Posted in diabetes, food, Health, news

Doctors May Fail to Recognize Type 1.5 Diabetes

A form of diabetes, having features that overlap with both Type 1 and Type 2 diabetes, has been given the name, Type 1.5 Diabetes.  Researchers suggest that Latent Autoimmune Diabetes in Adults (LADA), may comprise 10% of the diabetic population, and require insulin treatment be instituted earlier than in those previously diagnosed with Type 2 diabetes, because they may have an autoimmune etiology (seen in Type 1 diabetics)…… hence a Diabetes Type 1.5.

Type I vs. Type II vs. Type 1.5 Diabetes

Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need.  Insulin has to be administered regularly.

Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes,  occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance.  This is the fastest growing type of diabetes in both children and adults.

So Type 1.5 Diabetes may develop after childhood, as a working pancreas may, during adulthood, become damaged by the body’s immune system or, suggested by some, a virus.  Those with Type 1.5 diabetes therefore may not be obese, may have had difficulty managing their blood sugar by diet and exercise alone, and may need assistance with insulin supplementation.  If medical providers don’t recognize this early, and appropriate treatment is delayed, a patient may suffer multiple health issues and risks the longer their blood glucose levels are uncontrolled.

What is Diabetes?

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly.  When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function.  They get absorbed in the small intestine and make it to the blood stream.   In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in.  It’s similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter.  Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.

Diabetes Explained

So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell.  Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce.  The kidneys are going to want dump the excess sugar, so to do so, one would urinate more, again causing thirst.  So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Complications of Diabetes

Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.

Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst.  Moreover, high blood sugar weakens blood vessels.

Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.

Infections – pathogens love sugar. Its food for them.  Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.

Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.

Dementia – as with the heart and other organs, the brain needs healthy blood and flow.  Diabetes has been found to increase risk of Alzheimer’s as well.

What is insulin resistance?

Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance.  It’s also been associated with an increase in heart disease.

Blood sugar numbers

If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic.  Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl.  If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.

 

dmp-blood-sugar-levels-chart

SOURCE DIABETESMEALPLANS.COM

 

Preventing/Controlling Diabetes

1/3 of American adults are currently pre-diabetic.  Experts predict 1/3 of US Adults will be diabetic by the year 2050.  Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.

Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.

For more information, visit http://www.diabetes.org/.

 

Can Diet Soda CAUSE Diabetes?

 

 

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Great Gift!!!

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in diabetes, Health, news

Diabetes Again Linked to Pancreatic Cancer

Another study highlights the risk between high blood sugar and pancreatic cancer.

Researchers from Kangbuk Samsung Hospital in Seoul found as study participants’ blood sugar rose so did their incidence of pancreatic cancer.  Some theories behind one getting cancer could be the following:

  • A virus causes a pancreas to decrease its insulin producing capabilities and this same virus may be culprit in future cancer
  • One with a high sugar diet may be over consuming what the pancreas can handle and the overwork puts one at risk of cancer

According to the CDC, 30.3 million people in the US have diabetes, and at least 100 million Americans suffer from pre-diabetes or diabetes.

Previously the 7th leading killer of Americans, diabetes affects so many people that it has now become third leading cause of death in the US.  A study in 2017 found 12% of deaths in the US is caused by diabetes, trailing behind heart disease and cancer, ranked at #1 and #2.

What is Diabetes?

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly.  When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function.  They get absorbed in the small intestine and make it to the blood stream.   In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in.  It’s similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter.  Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.

Diabetes Explained

So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell.  Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce.  The kidneys are going to want dump the excess sugar, so to do so, one would urinate more, again causing thirst.  So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Complications of Diabetes

Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.

Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst.  Moreover, high blood sugar weakens blood vessels.

Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.

Infections – pathogens love sugar. Its food for them.  Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.

Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.

Dementia – as with the heart and other organs, the brain needs healthy blood and flow.  Diabetes has been found to increase risk of Alzheimer’s as well.

Type I vs. Type II Diabetes

Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need.  Insulin has to be administered regularly.

Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes,  occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance.  This is the fastest growing type of diabetes in both children and adults.

What is insulin resistance?

Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance.  It’s also been associated with an increase in heart disease.

Blood sugar numbers

If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic.  Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl.  If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.

 

dmp-blood-sugar-levels-chart

SOURCE DIABETESMEALPLANS.COM

Preventing/Controlling Diabetes

1/3 of American adults are currently pre-diabetic.  Experts predict 1/3 of US Adults will be diabetic by the year 2050.  Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.

Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.

For more information, visit http://www.diabetes.org/.

What are the risk factors for pancreatic cancer?

Known risk factors for pancreatic cancer include:

  • Older individuals
  • Male (though women are affected as well)
  • Diabetes
  • Alcohol use
  • Chronic pancreatitis
  • Genetics
  • African-American descent
  • Ashkenazi Jewish descent
  • Obesity
  • High fat diet
  • Hepatitis B
  • H. pylori infection
  • BRCA1 or BRCA2 mutations
     

    Can Diet Soda CAUSE Diabetes?

Artificial sweeteners have been linked to diabetes and diabetes is a risk factor for pancreatic cancer.  Their relationship to pancreatic cancer, however, still remains controversial.

 

ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Health, news, Social Media

Social Media Posts Can Indicate Medical Conditions

For years we’ve been hearing stories of children being diagnosed with brain tumors or liver disorders based on followers viewing their picture on social media and alerting parents to suspicious findings.  Now a study, published in PLOS One, finds 21 different medical conditions to be revealed based on the vocabulary people use when posting on their timeline.

dolphin.jpg

Penn State and Stony Brook medical researchers reviewed thousands of Facebook status updates and found certain key words surface more often with those having specific conditions.

 

journal.pone.0215476.g002.PNG

image from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215476

 

For Diabetes, for examples, key words included: pray, family, blessed, very, thank, thankful, doctor, blood, hospital

For Sexually Transmitted Illnesses, there were many expletives as well as the terms cry, scream, away, guess, wow and babe

For Drug Abuse, there were many expletives as well as well as the terms nobody, everybody, stop, call, text and bored

For High Blood Pressure, terms that commonly surfaced included doctor, blood, hospital, mother, good, peace, rip. 

MedicalXpress reports:

Some of the Facebook data that was found to be more predictive than demographic data seemed intuitive. For example, “drink” and “bottle” were shown to be more predictive of alcohol abuse. However, others weren’t as easy. For example, the people that most often mentioned religious language like “God” or “pray” in their posts were 15 times more likely to have diabetes than those who used these terms the least. Additionally, words expressing hostility—like “dumb” and some expletives— served as indicators of drug abuse and psychoses.
“Our digital language captures powerful aspects of our lives that are likely quite different from what is captured through traditional medical data,” said the study’s senior author Andrew Schwartz, Ph.D., a visiting assistant professor at Penn in Computer and Information Science, and an assistant professor of Computer Science at Stony Brook University. “Many studies have now shown a link between language patterns and specific disease, such as language predictive of depression or  that gives insights into whether someone is living with cancer. However, by looking across many medical conditions, we get a view of how conditions relate to each other, which can enable new applications of AI for medicine.”

The concept of using a “digital language” to help identify certain risk factors is nothing new when it comes to mental illness but is virgin territory when we discuss endocrinology conditions such as diabetes.

More research obviously needs to be done, however, this study demonstrates that not only can our physical actions tune a medical provider into our pathology but so can our social media behavior.

 

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Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

 

Posted in Health

Half of Americans at Risk for a Heart Attack

A report published in the American Heart Association’s Heart and Stroke Statistics annual report cite 48% of US adults have some type of cardiovascular disease.

The uptick could be due to rising obesity, and lowering thresholds for diagnosing guidelines such as high blood pressure (now considered high if over 130/80).

Although smoking rates have declined over the years, many still use tobacco and recent research has found E-cigs to increase risk of heart attack and stroke by 70%.

 

What is a stroke?

A stroke occurs when an area of the brain does not get the proper oxygen and blood flow it needs. There are two major types of stroke:  ischemic and hemorrhagic.

Ischemic strokes are more common than the latter and occur when a clot prevents blood flow to part of the brain.  80% of all strokes fall under ischemic.  It is a likened to a heart attack, except the brain tissue is being deprived of blood and nutrients.  Plaques commonly arise from arteriosclerosis that break off travel to the smaller vessels of the brain.

Hemorrhagic strokes are less common and occur when there is a bleed of one of the brain vessels.  The bleed prevents blood flow into the brain since it is seeping outside the brain tissue, causing damage to nearby cells.  The bleeds could occur from high blood pressure or aneurysms that rupture.

 

What are the signs of a stroke?

Since a clot or bleed usually affect one area of the brain, we see symptoms on one side of the body, many times its contralateral (opposite) side.  We can also see central effects.  The symptoms of stroke include the following:

  • Weakness of one side of the body
  • Loss of balance
  • Numbness on one side of the body
  • Slurred speech
  • Vision issues
  • Headache
  • Facial droop

and more…..

 

How are strokes treated?

If the stroke was caused by a clot (ischemic) immediate treatment includes dissolving/removing the clot.   Aspirin is used initially and if within the proper time frame, tissue plasminogen activator (TPA).  These clots can also be surgically removed and arteries widened to bring blood flow to the brain.

With a hemorrhagic  stroke, we need to stop the bleed and improve flow to the brain.  Controlling the bleed, bypassing the vessel, “clogging” the aneurysm with techniques such as “coiling” (endovascular embolization) are sometimes utilized.

Time is of the essence, so its crucial to identify the warning signs and call 911 immediately.  The American Stroke Association uses the acronym “FAST” (Facial drooping, Arm weakness, Speech difficulty, and Time to call 911).  The sooner a stroke victim receives medical attention the better the prognosis.

 

fast

COURTESY OF THE AMERICAN STROKE ASSOCIATION

 

What are the risk factors for stroke?

The following put us at risk of having a stroke.

  • High blood pressure
  • Family history of stroke
  • Diabetes
  • Cardiovascular disease (artery clogging, such as the heart and carotid arteries)
  • Abnormal heart rhythms, such as atrial fibrillation
  • Smoking
  • Drugs
  • Obesity
  • Inactivity
  • Clotting disorder
  • Sleep apnea
  • Being older (greater than 55)
  • African-Americans appear to be more at risk than Caucasians and Hispanics
  • Men seem to be more affected than women

 

How do we prevent strokes?

Avoid the following:

  • Excessive drinking
  • Drug use
  • Tobacco products
  • Control blood pressure, sugar and cholesterol
  • Get evaluated by a medical provider if at risk for heart disease or stroke.

 

Preventing Heart Disease

Firstly, we must know our risk factors. These include:

Family history of heart disease

Personal history of heart disease

High Blood Pressure

High Cholesterol

Diabetes

Smoking

Obesity

Inactivity

Males over 40

Females who are post menopausal

High stress

and even short stature has been cited as a potential risk factor.

As you can see, many of us can be at risk for heart disease.  Therefore secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.

Thirdly, reduce your risk by the following:

Maintain a normal blood pressure

Maintain normal blood sugar

Maintain normal cholesterol and lipid levels

Reduce stress

Maintain a balanced diet, rich in potassium-rich foods such as fruits and vegetables

Quit smoking

Stay active

Maintain a healthy weight.

 

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Entertainment, Health, news

Penny Marshall Dies at Age 75 From Complications Due to Diabetes

Actress, director, and producer, Penny Marshall, passed away Monday from complications due to diabetes.

The 75-year-old icon had been most known for her roles in Laverne and Shirley, Happy Days and Odd Couple.

She also made famous a “pepsi and milk” drink she would tout on her sitcom.

pepsi

She had been diagnosed with stage 4 lung cancer in 2009-2010 and was reportedly in remission by 2013.

Complications due to diabetes can include cardiovascular disease, stroke, and renal failure.

This is a developing story.

 

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

 

Posted in diabetes, food, Health, news

Leftover Pasta May Be Better For Diabetics than Freshly Made

Pasta is usually a no-no for those with high blood sugar as it has a high glycemic index. But researchers reveal a trick to allow those with diabetes to enjoy the popular dish:  cooling and then reheating it the next day.

Express.co.uk reports the following:

 ……eating cooled or reheated pasta can help reduce the rise of blood glucose levels, according to an experiment led by the University of Surrey’s Dr Denise Robertson and TV doctor Chris van Tulleken.
This is because when starch is cooked in water and then cooled, it changes shape.
The new structure is resistant to enzymes in the body so can’t be digested, becoming what is known as ‘resistant starch’.
When regular starch becomes resistant starch, most of the sugars it contains aren’t released in the gut, meaning the body will take in fewer calories from the same food.

When study authors tested their theory, they found cooled and reheated pasta did not cause the same spike in blood sugar as freshly made pasta.  There was still a surge in blood sugar, but not as much.

What is resistant starch?

There are four classifications of resistant starch.

resistant starch 1.jpg

Resistant starches get their name by being “resistant” to digestion.  They are carbohydrates that don’t get broken down as easily and act like fiber. The less they are digested, the less their “sugar” can enter the blood stream (diabetes explained below).  Starches that are cooled and then reheated undergo changes in their carbohydrate composition, rendering them less vulnerable to enzymatic breakdown.

Foods with resistant starches are found to be more beneficial when it comes to  insulin sensitivity and gut health.  They include:

  • Legumes
  • Oats
  • Green Bananas
  • Whole grains
  • Cooked and cooled rice and potatoes

 

resistant-starch-1024x986.jpg

 

What is Diabetes?

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly.  When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function.  They get absorbed in the small intestine and make it to the blood stream.   In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in.  It’s similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter.  Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.

Diabetes Explained

So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell.  Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce.  The kidneys are going to want dump the excess sugar, so to do so, one would urinate more, again causing thirst.  So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Complications of Diabetes

Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.

Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst.  Moreover, high blood sugar weakens blood vessels.

Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.

Infections – pathogens love sugar. Its food for them.  Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.

Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.

Dementia – as with the heart and other organs, the brain needs healthy blood and flow.  Diabetes has been found to increase risk of Alzheimer’s as well.

Type I vs. Type II Diabetes

Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need.  Insulin has to be administered regularly.

Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes,  occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance.  This is the fastest growing type of diabetes in both children and adults.

What is insulin resistance?

Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance.  It’s also been associated with an increase in heart disease.

Blood sugar numbers

If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic.  Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl.  If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.

 

dmp-blood-sugar-levels-chart

SOURCE DIABETESMEALPLANS.COM

Preventing/Controlling Diabetes

1/3 of American adults are currently pre-diabetic.  Experts predict 1/3 of US Adults will be diabetic by the year 2050.  Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.

Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.

For more information, visit http://www.diabetes.org/.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

Posted in diabetes, Health, medications, news

Genital Gangrene Linked to Newer Class of Diabetes Medications

The FDA has issued a warning for the class of diabetic medications, the sodium-glucose cotransporter-2 (SGLT2) inhibitors, following reports of Fournier’s gangrene, or necrotizing fasciitis of the perineum.

SGLT2 inhibitors are sometimes used to lower blood sugar in diabetics.  They work by preventing the body from reabsorbing glucose (sugar), forcing it to be excreted in the urine.

 

SGLT_kidneys-621x248

Image from Sirona Biochem

 

Medscape lists the common drugs in this class:

  • Canagliflozin (InvokanaInvokamet, Invokamet XR; Janssen)
  • Dapagliflozin (FarxigaXigduo XRQtern, AstraZeneca)
  • Empagliflozin (JardianceGlyxambi, Synjardy, Synjardy XR; Boehringer Ingelheim/Eli Lilly)
  • Ertugliflozin (Steglatro, Segluromet, Stelujan; Merck)

 

12 cases had been reported to the FDA, seven of which were men, and five were women, all having had taken an SGLT2 inhibitor. One died, despite treatment.

Last summer, Liu et al published a study in Scientific Reports suggesting an “increased risk of genital infections with SGLT2 inhibitors.”

Symptoms of Fournier’s gangrene may begin with fever, pain, redness or swelling that may occur behind and around the area of the genitalia.  Then necrotizing fasciitis ensues when the infection spreads rapidly across (and killing) the fascia, fibrous tissue that surrounds the muscles and organs.  Anyone experiencing any of the above symptoms must see a medical provider immediately.

The FDA reports the following:

Patients should seek medical attention immediately if you experience any symptoms of tenderness, redness, or swelling of the genitals or the area from the genitals back to the rectum, and have a fever above 100.4 F or a general feeling of being unwell. These symptoms can worsen quickly, so it is important to seek treatment right away.
Health care professionals should assess patients for Fournier’s gangrene if they present with the symptoms described above. If suspected, start treatment immediately with broad-spectrum antibiotics and surgical debridement if necessary. Discontinue the SGLT2 inhibitor, closely monitor blood glucose levels, and provide appropriate alternative therapy for glycemic control.
Fournier’s gangrene is an extremely rare but life-threatening bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels of the perineum. The bacteria usually get into the body through a cut or break in the skin, where they quickly spread and destroy the tissue they infect. Having diabetes is a risk factor for developing Fournier’s gangrene; however, this condition is still rare among diabetic patients. Overall published literature about the occurrence of Fournier’s gangrene for men and women is very limited. Publications report that Fournier’s gangrene occurs in 1.6 out of 100,000 males annually in the U.S., and most frequently occurs in males 50-79 years (3.3 out of 100,000).1-3 In our case series, however, we observed events in both women and men.
In the five years from March 2013 to May 2018, we identified 12 cases of Fournier’s gangrene in patients taking an SGLT2 inhibitor. This number includes only reports submitted to FDA* and found in the medical literature,4-6 so there may be additional cases about which we are unaware. In 2017, an estimated 1.7 million patients received a dispensed prescription for an SGLT2 inhibitor from U.S. outpatient retail pharmacies.7Although most cases of Fournier’s gangrene have previously been reported in men, our 12 cases included 7 men and 5 women. Fournier’s gangrene developed within several months of the patients starting an SGLT2 inhibitor and the drug was stopped in most cases. All 12 patients were hospitalized and required surgery. Some patients required multiple disfiguring surgeries, some developed complications, and one patient died. In comparison, only six cases of Fournier’s gangrene (all in men) were identified in review of other antidiabetic drug classes over a period of more than 30 years.

This is a developing story.

 

dw sketch.jpg

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada