Euglycemic Diabetic Keto Acidosis in a Type 1 Diabetic Patient After Glucose Like Peptide-1 Administration: A Case Presentation

Abstract

Type 1 diabetes mellitus (DM) occurs when insulin-producing beta cells are destroyed. Destruction of these cells and subsequent loss of insulin signaling can cause diabetic keto acidosis (DKA). This case describes a type 1 DM patient who presented to the emergency department (ED) with nausea and vomiting after glucose like peptide-1 (GLP-1) agonist administration. The patient was noted to have elevated anion gap and elevated beta-hydroxybutyrate with euglycemic blood glucose levels. The patient was confirmed to have a functioning insulin pump and then was sent home with nausea control. The patient was not able to consume food without vomiting and therefore did not administer any postprandial insulin. These symptoms were attributed to the GLP-1 agonist. It contributed to suppression of the patient’s appetite while also inhibiting gluconeogenesis, and glycogenolysis resulting in small amounts of blood glucose entering the blood stream, negating the need for a bolus of insulin. The patient was admitted and given dextrose with an insulin drip until the anion gap was returned to normal. As GLP-1 agonists become more popular, this presentation may become more common. If not easily recognized this can lead to patient endangerment and unnecessary medical costs.

Pharmacovigilance study of GLP-1 receptor agonists for metabolic and nutritional adverse events

“…In a case report of ketoacidosis resulting from an injection of Wegovy 1.7 mg for the treatment of type 1 diabetes mellitus (T1DM), the effects of appetite suppression and inhibition of gluconeogenesis and glycogenolysis produced by GLP-1 RAs contributed to the reduction of the patient’s insulin push and induced the development of diabetic keto acidosis. Moreover, this could become more prevalent with the widespread use of GLP-1 RAs ( Widhalm and Pulido, 2023 ). A meta-analysis of GLP-1 RAs as adjuvant therapy in patients with T1DM also observed that liraglutide was associated with higher odds of ketosis (OR 1.8; 95% CI, 1.1–2.8) ( Park et al, 2023 ).…”