At the beginning of last year, I was diagnosed with type 2 diabetes and began a long road to lower my blood sugar. The doctor prescribed me metformin and dapagliflozin in the hope that I could control my blood sugar and recover my health. At first, the effect of the drug was remarkable, and I seemed to see hope.
However, the good times were short-lived. A few months later, I started to experience nausea and vomiting, and when I checked my blood sugar and urine ketones, it was frighteningly high. I was diagnosed with diabetic ketoacidosis, and at that moment, it was as if I had fallen into the abyss. After a series of rehydration and insulin treatments, I slowly recovered my health, but the hypoglycemic regimen was also adjusted.
I thought everything would get back on track, but I didn't expect that this was just a prologue to my bumpy experience. Over the next few months, I was admitted to the hospital three times with the same symptoms. Nausea, vomiting every time, ketoacidosis every time. I began to be afraid, afraid of this painful torture, and even more afraid of the unknown risks that come with drugs.
I'm starting to wonder, what the hell is going on? Is it a problem with the medication, or is something wrong with my body? I started searching online trying to find answers. I've found many patients who have been through the same situation as me, and their experiences have made me feel relatable and more worrying.
It wasn't until recently that I met an experienced doctor. He carefully analyzed my condition and medication, and told me that dapagliflozin may trigger diabetic ketoacidosis, especially in patients like me who have good islet function but are prone to dehydration. He advised me to stop dapagliflozin and strengthen my diet and lifestyle changes.
Now, I have stopped dapagliflozin and switched to other hypoglycemic drugs. My condition gradually stabilized and my life returned to its former normal. However, I still have lingering palpitations. I want to tell you that although medicine can cure diseases, it can also bring unexpected side effects. When choosing a drug, we must be cautious and learn more about the side effects and precautions of the drug.
At the same time, I would like to ask everyone, have you had the same experience as me? How did you cope? Feel free to leave a message in the comment area to share your experience and views. Let's discuss how to better ensure the safety of medication and make our lives healthier and better!
Dapagliflozin and ketoacidosis
The above is a patient's self-report, with the rapid development of modern medicine, hypoglycemic drugs play a vital role in the field of diabetes treatment. However, recent cases of ketoacidosis caused by dapagliflozin (a novel hypoglycemic drug) have attracted widespread attention and patient concerns. I will combine my professional knowledge to help you with the relevant knowledge of science and pastagliflozin to solve the mystery behind this drug.
1. Get to know dapagliflozin
Dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor that lowers blood glucose levels by inhibiting the activity of SGLT-2 in the kidneys, reducing renal reabsorption of glucose and increasing urinary glucose excretion. This drug has good efficacy in the treatment of type 2 diabetes, but during its use, it also comes with certain risks.
2. The threat of ketoacidosis
Ketoacidosis is a serious complication of diabetes mellitus, which is mainly manifested by symptoms such as hyperglycemia, hyperketones, and acidosis. Traditionally, ketoacidosis is often associated with hyperglycemia, but ketoacidosis caused by dapagliflozin has its own specificity, that is, ketoacidosis occurs when blood glucose levels are normal or mildly elevated, and this condition is called euglycemic ketoacidosis (euDKA).
3. The association between dapagliflozin and ketoacidosis
In recent years, reports of ketoacidosis caused by dapagliflozin have attracted widespread attention. Studies have shown that ketoacidosis caused by dapagliflozin is related to a variety of factors:
Decreased insulin secretion: while dapagliflozin increases urinary glucose excretion, it may lead to a decrease in insulin secretion in the body or a decrease in the amount of exogenous insulin injection, so that peripheral tissues cannot fully utilize glucose, thereby promoting the breakdown of lipids and the production of ketone bodies.
Increased glucagon secretion: Dapagliflozin can directly act on pancreatic α cells, stimulate glucagon secretion, and further promote gluconeogenesis and ketone production.
Osmotic diuresis: dapagliflozin promotes the excretion of urinary sodium and glucose, producing osmotic diuretic effects, resulting in decreased circulating volume and increasing the risk of ketoacidosis.
Decreased renal clearance of ketones: Dapagliflozin can reduce the glomerular filtration rate, which reduces the kidneys' ability to clear ketones, resulting in the accumulation of ketones in the body.
4. High-risk factors and prevention
Ketoacidosis caused by dapagliflozin, although less prevalent, is more dangerous. Therefore, it is important to understand the risk factors and adopt prevention strategies accordingly. Here are some common risk factors and strategies to prevent them:
Insulin deficiency or improper use: Insulin is a key hormone for controlling blood sugar and preventing ketone production. Patients should maintain an adequate supply of insulin and use equipment such as an insulin pump correctly. Patients who are inappropriately taking insulin should be treated with prompt adjustments.
Diet-related factors: Factors such as a low-carbohydrate diet, alcohol abuse, gastrointestinal endoscopy, and perioperative fasting may contribute to dehydration and increased ketone production. Patients should maintain a balanced diet and avoid undesirable habits such as excessive restriction of carbohydrate intake or alcohol abuse.
Volume reduction/dehydration: Factors such as vomiting, gastrointestinal disorders such as diarrhea, and excessive exercise may cause rapid reduction in intrabody volume and dehydration. Patients should maintain adequate fluid intake and avoid excessive exercise or exertion.
Drug interactions: Concomitant use with other drugs such as glucocorticoids and illicit drugs may increase the risk of ketoacidosis. Patients should inform their doctor of all medications they are taking to avoid unnecessary drug interactions.
In view of the above high-risk factors, pharmacists and doctors should strengthen the pharmaceutical monitoring and education of patients, and timely identify and deal with the factors that may lead to ketoacidosis. In patients who have developed ketoacidosis, dapagliflozin should be discontinued immediately and treatment should be taken, including rehydration, correction of electrolyte imbalances, and acidosis.
V. Conclusions
Dapagliflozin, as a new type of hypoglycemic drug, has good efficacy in the treatment of type 2 diabetes. However, the risk of ketoacidosis should not be overlooked. By strengthening pharmaceutical monitoring and education, timely detection and treatment of high-risk factors, we can effectively prevent ketoacidosis caused by dapagliflozin and ensure the drug safety of patients. In the future, with the in-depth medical research and the accumulation of clinical experience, we believe that we can better grasp the use of dapagliflozin and precautions, and provide more safe and effective treatment options for diabetic patients.
Here, I would like to say to the majority of patients: although the medicine is good, it should also be used with caution. When choosing and using medications, be sure to follow your doctor's advice and guidance and pay close attention to your body's reaction.