Skip to main content

Advertisement

SpringerLink
Log in

Prolonged diabetic ketoacidosis and glycemic fluctuations associated with dapagliflozin: a case report

  • Case Report
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Aim

Sodium-glucose co-transporter 2 inhibitors (SGLT-2I) are oral anti-diabetic drugs. We aimed to raise awareness by presenting a difficult and long-lasting DKA case that developed after the addition of dapagliflozin to the treatment.

Case presentation

We report a case of a 40-year-old woman who developed diabetic ketoacidosis (DKA) after 2 weeks use of dapagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT-2I). She had complaints of nausea, vomiting, loss of consciousness, fever, and shortness of breath. DKA was detected in her laboratory results despite the absence of marked hyperglycemia. The patient had metabolic acidosis episodes accompanied by ketonuria on the 5th (mild) and 9th (severe) day despite discontinuation of dapagliflozin. Sudden fluctuations in blood glucose levels of the patient lasted for 10 days and made it difficult to switch to routine basal-bolus insulin treatment.

Conclusion

Prolonged DKA may be a result of SGLT-2 inhibition and individualized treatment and follow-up should be performed instead of standard DKA treatment. Also, we suggest that we need to evaluate endogenous insulin reserves of the patients before starting a SGLT-2I treatment. We believe that in order to raise awareness, these cases should be reported.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fioretto P, Zambon A, Rossato M, et al. SGLT2 inhibitors and the diabetic kidney. Diabetes Care. 2016;39(2):165–71.

    Article  Google Scholar 

  2. Hemmingsen B, Krogh J, Metzendorf MI, et al. Sodium glucose cotransporter (SGLT) 2 inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev. 2016;4:CD012106.

    PubMed  Google Scholar 

  3. Scheen AJ. Pharmacodynamics, efficacy and safety of sodium-glucose co-transporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus. Drugs. 2015;75:33–59.

    Article  CAS  Google Scholar 

  4. US Food and Drug Administration. FDA drug safety communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm. Published May 15, 2015. Accessed 2 May 2017.

  5. Goldenberg RM, Berard LD, Cheng AY, et al. SGLT2 inhibitor-associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis. Clin Ther. 2016;38:2654–64.

    Article  CAS  Google Scholar 

  6. Monami M, Nreu B, Zannoni S, Lualdi C, Mannucci E. Effects of SGLT-2 inhibitors on diabetic ketoacidosis: a meta-analysis of randomised controlled trials. Diabetes Res Clin Pract. 2017;130:53–60.

    Article  CAS  Google Scholar 

  7. Rosenstock J, Ferrannini E. Euglycemic diabetic ketoacidosis: a predictable, detectable, and preventable safety concern with SGLT2 inhibitors. Diabetes Care. 2015;38:1638–42.

    Article  CAS  Google Scholar 

  8. Sloan G, Kakoudaki T, Ranjan N. Prolonged diabetic ketoacidosis associated with canagliflozin. Endocrinol Diabetes Metab Case Rep. 2018;1:1–5.

    Google Scholar 

  9. Pujara S, Ioachimescu A. Prolonged ketosis in a patient with euglycemic diabetic ketoacidosis secondary to dapagliflozin. JIMHICR. 2017;5:1–4.

    Google Scholar 

  10. Hayami T, Kato Y, Kamiya H, Kondo M, Naito E, Sugiura Y, et al. Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet. J Diabetes Investig. 2015;6:587–90.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internal Medicine Department, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey

    Seher Kir & İbrahim Tiken

Authors
  1. Seher Kir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. İbrahim Tiken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seher Kir.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The authors certify that they have obtained all the appropriate consent forms.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kir, S., Tiken, İ. Prolonged diabetic ketoacidosis and glycemic fluctuations associated with dapagliflozin: a case report. Int J Diabetes Dev Ctries 40, 633–635 (2020). https://doi.org/10.1007/s13410-020-00823-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13410-020-00823-6

Keywords

Search

Navigation