钠-葡萄糖协同转运蛋白-2(SGLT2)抑制剂是一类相对新颖的用于治疗2型糖尿病(T2DM)的口服药物。由于其有益的肾脏和心血管结果,它们的使用最近有所增加,但是在正常或轻微升高的血糖值下,它们伴随着糖尿病酮症酸中毒(DKA)的罕见风险,称为正常血糖DKA(euDKA)。最近,缺乏碳水化合物,生酮饮食已获得普及,由于减肥的好处和改善控制T2DM。我们描述了2例T2DM患者在生酮饮食中使用SGLT2抑制剂引起的euDKA,并提供了文献综述。
■我们描述了医院的课程,实验室数据,并对2例患者的治疗进行文献综述。
■我们发现两名患者的血糖水平正常或轻度升高,阴离子间隙升高和酮症,euDKA的代表。第一例患者仅服用1剂依帕列净后出现euDKA,而第二例患者在服用SGLT2抑制剂时仅服用生酮饮食1周后就出现了euDKA。
■虽然有一些关于使用SGLT2抑制剂和生酮饮食的euDKA的报道,许多开这些药物的医生可能没有意识到这种关联。因此,如果服用SGLT2抑制剂,他们必须告知患者避免生酮饮食.如果患者出现DKA症状,并且在服用SGLT2抑制剂的同时饮食不含碳水化合物,应该有一个低门槛来筛选DKA。
UNASSIGNED: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a relatively novel class of oral medications for the treatment of type 2 diabetes mellitus (T2DM). Their use has increased recently due to their beneficial renal and cardiovascular outcomes, but they come with the rare risk of diabetic ketoacidosis (DKA) at normal or slightly elevated glucose values, termed euglycemic DKA (euDKA). Recently, carbohydrate-deprived, ketogenic diets have gained popularity due to benefits of weight loss and improved control of T2DM. We describe 2 patients with T2DM who developed euDKA caused by SGLT2 inhibitor use while on a ketogenic diet and provide a
review of the literature.
UNASSIGNED: We describe the hospital course, laboratory data, and treatment of 2 patients and provide a literature
review.
UNASSIGNED: Both of our patients were found to have normal or mildly elevated serum glucose levels, with an elevated anion gap and ketosis, representative of euDKA. The first patient developed euDKA after only 1 dose of empagliflozin, while the second patient developed euDKA after only 1 week of being on a ketogenic diet while on an SGLT2 inhibitor.
UNASSIGNED: While there have been a few reports of euDKA with SGLT2 inhibitors and ketogenic diets, many physicians prescribing these medications may not be aware of this association. Therefore, they must inform their patients to avoid a ketogenic diet if on an SGLT2 inhibitor. If a patient presents with symptoms of DKA and is eating a carbohydrate-free diet while taking an SGLT2 inhibitor, there should be a low threshold to screen for DKA.