Japanese cases of acute onset diabetic ketosis without acidosis in the absence of glutamic acid decarboxylase autoantibody

Iwasaki, Yorihiro; Hamamoto, Yoshiyuki; Kawasaki, Yukiko; Ikeda, Hiroki; Honjo, Sachiko; Wada, Yoshiharu; Koshiyama, Hiroyuki

doi:10.1007/s12020-009-9301-0

Cited by 10 publications

(10 citation statements)

References 13 publications

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“…Diabetic ketonuria is common among newly diagnosed or untreated patients with T2D and has been used to predict pathologic features or metabolic acidosis 14. Among Japanese patients with acute onset diabetic ketosis, there was a preponderance of males 24. The present study obtained similar results: T2DK was poorly controlled and male in the majority.…”

Section: Discussionsupporting

confidence: 77%

Evaluation of Ischemia-Modified Albumin and C-Reactive Protein in Type 2 Diabetics with and without Ketosis

Yao

Wen

et al. 2012

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OverviewTo investigate whether serum ischemia-modified albumin or C-reactive protein is reliable for predicting type 2 diabetic patients with ketosis.ApproachOne hundred and four diabetic patients, 48 with diabetic ketosis, and 33 controls were enrolled in the study. Serum ischemia-modified albumin and C-reactive protein were measured and evaluated for their ability to distinguish diabetic ketosis.ResultsCompared to the controls, the ischemia-modified albumin and C-reactive protein levels were higher in patients with diabetic ketosis and type 2 diabetes at the baseline. The levels of ischemia-modified albumin were higher in patients with type 2 diabetes than in the controls. C-reactive protein and ischemia-modified albumin levels were reduced after insulin treatment. The level of ischemia-modified albumin was an independent risk marker for diabetic ketosis (OR = 1.085, P = 0.008, 95% CI: 1.022–1.152). Receiver operating characteristic curves revealed that the areas under the curve were 0.917 for the modified albumin and 0.357 for C-reactive protein.ConclusionThis study indicates that ischemia-modified albumin was significantly associated with diabetic ketosis and was more sensitive than C-reactive protein in reflecting diabetic ketosis.

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Section: Discussionsupporting

confidence: 77%

Evaluation of Ischemia-Modified Albumin and C-Reactive Protein in Type 2 Diabetics with and without Ketosis

Yao

Wen

et al. 2012

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“…He had consumed 1-3 liters of sweet beverages daily until admission, in an effort to quench his thirst. The observations made in this case, taken together, indicated that he was suffering from "soft-drink diabetic ketosis" [5]. The blood triglyceride and total cholesterol levels were extremely elevated, having reached 5,449 mg/dL and 718 mg/dL, respectively ( Table 2).…”

Section: Case Presentationmentioning

confidence: 75%

“…Soft-drink diabetic ketosis has an acute onset and is induced by excessive ingestion of sugar-containing soft drinks in obese type 2 diabetic patients, and has most commonly been reported in Japanese subjects [5][6][7]. Soft-drink diabetic ketosis shows a male predominance, a tendency for obesity, family history of type 2 diabetes mellitus, and patients are generally negative for antiglutamic acid decarboxylase (GAD) antibody.…”

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confidence: 99%

Eruptive xanthomas in a patient with soft-drink diabetic ketosis and apolipoprotein E4/2

et al. 2019

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Soft-drink diabetic ketosis, characterized by acute onset ketosis induced by excessive ingestion of sugar-containing drinks, is often seen in obese, young patients, even with undiagnosed type 2 diabetes. We herein report a 15-year-old obese patient with the apolipoprotein E4/2 phenotype, in whom eruptive xanthomas lead to a diagnosis of soft-drink diabetic ketosis. He developed multiple asymptomatic yellowish papules on the auricles, back, buttocks and the extensor surfaces of the elbows and knees. He initially visited a dermatology clinic and his blood triglyceride and HbA1c levels were found to be 6,490 mg/dL and 16.5%, respectively. He was referred to our hospital for treatment of hyperglycemia and hypertyriglyceridemia. On admission, he had ketonuria and increased blood levels of 3-hydroxybutylate and acetoacetate. He habitually drank 1-3 litters of sweet beverages daily to quench his thirst. Therefore, "soft-drink diabetic ketosis" was diagnosed. Severe hypertriglyceridemia was considered to have been a consequence of impaired insulin action and his apolipoprotein E4/2 phenotype. We treated the diabetic ketosis and hypertriglyceridemia with intensive insulin therapy and a fat-restricted diet. At discharge, he no longer required insulin therapy and his blood glucose levels were controlled with metformin and voglibose. Along with amelioration of the hyperglycemia, triglyceride levels decreased to 247 mg/dL without administration of anti-hyperlipidemia agents. The eruptive xanthoma lesions gradually diminished in size and number and eventually disappeared by 12 months. This case provides an instructive example of eruptive xanthomas serving as a sign of severe dysregulation, not only of lipid, but also glucose, metabolism.

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“…The present patient did not have such an event. In a report, however, about half of type 2 diabetes patients who developed DKA had no identifiable antecedent or concurrent stressful condition (8).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we diagnosed that her diabetes was type 2. Al- though DKA typically occurs in type 1 diabetes, it is also known to be occur in type 2 diabetes (7,8), under conditions such as serious infection, trauma, cardiovascular emergency, and omission of treatment (1). The present patient did not have such an event.…”

Section: Discussionmentioning

confidence: 99%

A Case of Diabetic Ketoacidosis Associated with Guillain-Barre Syndrome

et al. 2011

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A 64-year-old woman was referred to our center presenting with thirst, malaise, and pain in both legs which occurred one week before admission. She was revealed to have hyperglycemia and diabetic ketoacidosis (DKA). After therapy for diabetic ketoacidosis was started, her blood glucose levels were improved, but urinary ketone body excretion persisted. Laboratory examination indicated a significant impairment of insulin secretion, although anti-GAD and anti-IA-2 antibody were not detected. After admission, she complained about weakness of lower extremities, which spread to her upper extremities. The diagnosis of Guillain-Barré syndrome (GBS) was made based on the nerve conduction study and cerebrospinal fluid analysis. The intravenous immunoglobulin therapy was started, and her muscle weakness showed gradual improvement. Although the possibility that GBS was casually accompanied with DKA could not be completely excluded, we considered that DKA triggered the development of GBS in this case. Although GBS is a rare condition, the present case suggests that GBS should be included in the differential diagnosis of DKA with its atypical course.

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Japanese cases of acute onset diabetic ketosis without acidosis in the absence of glutamic acid decarboxylase autoantibody

Cited by 10 publications

References 13 publications

Evaluation of Ischemia-Modified Albumin and C-Reactive Protein in Type 2 Diabetics with and without Ketosis

Evaluation of Ischemia-Modified Albumin and C-Reactive Protein in Type 2 Diabetics with and without Ketosis

Eruptive xanthomas in a patient with soft-drink diabetic ketosis and apolipoprotein E4/2

A Case of Diabetic Ketoacidosis Associated with Guillain-Barre Syndrome

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