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Amphetamine-Like Analogues in Diabetes: Speeding towards Ketogenesis
Natalia M Branis1, Steven D Wittlin1
1Division of Endocrinology, Diabetes and Metabolism, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, P.O. Box 693, Rochester, NY 14642, USA.
Case Reports in Endocrinology
|May 12, 2015
Summary
Weight loss drugs like Diethylpropion can trigger diabetic ketoacidosis (DKA) in patients with diabetes. This occurs due to increased norepinephrine, leading to ketosis, especially with insulin deficiency.
Area of Science:
- Endocrinology
- Pharmacology
- Metabolic Disorders
Background:
- Obesity is a prevalent comorbidity in patients diagnosed with type 1 and type 2 diabetes mellitus.
- Amphetamine-like analogues are frequently prescribed weight loss medications.
Purpose of the Study:
- To report a case of diabetic ketoacidosis (DKA) precipitated by Diethylpropion, an amphetamine-like analogue, in a patient with type 1 diabetes.
- To elucidate the mechanism by which amphetamine-like analogues may induce ketosis, particularly in individuals with diabetes.
Main Methods:
- A clinical case presentation of a 34-year-old female with type 1 diabetes, obesity, and dyslipidemia.
- Review of patient's symptoms, laboratory findings (blood glucose, pH, bicarbonate, anion gap, ketones), and medication history.
- Discussion of the pharmacological effects of amphetamine-like analogues on norepinephrine and ketone body metabolism.
Main Results:
- The patient developed severe hyperglycemia (718 mg/dL), metabolic acidosis (pH 7.32), and ketosis (large urine ketones, anion gap 19 mmol/L) shortly after initiating Diethylpropion.
- Diabetic ketoacidosis (DKA) was diagnosed and successfully treated with discontinuation of Diethylpropion.
- The patient's condition resolved with standard DKA management and medication cessation.
Conclusions:
- Amphetamine-like analogues, through norepinephrine release, can promote ketogenesis and impair ketone clearance.
- This effect is significantly augmented in patients with insulin deficiency, increasing the risk of diabetic ketoacidosis (DKA).
- Clinicians should exercise caution when prescribing these agents to diabetic patients, especially those with poor glycemic control.
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