Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulin
Background/objective: A 26-year-old Taiwanese woman with type 1 diabetes mellitus developed diabetic ketoacidosis after missing a premixed insulin dose. The case is notable for recurrent ketosis and hyperglycemia despite a 6-h overlap during the transition from intravenous to subcutaneous insulin th...
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Elsevier
2025-06-01
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| Series: | Journal of Clinical and Translational Endocrinology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214624525000097 |
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| author | Hsin-I Chi Ye-Fong Du |
| author_facet | Hsin-I Chi Ye-Fong Du |
| author_sort | Hsin-I Chi |
| collection | DOAJ |
| description | Background/objective: A 26-year-old Taiwanese woman with type 1 diabetes mellitus developed diabetic ketoacidosis after missing a premixed insulin dose. The case is notable for recurrent ketosis and hyperglycemia despite a 6-h overlap during the transition from intravenous to subcutaneous insulin therapy. The objective of this report is to describe the challenges of transitioning insulin regimens with ultra-long-acting insulin. Case presentation: A 26-year-old woman presented with severe diabetic ketoacidosis, confirmed by laboratory findings of blood glucose at 520 mg/dL, pH 7.14, bicarbonate 8 mmol/L, and serum ketones 5.9 mmol/L. She received intravenous insulin for 48 hours before transitioning to subcutaneous IGlar-300 with a 6-h overlap. Despite initial improvement, ketones rebounded to 4.2 mmol/L with hyperglycemia 7 hours after intravenous insulin discontinuation. Reintroduction of intravenous insulin for 48 hours and subsequent doses of IGlar-300 stabilized her condition, allowing discharge with resolved ketosis and improved glycemic control. Discussion: This case underscores the challenges of transitioning to ultra-long-acting insulin during management of diabetic ketoacidosis. The pharmacokinetics of basal insulin analogs like IGlar-300 may necessitate extended overlap with intravenous insulin to maintain stable glycemic control and prevent rebound ketosis. Conclusion: This case highlights the need for careful management during the transition from intravenous to subcutaneous ultra-long-acting insulin to prevent rebound ketosis. Although not specifically addressed in current guidelines, an extended overlap with intravenous insulin may be required in similar cases. Clinical Relevance: This case underscores the importance of tailored DKA management when using ultra-long-acting insulins, highlighting the need for extended overlap durations to ensure ketone clearance and avoid rebound ketoacidosis. |
| format | Article |
| id | doaj-art-e24cc3f98afa4ddca2921398164e5513 |
| institution | Kabale University |
| issn | 2214-6245 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Clinical and Translational Endocrinology Case Reports |
| spelling | doaj-art-e24cc3f98afa4ddca2921398164e55132025-08-20T03:25:59ZengElsevierJournal of Clinical and Translational Endocrinology Case Reports2214-62452025-06-013610019010.1016/j.jecr.2025.100190Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulinHsin-I Chi0Ye-Fong Du1Department of Internal Medicine, Tainan Municipal Hospital, Tainan, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Corresponding author. Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Shengli Road, North District, Tainan, 70403, Taiwan.Background/objective: A 26-year-old Taiwanese woman with type 1 diabetes mellitus developed diabetic ketoacidosis after missing a premixed insulin dose. The case is notable for recurrent ketosis and hyperglycemia despite a 6-h overlap during the transition from intravenous to subcutaneous insulin therapy. The objective of this report is to describe the challenges of transitioning insulin regimens with ultra-long-acting insulin. Case presentation: A 26-year-old woman presented with severe diabetic ketoacidosis, confirmed by laboratory findings of blood glucose at 520 mg/dL, pH 7.14, bicarbonate 8 mmol/L, and serum ketones 5.9 mmol/L. She received intravenous insulin for 48 hours before transitioning to subcutaneous IGlar-300 with a 6-h overlap. Despite initial improvement, ketones rebounded to 4.2 mmol/L with hyperglycemia 7 hours after intravenous insulin discontinuation. Reintroduction of intravenous insulin for 48 hours and subsequent doses of IGlar-300 stabilized her condition, allowing discharge with resolved ketosis and improved glycemic control. Discussion: This case underscores the challenges of transitioning to ultra-long-acting insulin during management of diabetic ketoacidosis. The pharmacokinetics of basal insulin analogs like IGlar-300 may necessitate extended overlap with intravenous insulin to maintain stable glycemic control and prevent rebound ketosis. Conclusion: This case highlights the need for careful management during the transition from intravenous to subcutaneous ultra-long-acting insulin to prevent rebound ketosis. Although not specifically addressed in current guidelines, an extended overlap with intravenous insulin may be required in similar cases. Clinical Relevance: This case underscores the importance of tailored DKA management when using ultra-long-acting insulins, highlighting the need for extended overlap durations to ensure ketone clearance and avoid rebound ketoacidosis.http://www.sciencedirect.com/science/article/pii/S2214624525000097Rebound ketoacidosisUltra-long-acting insulinProlonged overlap |
| spellingShingle | Hsin-I Chi Ye-Fong Du Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulin Journal of Clinical and Translational Endocrinology Case Reports Rebound ketoacidosis Ultra-long-acting insulin Prolonged overlap |
| title | Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulin |
| title_full | Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulin |
| title_fullStr | Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulin |
| title_full_unstemmed | Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulin |
| title_short | Rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra-long-acting insulin |
| title_sort | rebound ketoacidosis in a patient with diabetic ketoacidosis using ultra long acting insulin |
| topic | Rebound ketoacidosis Ultra-long-acting insulin Prolonged overlap |
| url | http://www.sciencedirect.com/science/article/pii/S2214624525000097 |
| work_keys_str_mv | AT hsinichi reboundketoacidosisinapatientwithdiabeticketoacidosisusingultralongactinginsulin AT yefongdu reboundketoacidosisinapatientwithdiabeticketoacidosisusingultralongactinginsulin |