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New class of diabetes medication accidentally masks symptoms of a serious condition

Posted July 19, 2019

Having diabetes presents all sorts of challenges. You have to keep an eye on your blood sugar levels, you have to maintain a certain diet and you, most likely, have to take some sort of medication daily. Doctors have to keep that in mind when performing certain procedures. Scientists from the University of Adelaide have found that a new class of diabetes medications is masking the potentially dangerous condition of ketoacidosis.

Diabetes presents all sorts of challenges – some medication can mask other potentially lethal conditions. Image credit: Reversing Your Diabetes Today via Wikimedia

Ketoacidosis a potentially lethal build-up of acid in the blood. Obviously, if ketoacidosis sets in before a surgery, doctors need to know and assess the situation. In fact, it is likely to start before a weight reduction surgery, when diabetic patients are not able to eat and drink normally. Scientists say that euglycaemic ketoacidosis is quite deceiving, because it starts blood sugar levels are low or normal, especially when people are taking a new class of diabetes medication called gliflozin.

Gliflozin is prescribed more and more often, since it is very effective at protecting people with diabetes against heart and kidneys diseases. Gliflozin medications work by extracting excess sugar in diabetic patients’ urine right in the kidneys. Gliflozin helps maintaining a low blood sugar level, which is great, but because of it, it is difficult to recognize euglycaemic ketoacidosis. Diabetic ketoacidosis is an extremely dangerous condition, when body doesn’t have enough insulin and can’t break down sugar for energy. Fat becomes a source of energy and acids called ketones start accumulating in the body. This can happen to people with type 1 and 2 diabetes and can lead to coma and death.

Blood sugar levels are typically high when the diabetic ketoacidosis starts, but gliflozin medications simply mask this symptom, making it pretty much impossible to detect. This can happen around surgeries and other symptoms, such as mild acid build up, vomiting and abdominal pain, may seem normal.

Dr Venkatesan Thiru, one of the authors of the study, said: “In the 42 cases identified in the study, euglycaemic ketoacidosis occurred within a few hours after surgery and up to a few weeks after their operation. Changes in patients’ diabetes medications, diet and illnesses were found to be responsible”. The good news is that scientists know how cases of euglycaemic ketoacidosis can be prevented.

The best strategy for prevention of diabetic ketoacidosis is extra vigilance. Patients have to be educated about the threat and doctors have to be extra careful. Testing for acid load and blood ketone levels could reduce this risk. The good news is that some of the latest blood glucose home monitoring kits actually do test for acid build up.


Source: University of Adelaide

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