Markedly increased serum and urinary fructose concentrations in diabetic patients with ketoacidosis or ketosis

To investigate fructose concentrations in diabetic patients with ketoacidosis or ketosis, serum fructose concentrations and daily urinary fructose excretion were measured in 23 patients with ketoacidosis (n = 16) and ketosis (n = 7) on the first day of admission. Seventeen patients were diagnosed with type 1, one patient with mitochondrial, and 4 patients with atypical diabetes. In 16 of the 23 patients, serum and urinary fructose could be assessed after starting treatments. Mean serum fructose concentration was 71.6 +/- A 108.1 mu mol/l, and mean daily urinary fructose excretion was 352.1 +/- A 473.7 mu mol/day. Serum fructose levels in patients with atypical diabetes were much higher (205.0 +/- A 213.3 mu mol/l) than those in patients with type 1 diabetes (45.1 +/- A 44.5 mu mol/l), while urinary fructose levels in atypical diabetes (249.7 +/- A 92.4 mu mol/day) tended to be lower than those in type 1 diabetes (382.6 +/- A 533.2 mu mol/day). Serum fructose concentrations decreased significantly (P < 0.05) from 88.1 +/- A 126.3 to 18.0 +/- A 11.0 mu mol/l, and daily urinary fructose excretion also decreased significantly (P < 0.05) from 459.8 +/- A 530.9 to 75.1 +/- A 62.0 mu mol/day in accordance with glycemic normalization after treatment. Marked and reversible increases in serum and urinary fructose concentrations were observed in diabetics with ketoacidosis and ketosis.