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Side effects that carry a certain moral fuzziness, enough to make even art gallerists like Ellie Rines skittish: If someone can turn down a cookie, they can turn down the delicious satisfaction of buying an artwork, too

Why Blood Sugar May Not Be Very High In classic DKA: Insulin deficiency severe hyperglycemia In euglycemic DKA: Some insulin is still being administered Blood glucose may appear only mildly elevated But insulin is insufficient to prevent ketogenesis This can delay recognition because: Patients and clinicians may not suspect DKA with glucose under 250 mg/dL Symptoms may initially resemble dehydration or GI illness Additional Contributing Factors GLP-1 use in Type 1 diabetes may also increase DKA risk due to: Vomiting dehydration stress hormones ketone rise Intentional insulin reduction due to fear of hypoglycemia Reduced basal insulin during weight loss Increased glycemic variability from delayed gastric emptying Hypoglycemia and the Insulin Reduction Trap Another issue is the cycle that can develop: Appetite decreases Insulin dose is reduced Hypoglycemia occurs intermittently Insulin is reduced further Ketone production increases Over time, this can push the patient into metabolic instability

Label each vial with the date received and the lot number

Ehtisham, S., Crabtree, N., Clark, P., Shaw, N

Methods: In this retrospective cohort study, we included all patients with type 2 diabetes on antidepressant medications referred to our endocrine clinics between January 1, 2016, and January 1, 2017