AI Article Synopsis
- Glucagon-like peptide-1 (GLP-1) is important for managing blood sugar and weight, and dulaglutide, a GLP-1 receptor agonist, helps control blood glucose but may cause gastrointestinal issues and diabetic ketoacidosis (DKA).
- A 50-year-old female with diabetes transitioned from insulin to dulaglutide but developed severe nausea and was later diagnosed with DKA, highlighting potential risks.
- After switching back to insulin, her blood glucose levels improved, emphasizing the need for careful monitoring and considering GLP-1RAs in patients with different types of diabetes.
Article Abstract
Rationale: Glucagon-like peptide-1 is an endogenous incretin that plays an active role in weight loss and hypoglycemia. Dulaglutide is a long-acting glucagon-like peptide-1 receptor agonist (GLP-1RA), which has been approved for the treatment of patients with type 2 diabetes (T2D). GLP-1RAs can increase insulin secretion and inhibit glucagon release, thereby leading to a decrease in blood glucose levels within the body. Specifically, GLP-1RAs control postprandial blood glucose levels by inhibiting hepatic glucose production and delaying gastric emptying. However, attention should be given to gastrointestinal adverse reactions. There are currently a few cases of GLP-1RA causing diabetic ketoacidosis (DKA).
Patient Concerns: The following report details the case of a 50-year-old Chinese female who has been living with diabetes for 12 years. Initially diagnosed with T2D, she was subsequently identified as a patient with latent autoimmune diabetes in adults (LADA) following treatment. The patient presented severe nausea, vomiting, and fatigue 1 day after injecting dulaglutide 1 time and discontinuing insulin therapy. She was diagnosed with severe DKA in the emergency department.
Diagnoses: LADA and DKA.
Interventions: Changed from dulaglutide to insulin therapy.
Outcomes: After discontinuing dulaglutide and switching to insulin for blood glucose reduction, the patient's DKA was corrected, and blood glucose levels returned to normal.
Lessons: This case suggests that clinicians should be alert to patients with severe DKA in cases of severe gastrointestinal adverse reactions after the use of GLP-1RAs. In addition, in most countries, GLP-1RAs are administered to patients with T2D, but we should consider the use of GLP-1RAs in patients with type 1 diabetes and LADA.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441871 | PMC |
| http://dx.doi.org/10.1097/MD.0000000000039799 | DOI Listing |
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