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Diabetes
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Symptoms of type I diabetes include polydipsia (excessive thirst), bedwetting, polyuria (excessive urination), lack of energy, fatigue, constant hunger, and/or sudden weight loss. Diabetic ketoacidosis, a serious complication of diabetes that occurs when the body produces high levels of blood acids called ketones, is seen in approximately one-third of individuals with type I diabetes. Symptoms of type II diabetes can have some similarities with those of type I diabetes; however, individuals with type II diabetes may also be completely asymptomatic.
The patient with acute endocrine problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Differential diagnosis:Diabetic ketoacidosis: known history of diabetes.Alcoholic ketoacidosis: usually known history of alcohol abuse (no hyperglycaemia).
Diabetes
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Diabetic ketoacidosis occurs with an increase in high blood sugar but lack of insulin. Without insulin, the cells are deprived of the essential glucose needed for cellular energy. Cell starvation triggers off an array of metabolic disturbances which include the production of ketones.
Comparative safety of sodium-glucose co-transporter 2 inhibitors in elderly patients with type 2 diabetes mellitus and diabetic kidney disease: a systematic review and meta-analysis
Published in Renal Failure, 2023
Yi Liu, Chuan An, Peilong Liu, Fan Yang, Quanlin Zhao
A total of 58489 patients (32530 in the SGLT2 inhibitors group and 25959 in the placebo group) participated in 9 studies on the hypoglycemic outcome. Meta-analysis results showed no significant difference in the incidence of hypoglycemia between patients on SGLT2 inhibitors and those on placebo (RR: 0.97; 95%CI [0.93–1.01], p = 0.18, I2=44%) (Figure 4(a)). 11 studies reporting data related to adverse events of urinary tract infections (UTIs), the meta-analysis showed no significant difference in the probability of UTIs using SGLT2 inhibitors compared with placebo (RR: 1.06; 95%CI [1.00–1.11], p = 0.04, I2=35%) (Figure 4(b)). We extracted data on events consistent with genital mycotic infections from baseline to end of follow-up from 10 studies. The results showed that the SGLT2 inhibitor group was significantly different from placebo, and genital mycotic infections are more likely to occur with SGLT2 inhibitors (RR: 3.47; 95%CI [2.97–4.04], p < 0.00001, I2=26%) (Figure 4(c)). 7 studies reported diabetic ketoacidosis. Participants who were treated with SGLT2 inhibitors had a significantly higher risk of diabetic ketoacidosis than those treated with placebo (RR: 2.25; 95%CI [1.57–3.24], p < 0.0001, I2=0%) (Figure 4(d)). Results of meta-analysis showed that the use of SGLT2 inhibitors did not increase the incidence of fractures (RR: 1.07; 95%CI [0.99–1.16], p = 0.08, I2=0%) (Figure 5(a)).
New-onset diabetic ketoacidosis with purpura fulminans in a child with COVID-19-related multisystem inflammatory syndrome
Published in Infectious Diseases, 2022
Parvathi Parappil, Sushant Ghimire, Apoorv Saxena, Sweta Mukherjee, B. M. John, Vishal Sondhi, P. Sengupta, Suchi Acharya
On admission, he was febrile and had tachypnoea, tachycardia, hypotension and decreased urine output. His initial examination demonstrated a drowsy but arousable boy with dry mucous membranes, reduced skin turgor, soft, non-distended, non-tender abdomen and normal vesicular breath sound on lung auscultation. An initial point of care blood glucose was 713 mg/dL. Other laboratory investigations demonstrated neutrophilic leukocytosis on admission, lymphopenia on Day 2 of admission along with azotemia (Table 2). The urinalysis was significant for 4+ ketones and 4+ glucose. The clinical and laboratory findings were consistent with diabetic ketoacidosis (Table 2). As per current hospital policy, a nasopharyngeal swab was tested for the presence of SARS-CoV-2 RNA, which returned negative.
Careful use to minimize adverse events of oral antidiabetic medications in the elderly
Published in Expert Opinion on Pharmacotherapy, 2021
Of note, in these observational studies, only 5.8% of the patients treated with SGLT2is were ≥65 years [136] or mean age averaged 61 years [132] or 53 years only [137], so that the impact of old age on this complication is uncertain. A population–based cohort study that used two commercial and Medicare claims databases estimated the rate of lower limb amputation among new users of canagliflozin according to age and cardiovascular disease. The increase in rate of amputation with canagliflozin was small and not significant in patients <65 years. In T2D individuals ≥65 years, it was more apparent in patients with baseline cardiovascular disease (HR 3.66, 95% CI 1.74–5.59) compared with patients without baseline cardiovascular disease (HR 1.30, 95% CI 0.52-3.26) [139]. In those T2D patients with both established cardiovascular disease and peripheral artery disease, the dilemma will be to define the priorities, either insure a cardiovascular (and renal) protection or avoid peripheral lower-limb amputation. Thus, for patients who are at high risk of amputation, such as those with severe vascular disease, diabetic foot ulcer, or previous amputation, all conditions that are more frequently observed in the elderly population, SGLT2is should be used with caution and a close surveillance. (7) Diabetic ketoacidosis