[Euglycemic ketosis in an adolescent with type 1 diabetes on insulin and dapaglifozin: Case report].

Abstract

Dapagliflozin, an insulin-independent sodium-glucose cotransporter 2 inhibitor (SGLT2-I) induces glycosuria and reduces hyperglycemia in adults with type 2 diabetes.

OBJECTIVE:

To present an “euglycemic” diabetic ketosis in an adolescent with type 1 diabetes (T1D) receiving dapagliflozin, to alert about the risk of a drug not approved in children nor in T1D.

CASE REPORT:

A 17 years old adolescent with T1D during 9 years, was started on dapagliflozin 10 mg / day to reduce insulin dose and weight. During 11 months on treatment, capillaries ketones were undetectable and she exhibited a reduction in body mass index 23.9 to 21.1 kg/m2, basal insulin 40 to 17 U, glycated hemoglobin 8.3 to 7.5%, capillary glucose 175 to 161 mg/dl and glucose variability (standard deviation) 85 to 77. Suddenly nausea and vomits appeared. The patient was on an insulin pump and well calibrated continuous glucose monitoring, showing stable glucose levels under 200 mg/dl, and an insulin bolus was delivered. Vomiting without hyperglycemia persisted; three hours later, she was severely dehydrated and fainting, with ketones 4.6 nmol/l and glucose 224 mg/dl. She received IV saline fluids, ondansetron, carbohydrates and several insulin boluses. Hydration and general condition improved soon, however despite several insulin doses, ketosis continued for 24 hours. It is remarkable that the pump was working well and the cannula was not changed. After the ketosis was resolved, she continued using the same cannula with good metabolic control.

CONCLUSION:

Euglycemic ketosis is a life-threatening condition that must be suspected.

• Authors: Marcia Pereyra A, Cristhian Ramírez, Rossana Román
• Journal: Revista chilena de pediatria (Rev Chil Pediatr) Vol. 88 Issue 3 Pg. 404-410 (Jun 2017) ISSN: 0717-6228 [Electronic] Chile
• Vernacular Title: Cetosis normoglicémica en adolescente con diabetes tipo 1 recibiendo insulina y dapaglifozina: Reporte de un caso.
• PMID: 28737202 (Publication Type: Case Reports, Journal Article)

Chemical References

• Benzhydryl Compounds
• Biomarkers
• Blood Glucose
• Glucosides
• Hypoglycemic Agents
• Insulin
• dapagliflozin

Topics

• Adolescent
• Benzhydryl Compounds (adverse effects, therapeutic use)
• Biomarkers (blood)
• Blood Glucose (metabolism)
• Diabetes Mellitus, Type 1 (blood, complications, drug therapy)
• Diabetic Ketoacidosis (blood, chemically induced, diagnosis)
• Drug Therapy, Combination
• Female
• Glucosides (adverse effects, therapeutic use)
• Humans
• Hypoglycemic Agents (adverse effects, therapeutic use)
• Insulin (therapeutic use)