Home Type 2 Should all diabetic ketoacidosis be treated the same?

Should all diabetic ketoacidosis be treated the same?

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Sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated diabetic ketoacidosis (DKA) in patients with type 2 diabetes (T2D) is characterized by a degree of hyperglycemia during the first 24 hours of treatment that is similar to that observed in other patients. It is associated with something lower than something. type 1 diabetes (T1D) Associated DKA. Using the same insulin infusion protocol can cause hypoglycemia or hyperglycemia.


  • A retrospective cohort study comparing the natural history and response to treatment of 37 episodes of SGLT2i-related DKA (n = 27) or ketosis (n = 10) in T2D patients and 19 episodes of T1D-related DKA in the same age range of people in the T2D group. were identified from endocrine consultation requests at two tertiary hospitals in South Australia.


  • Patients with T2D and SGLT2i-related DKA had milder DKA than T1D-related DKA (median ketone peak 5.3 vs. 6.5 mmol/L; P = .02).
  • The SGLT2i group had delayed recovery compared to the T1D group (median time: 36 hours vs. 18 hours; P = .002).
  • Body weight was higher in the T2D SGLT2i group than in the T1D group (81.8 kg vs. 67.7 kg; P = 0.04), SGLT2i DKA patients had significantly lower amounts of insulin (intravenous and subcutaneous) administered during the first 24 hours of treatment compared to the T1D DKA group (median dose : 44.0 vs. 87.0 units, P = .01).
  • In SGLT2i DKA, changes in ketone levels during the first 24 hours were significantly associated with baseline insulin therapy (P = .002), lower bicarbonate limit (P = .02), higher admission plasma glucose (P = .24).

in fact:

“T1D DKA is caused by absolute insulin deficiency, leading to ketosis and hyperglycemia. In contrast, SGLT2i DKA is caused by a decrease in plasma glucose due to urinary glucose loss, resulting in decreased insulin secretion and decreased blood glucose levels. rise. glucagon secreted and causes ketosis. Therefore, plasma glucose levels in SGLT2i DKA are often normal or slightly elevated. “Despite these differences, the American College of Clinical Endocrinologists and the American College of Endocrinologists recommend the same protocol for treatment of both types.” This can result in: there is hypoglycemia If the patient is on a fixed-dose insulin infusion, or if there is inadequate insulin dosing and the patient is on a dynamic insulin infusion and ketone body clearance is reduced. ” glucose, increasing the infusion rate and concentration of glucose, allowing for increased insulin dosing and suppression of ketosis. ”


Conducted by Mahesh M. Umapathysivam, DPhil, and colleagues from the South Adelaide Diabetes and Endocrinology Service, Flinders Medical Center, Adelaide, South Australia, Australia.the study Published online JAMA network open.


This study was retrospective and the sample size was small.


This research was supported by a South Australian Diabetes Researcher Grant and support from the Hospital Research Foundation. Mr Umapasisivam reported receiving grants from Diabetes SA during the conduct of the study and, outside of the submitted research, from Diabetes Australia, which is funded by AstraZeneca.

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