[Preview] Q&A about ketosis with Dr. Dominic D’Agostino

[Preview] Q&A about ketosis with Dr. Dominic D’Agostino

November 2, 2019 4 By William Morgan


There is a clinical issue in the management
of diabetes that I’m worried about
and it’s the state of pharmacologic ketosis
using powerful drugs.
I have heard this term used now
in the endocrinology world
and there are these drugs
called SGLT-2 inhibitors.
Can you shed any light on the idea
that you can have ketoacidosis
with normal glycemia?
And I’ve never seen ketoacidosis
with nutritional ketosis
in 10 years of clinical practice
until one of my patients
was on one of these SGLT-2 inhibitors
and I’m concerned that there’s
an underlying disaster waiting to happen
and we need to know
why these drugs do what they do
and until we have more research I advise
people not to take those medications.
Yeah, that’s really interesting to hear.
You know as of now
we don’t do any research on that
so I’m usually hesitant to talk
about things that don’t directly study,
but it does sound like it’s…
So you saw ketoacidosis in a patient,
normal glycemic,
but something…
what was their insulin levels?
So that’s an important question
because, you know, insulin really parallels…
insulin is low, Ketogenesis goes up
and vice versa.
Like you saw the study
with fasting patients
when you inject someone who’s fasting
no food coming in,
their glucose goes down and their
beta hydroxybutyrate goes down because…
But you can have
runaway Ketogenesis if your insulin…
Like I have a student that’s type 1 diabetic
and he follows interestingly
a low-carb ketogenic diet
and he can cut his insulin
by like 70% or 80%.
He does much better,
I feel much safer with him being on it,
he has much less lows
and much less, you know, highs
and if we look at his Dexcom
instead of going like this, it’s like this.
You know it’s like really tight.