OBJECTIVE In this prospective, randomized, open trial, we compared the efficacy and safety of aspart insulin given subcutaneously at different time intervals to a standard low-dose intravenous (IV) infusion protocol of regular insulin in patients with uncomplicated diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS A total of 45 consecutive patients admitted with DKA were randomly assig...

OBJECTIVES Ramadan is the ninth month on the lunar calendar and it is a holy month for Muslims during which all healthy adults must fast from dawn to sunset. The risk of diabetic ketoacidosis is thought to be higher during Ramadan fasting due to insulin and glucagon alterations. METHODS A descriptive retrospective analysis of the records of all patients admitted with diabetic ketoacidosis to ...

INTRODUCTION It has been previously unclear whether a "mild" degree of low carbohydrate or "starvation" ketonemia and acidosis induced by a low carbohydrate diet is clinically relevant to a patient. CASE PRESENTATION A 30-year-old Caucasian male on a low carbohydrate diet presented with nausea, vomiting and abdominal pain. The patient's bicarbonate level was 12 and he had hyperglycemia and ke...

Ketoacidosis occurring during lactation has been described infrequently. The condition is incompletely understood, but it appears to be associated with a combination of increased metabolic demands during lactation, reduction in carbohydrate intake and acute illness. We present a case of a 27-year-old woman, 8 weeks post-partum, who was exclusively breastfeeding her child whilst following a low ...

More than 10 million Canadians are currently living with diabetes.1 Of those, 90% have type 2 diabetes mellitus (T2DM).1 Recently launched oral medications known as sodium-glucose cotransporter-2 (SGLT2) inhibitors were approved by the US Food and Drug Administration (FDA) in 2013 for treating T2DM.2 Approval by Health Canada was granted in 2014.3 Treatment with SGLT2 inhibitors (canagliflozin,...

OBJECTIVE Excess GH causes insulin resistance and impaired glucose metabolism. The objective of this study was to clarify the prevalence of ketoacidosis as the initial presenting symptom of acromegaly. DESIGN AND METHODS Data were collected from 860 patients with acromegaly who underwent pituitary surgery at Toranomon Hospital over the last 32 years, between 1980 and 2011. RESULTS Nine case...

BACKGROUND The increasing global prevalence of both dengue and diabetes may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue. Dengue illness is rarely known to precipitate diabetic ketoacidosis among diabetic patients. Both type 1 and type 2 diabetes increase the release of pro-inflammatory cytokines b...

The mechanisms of fluid and solute abnormalities that should be considered in any patient with severe hyperglycemia include changes in the total amount of extracellular solute, osmotic diuresis, intake of water driven by thirst, and influences from associated conditions. The absence of osmotic diuresis distinguishes dialysis-associated hyperglycemia (DH) from hyperglycemia with preserved renal ...

Programmed cell death-1 (PD-1), an immunoreceptor, is located on T cells and pro-B cells and interacts with its ligands to inhibit T cell activation and proliferation, thereby promoting immunological self-tolerance. Nivolumab, an anti-PD1 antibody, blocks PD-1 and can restore anticancer immune responses by abrogating PD-1 pathway-mediated T-cell inhibition. Autoimmune adverse events are expecte...