Euglycemic ketosis in an adolescent with type 1 diabetes on insulin and dapaglifozin. Case Report
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Keywords

Ketosis
Type 1 Diabetes
Dapagliflozin
SGLT2 Inhibitor
Endocrinology 
Pharmacology
Glucose Metabolism
Adverse Drug Reaction

How to Cite

1.
Pereyra A. M, Ramírez C, Román R. Euglycemic ketosis in an adolescent with type 1 diabetes on insulin and dapaglifozin. Case Report. Andes pediatr [Internet]. 2017 Jul. 27 [cited 2025 Oct. 22];88(3):404-10. Available from: https://andespediatrica.cl/index.php/rchped/article/view/297

Abstract

Introduction: 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, arbohydrates 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

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