Taking sugar-removing drugs to lower blood sugar, fasting to lose weight and a big belly, actually led to ketoacidosis!

In recent years, the number of people taking sugar-removing drugs has increased significantly due to their effects on weight loss and protecting the heart and kidneys. However, doctors warn that if you take sugar-excreting drugs and rashly adopt fasting to lose weight, you may develop ketoacidosis!

Ms. Cai, 54, is a type 2 diabetes patient who has been taking sugar-excreting drugs (SGLT2 inhibitors) for a long time. Recently, she felt her lower abdomen getting bigger, so she tried fasting to lose weight. She developed general fatigue and shortness of breath, and was diagnosed with ketoacidosis. Cai Minrui, director of the Department of Nephrology at the Changhua Hospital of the Ministry of Health and Welfare, said that in recent years, the number of people taking sugar-excreting drugs has increased significantly due to their effects on weight loss and protecting the heart and kidneys. It is estimated that there are hundreds of thousands of people nationwide. He called on them not to fast or abstain arbitrarily to avoid serious consequences.

Ms. Cai was diagnosed with diabetes 5 years ago. She has been taking sugar-excreting drugs for the past 2 years. Her blood sugar is well controlled, and her glycosylated hemoglobin is mostly less than 7. She recently started a 186-day fast (daily food intake is controlled within 6 consecutive hours, and no food is taken for the other 18 hours). A few days later, she felt weak all over. She thought it was just muscle weakness due to hunger, but she developed shortness of breath, so she rushed to the emergency room for treatment. Her respiratory rate reached 45 beats per minute (normal is about 8 to 12 beats per minute), her blood sugar was 200 mg/dl, and her ketone body data was as high as 4.1 mg/dl (normal value is less than 0.5 mg/dl). She was diagnosed with ketoacidosis and was out of danger after emergency treatment.

Cai Minrui said that there are many kinds of diabetes medications, among which SGLT2 inhibitors are new drugs in recent years. Their mechanism of action is in the renal tubules, which can inhibit the kidney's ability to reabsorb urine sugar and excrete excess sugar from the urine, thereby lowering blood sugar and possibly causing weight loss. Studies have also found that it can reduce the risk of heart failure and delay the progression of kidney disease. Single or combined drugs are regarded as the latest dream drugs for patients with type 2 diabetes in recent years, and the number of users continues to increase.

Cai Minrui said that Ms. Cai had been fasting for a very long time and her sugar intake was insufficient. However, due to the effect of the sugar-excreting drugs, her kidneys were still excreting sugar, which made it impossible for the body to use blood sugar to produce energy. According to the body's mechanism, fat would be broken down to produce fatty acids as the energy needed by the body. The fatty acids were further converted into ketone bodies in the liver, which increased the concentration of ketone bodies in the blood and caused metabolic acidosis, which is ketoacidosis. The clinical symptoms of ketoacidosis are abdominal pain, nausea, vomiting, weakness, and in severe cases, breathing may become faster, panting, and difficulty breathing, which can be fatal.

Cai Minrui pointed out that sugar-excreting drugs cannot be used as medication for patients with type 1 diabetes because the risk of causing ketoacidosis is too high. (Photo courtesy of Changhua Hospital, Ministry of Health and Welfare)

Cai Minrui pointed out that sugar-excreting drugs cannot be used as medication for patients with type 1 diabetes because the risk of causing ketoacidosis is too high. As for type 2 diabetic ketoacidosis, the incidence rate is only about 1%. Although it is not high, the consequences may be serious. The characteristic is that the patient's blood sugar level is usually not high, or even normal, which is called "euglycemic diabetic ketoacidosis (euDKA)".

Sugar-excreting drugs have many benefits for diabetic patients, and their weight loss effect is even more attractive, but it may not be effective for everyone. In this case, Ms. Cai did not lose weight as a result. Instead, she fasted on her own to lose weight, which led to ketoacidosis. In addition, there was another case where 52-year-old Ms. Chen fasted because she had to undergo surgery for a fracture and she also developed ketoacidosis 2 days after the surgery.

Cai Minrui emphasized that most patients know that the most important thing when taking sugar-reducing drugs is to drink plenty of water to avoid urinary tract infections, but they should also pay attention to the risks of fasting or fasting and not try it lightly. If fasting is necessary due to surgery, they should also inform the doctor and evaluate whether to stop the medication or replace it with other blood sugar-lowering drugs.

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