Episode 59: When Is Toxicology Biochemistry? Exploring Drugs That Alter Glucose Metabolism

Welcome back to The Tox Lab! We are kicking off 2026 by exploring drugs that disrupt metabolism and the consequences that can follow.

In this episode, we focus on compounds that alter glucose metabolism and the interplay between toxicology and biochemistry. We discuss a fatal case of metformin toxicity and the analytical and interpretive challenges involved in recognising this diagnosis.

We then turn to amphetamine-like weight loss drugs, examining the risks they pose to individuals with diabetes and the evidence linking methamphetamine use to an increased risk of fatal diabetic ketoacidosis. Finally, we explore a case involving SGLT2 inhibitor therapy and unexpected positive urine ethanol results, highlighting the importance of pre-analytical factors and careful interpretation in toxicology.

Join us as we unpack how drugs can interfere with metabolic pathways, why these effects matter clinically, and what toxicologists need to consider when metabolism goes wrong.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/pii/S037907382500324X

https://onlinelibrary.wiley.com/doi/10.1155/2015/917869

https://journals.sagepub.com/doi/10.1177/00258024211020936?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

https://www.nejm.org/doi/full/10.1056/NEJMc2313463

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