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Diabetic ketoacidosis in a patient with type 2 diabetes precipitated by infection, steroids and SGLT2 inhibitor
Author(s) -
Aung Ei Thuzar,
Koshy Rithika Mary,
Jacob Koshy
Publication year - 2019
Publication title -
practical diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.205
H-Index - 24
eISSN - 2047-2900
pISSN - 2047-2897
DOI - 10.1002/pdi.2217
Subject(s) - medicine , diabetic ketoacidosis , type 2 diabetes , diabetes mellitus , complication , exacerbation , sepsis , insulin resistance , type 1 diabetes , ketoacidosis , insulin , intensive care medicine , stroke (engine) , endocrinology , pediatrics , mechanical engineering , engineering
Abstract Diabetic ketoacidosis (DKA) is a serious, life‐threatening hyperglycaemic emergency commonly associated as a complication of type 1 diabetes (T1DM). The pathophysiology associated with type 2 diabetes (T2DM) makes it less likely to develop DKA, though it still could be precipitated by certain coexisting factors such as infection, medication non‐compliance, vascular events such as myocardial infarction and stroke, medications such as steroids, thiazides or sodium glucose co‐transporter 2 (SGLT2) inhibitors, and pancreatic neoplasm. DKA associated with the use of SGLT2 inhibitors, although not common, is a well‐recognised complication. Glucocorticoid use is not a commonly described association for DKA in T2DM. The diabetogenic propensity of steroids is due to a combination of increased insulin resistance as well as β‐cell dysfunction. We report a case of T2DM who presented to our hospital with DKA following exacerbation of his hyperglycaemia by concomitant sepsis, steroid usage and use of SGLT2 inhibitor. Copyright © 2019 John Wiley & Sons.