| Popis: |
Gliflozins are synthetic glucose transporter inhibitors and have a blood glucose lowering effect independent of any insulin effect. They induce glucosuria by inhibiting glucose reabsorption from the urine volume. Case: A 58 year old white male, 4 years since diabetes diagnosis and on a As expected, serum glucose was reduced through induced glucosuria by 1-1.5 mmol/L. Other expected effects were polyuria and polydipsia, associated with awakening 4-6 times per night. Some loss of weight was recorded, but whether this relates to glucose loss or the near-diarrhoeal intestinal side effect is difficult to determine. Shortly after commencing treatment, a serum lipid test was conducted indicating dyslipidaemia and insulin resistance. A further serum lipid test following a two week cessation of Dapagliflozin near the middle of the 5 month treatment period resulted in a reversion to a lipids profile prior to treatment. The glucagon stimulation by gliflozins was noted as an increased fasting glucose concentration from approximately 8-10 mmol/L to 12-16 mmol/L before and after treatment. It is unknown whether this would be self-correcting as Glipizide, and subsequently insulin, treatment commenced. Although glucagon stimulation has been suggested to occur via SGLT2 inhibition of pancreatic α-cells, the presence of SGLT2 here is disputed. However, gastrointestinal α-cells could be the glucagon source associated with SGLT1 inhibition. |
