Reversal of ketosis in type 1 diabetes is not adversely affected by SGLT2 inhibitor therapy

Stephan Siebel, Alfonso Galderisi, Neha Patel, Lori R. Carria, William V. Tamborlane, Jennifer L. Sherr

Research output: Contribution to journalArticle

Abstract

Objective: We have shown that "euglycemic DKA" in patients with type 1 diabetes receiving a sodium-glucose cotransporter 2-inhibitor (SGLT2i) is due to normal increases in rates of ketogenesis but blunted increases in plasma glucose levels. In this analysis, we assessed whether rescue treatment of early ketoacidosis with insulin is altered by SGLT2i use. Research Design and Methods: Participants received 0.2 U/kg of aspart insulin after two 6-h interruptions of basal insulin that increased beta-hydroxybutyrate (BHB) by 1.2 ± 0.7 mmol/L before and by 1.5 ± 0.2 mmol/L during canagliflozin treatment. BHB and free fatty acid (FFA) were monitored every 30 min for 120 min after receiving a 0.2 U/kg subcutaneous injection of aspart insulin. Results: Ten adults (23 ± 5 years) were studied. During the 120 min after rescue therapy with insulin, the reductions in BHB and FFA were nearly identical between the pre- and during canagliflozin treatment studies, respectively (-1.27 ± 0.76 and -1.13 ± 0.69, P = 0.671 for BHB and -0.50 ± 0.35 vs. -0.41 ± 0.41, P = 0.603 for FFA). Conclusion: These data indicate that turning ketogenesis off, as well as on, does not appear to be affected by SGLT2i use.

Original languageEnglish (US)
Pages (from-to)101-104
Number of pages4
JournalDiabetes Technology and Therapeutics
Volume21
Issue number3
DOIs
StatePublished - Mar 1 2019

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Ketosis
3-Hydroxybutyric Acid
Sodium-Glucose Transport Proteins
Type 1 Diabetes Mellitus
Insulin Aspart
Nonesterified Fatty Acids
Insulin
Subcutaneous Injections
Therapeutics
Research Design
Glucose
Canagliflozin

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Medical Laboratory Technology

Cite this

Siebel, Stephan ; Galderisi, Alfonso ; Patel, Neha ; Carria, Lori R. ; Tamborlane, William V. ; Sherr, Jennifer L. / Reversal of ketosis in type 1 diabetes is not adversely affected by SGLT2 inhibitor therapy. In: Diabetes Technology and Therapeutics. 2019 ; Vol. 21, No. 3. pp. 101-104.
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Reversal of ketosis in type 1 diabetes is not adversely affected by SGLT2 inhibitor therapy. / Siebel, Stephan; Galderisi, Alfonso; Patel, Neha; Carria, Lori R.; Tamborlane, William V.; Sherr, Jennifer L.

In: Diabetes Technology and Therapeutics, Vol. 21, No. 3, 01.03.2019, p. 101-104.

Research output: Contribution to journalArticle

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T1 - Reversal of ketosis in type 1 diabetes is not adversely affected by SGLT2 inhibitor therapy

AU - Siebel, Stephan

AU - Galderisi, Alfonso

AU - Patel, Neha

AU - Carria, Lori R.

AU - Tamborlane, William V.

AU - Sherr, Jennifer L.

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N2 - Objective: We have shown that "euglycemic DKA" in patients with type 1 diabetes receiving a sodium-glucose cotransporter 2-inhibitor (SGLT2i) is due to normal increases in rates of ketogenesis but blunted increases in plasma glucose levels. In this analysis, we assessed whether rescue treatment of early ketoacidosis with insulin is altered by SGLT2i use. Research Design and Methods: Participants received 0.2 U/kg of aspart insulin after two 6-h interruptions of basal insulin that increased beta-hydroxybutyrate (BHB) by 1.2 ± 0.7 mmol/L before and by 1.5 ± 0.2 mmol/L during canagliflozin treatment. BHB and free fatty acid (FFA) were monitored every 30 min for 120 min after receiving a 0.2 U/kg subcutaneous injection of aspart insulin. Results: Ten adults (23 ± 5 years) were studied. During the 120 min after rescue therapy with insulin, the reductions in BHB and FFA were nearly identical between the pre- and during canagliflozin treatment studies, respectively (-1.27 ± 0.76 and -1.13 ± 0.69, P = 0.671 for BHB and -0.50 ± 0.35 vs. -0.41 ± 0.41, P = 0.603 for FFA). Conclusion: These data indicate that turning ketogenesis off, as well as on, does not appear to be affected by SGLT2i use.

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