Ketone bodies produced by sodium-glucose cotransporter 2 (SGLT2) inhibitors can be advantageous, providing an efficient and stable energy source for the brain and muscles. However, in patients with diabetes, ketogenesis induced by SGLT2 inhibitors may be harmful, potentially resulting in severe diabetic ketoacidosis (DKA). During fasting, ketone body production serves as an alternative and efficient energy source for the brain by utilizing stored fat, promoting mental clarity, and reducing dependence on glucose. The concurrent use of SGLT2 inhibitors during perioperative fasting may further elevate the risk of euglycemic DKA. We describe a case of DKA that occurred during perioperative fasting in a patient receiving empagliflozin, an SGLT2 inhibitor. This case underscores the importance of recognizing the potential risk of DKA in patients with diabetes using SGLT2 inhibitors during perioperative fasting.
Background Obesity is considered a state of enhanced oxidative stress as well as chronic and low-grade inflammation. The copper–zinc ratio in obese individuals has been reported to reflect systemic oxidative stress and inflammatory status. We investigated whether the neutrophil–lymphocyte ratio is related to the copper–zinc ratio in hair, within the context of a normal white blood cell count among overweight or obese Korean individuals.
Methods We included 56 participants aged older than 20 years who voluntarily sought weight reduction treatment and met the inclusion criterion of body mass index of 23 kg/m2 or greater. Intra-abdominal visceral adipose tissue was measured by computed tomography imaging, while the copper and zinc levels were measured by hair mineral analysis. Using multiple linear regression analysis, we examined the associations between the neutrophil–lymphocyte ratio and the copper–zinc ratio.
Results The mean age, body mass index, and visceral adipose tissue were 46.0±10.5 years, 29.0±4.1 kg/cm2 , and 142.9±68.8 cm2 , respectively. Pearson’s correlation analysis revealed the association of the neutrophil–lymphocyte ratio with copper level (r=0.475, P<0.001) and copper–zinc ratio (r=0.494, P<0.001). After adjusting for confounding variables, we found the neutrophil–lymphocyte ratio was significantly associated with the level of copper and the copper–zinc ratio in hair (regression coefficient: 0.055±0.015; P<0.001 and regression coefficient: 0.761±0.185; P<0.001, respectively).
Conclusion A higher copper–zinc ratio in hair is positively and independently associated with the neutrophil–lymphocyte ratio. Thus, a high hair copper–zinc ratio could be a useful parameter for oxidative burden of individuals predisposed to obesity-related comorbidity.
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Background : Recently, inflammation has been associated with insulin resistance and the development of type 2 diabetes mellitus. We investigated the relationship between white blood cell (WBC) count and the incidence of hyperglycemia and the interactive effects of smoking and elevated WBC count on hyperglycemia.
Methods : We prospectively examined 6,734 Korean males without IFG (fasting plasma glucose concentration of ≥ 110 mg/dL) or type 2 diabetes mellitus from 1994 to 2002. We divided WBC counts into 4 groups: 2.9∼5.9 (reference quartile), 6.0∼6.9, 7.0∼8.1, 8.2∼16.5 (×103 cells/μL), respectively. The odds ratios were calculated by multiple logistic regression according to WBC quartiles after adjusting for predictive risk factors of type 2 diabetes mellitus. Also the odds ratios were calculated after stratification according to smoking status.
Results : Compaired to reference quartile, the odds ratio for hyperglycemia was 1.09 (95% CI, 0.91∼1.30), 1.17 (95% CI, 0.99∼1.40), 1.34 (95% CI, 1.12∼1.60) (P value for trend=0.0009), respectively. And the odds ratio for IFG or type 2 diabetes mellitus was 1.08 (95% CI, 0.83∼1.42), 1.16 (95% CI, 0.89∼1.50), 1.28 (95% CI, 1.00∼1.65) (P value for trend=0.0395) among the current smoking group, respectively.
Conclusion : Our findings demonstrate that an elevated WBC count is associated with an increased risk of hyperglycemia, particularly in current and former smokers. These results support our hypothesis that inflammation increases the risk of hyperglycemia.
Norovirus is one of the common causative agents of viral gastroenteritis in developed countries. A large outbreak of gastroenteritis occurred among girls' high school students in Cheongju city, Chungbuk province, who had attended a school trip to Cheju island from 19 to 21 May 2003. One hundred and ninety six students were consistent with case definition and attack rate was 54.9%. The epidemic curve was characteristic of a point-source outbreak. The frequency of diarrhea was 1 to 6 times (76.8%) and the duration of diarrhea was within two days (85.1%) in most cases. The most common symptom with diarrhea was abdominal pain followed by headache, tenesmus, febrile sense, chill and vomiting. The following bacterial organisms, Salmonella spp, Shigella spp, Vibrio spp, Staphylococcus aureus, and E coli O157were examined in 196 stool specimens, but no suspicious organism was detected. In virological examinations, Noroviruswas dectected in 3 out of 25 stool specimens from the sick students. Among the 22 stool specimens of the food handlers during the school trip, both bacterial and virological examinations were all negative. Among the 13 environmental specimens, the groundwater of the hotel, where the students had stayed during their school trip, was contaminated with general bacteria and E. Coli. However, we could not detect Norovirus in the groundwater of the hotel. We concluded that Norovirus might be a possible cause of this outbreak, and the water supply of the hotel might be a probable source of this outbreak.
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