic diabetic ketoacidosis may easily be overlooked or missed. CASE PRESENTATION: We present the case of a 37-year-old Malay gentleman with underlying type 2 diabetes mellitus on empagliflozin, who presented to our hospital with symptomatic coronavirus disease 2019 infection and diabetic ketoacidosis. He developed severe rebound euglycemic diabetic ketoacidosis due to the continuous usage of empagliflozin for glycemic control alongside intravenous insulin. CONCLUSIONS: Physicians should have a high index of suspicion in diagnosing and managing euglycemic diabetic ketoacidosis, including withholding treatment of sodium-glucose cotransporter 2 inhibitors during the acute management of diabetic ketoacidosis.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Diabetic Ketoacidosis , Sodium-Glucose Transporter 2 Inhibitors , Adult , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/drug therapy , Glucose , Humans , Male , SARS-CoV-2 , Sodium , Sodium-Glucose Transporter 2 Inhibitors/adverse effects
6.
Drug Saf ; 43(12): 1211-1221, 2020 12.
Article in English | MEDLINE | ID: covidwho-1092871

ABSTRACT

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a major advance in the fields of diabetology, nephrology, and cardiology. The cardiovascular and renal benefits of SGLT2 inhibitors are likely largely independent of their glycaemic effects, and this understanding is central to the use of these agents in the high-risk population of people with type 2 diabetes and chronic kidney disease. There are a number of potential safety issues associated with the use of SGLT2 inhibitors. These include the rare but serious risks of diabetic ketoacidosis and necrotising fasciitis of the perineum. The data regarding a possibly increased risk of lower limb amputation and fracture with SGLT2 inhibitor therapy are conflicting. This article aims to explore the potential safety issues associated with the use of SGLT2 inhibitors, with a particular focus on the safety of these drugs in people with type 2 diabetes and chronic kidney disease. We discuss strategies that clinicians can implement to minimise the risk of adverse effects including diabetic ketoacidosis and volume depletion. Risk mitigation strategies with respect to SGLT2 inhibitor-associated diabetic ketoacidosis are of particular importance during the current coronavirus disease 2019 (COVID-19) pandemic.


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Diabetic Ketoacidosis/chemically induced , Fasciitis, Necrotizing/chemically induced , Hypovolemia/chemically induced , Renal Insufficiency, Chronic/complications , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Acute Kidney Injury/chemically induced , Amputation/statistics & numerical data , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/metabolism , Fournier Gangrene/chemically induced , Fractures, Bone/chemically induced , Humans , Hypoglycemia/chemically induced , Patient Education as Topic , Perineum , Reproductive Tract Infections/chemically induced , Risk Factors , Urinary Tract Infections/chemically induced
7.
Ann Endocrinol (Paris) ; 81(2-3): 101-109, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-380104

ABSTRACT

Diabetes is among the most frequently reported comorbidities in patients infected with COVID-19. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. On the other hand, diabetes is a risk factor for developing severe and critical forms of COVID-19, the latter requiring admission to an intensive care unit and/or use of invasive mechanical ventilation, with high mortality rates. The characteristics of diabetic patients at risk for developing severe and critical forms of COVID-19, as well as the prognostic impact of diabetes on the course of COVID-19, are under current investigation. Obesity, the main risk factor for incident type 2 diabetes, is more common in patients with critical forms of COVID-19 requiring invasive mechanical ventilation. On the other hand, COVID-19 is usually associated with poor glycemic control and a higher risk of ketoacidosis in diabetic patients. There are currently no recommendations in favour of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Metformin and SGLT2 inhibitors should be discontinued in patients with severe forms of COVID-19 owing to the risks of lactic acidosis and ketoacidosis. Finally, we advise for systematic screening for (pre)diabetes in patients with proven COVID-19 infection.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Acidosis, Lactic/chemically induced , Acidosis, Lactic/epidemiology , Acidosis, Lactic/virology , Betacoronavirus/physiology , COVID-19 , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Critical Illness/epidemiology , Critical Illness/therapy , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/epidemiology , Diabetic Ketoacidosis/virology , Humans , Mass Screening/methods , Mass Screening/standards , Metformin/therapeutic use , Obesity/complications , Obesity/epidemiology , Obesity/therapy , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prediabetic State/complications , Prediabetic State/diagnosis , Prediabetic State/epidemiology , Prediabetic State/therapy , Renin-Angiotensin System/physiology , Risk Factors , Risk Management , SARS-CoV-2 , Severity of Illness Index , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Withholding Treatment
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