Diabetic ketoacidosis: Difference between revisions

Drugs in the [[SGLT2 inhibitor|gliflozin]] class ([[SGLT2]] inhibitors), which are generally used for type 2 diabetes, have been associated with cases of diabetic ketoacidosis where the blood sugars may not be significantly elevated ("euglycemic DKA").<ref name=Goldenberg2016>{{cite journal |last1=Goldenberg |first1=RM |last2=Berard |first2=LD |last3=Cheng |first3=AYY |last4=Gilbert |first4=JD |last5=Verma |first5=S |last6=Woo |first6=VC |last7=Yale |first7=JF |title=SGLT2 Inhibitor-associated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis. |journal=Clinical Therapeutics |date=December 2016 |volume=38 |issue=12 |pages=2654–2664.e1 |doi=10.1016/j.clinthera.2016.11.002 |pmid=28003053}}</ref> While this is a relatively uncommon adverse event, it is thought to be more common if someone receiving an SGLT2 inhibitor who is also receiving insulin has reduced or missed insulin doses. Furthermore it can be triggered by severe acute illness, dehydration, extensive exercise, surgery, low-carbohydrate diets, or excessive alcohol intake.<ref name=Goldenberg2016/> SGLT2 inhibitors should be stopped before surgery and only recommenced when it is safe to do so.<ref>{{Cite journal|last1=Milder|first1=D. A.|last2=Milder|first2=T. Y.|last3=Kam|first3=P. C. A.|date=August 2018|title=Sodium-glucose co-transporter type-2 inhibitors: pharmacology and peri-operative considerations|journal=Anaesthesia|language=en|volume=73|issue=8|pages=1008–1018|doi=10.1111/anae.14251|pmid=29529345|doi-access=free}}</ref> SGLT2 inhibitors may be used in people with type 1 diabetes, but the possibility of ketoacidosis requires specific risk management. Specifically, they should not be used if someone is also using a [[low carbohydrate diet|low carbohydrate]] or [[ketogenic diet]].<ref name=Dan2019>{{cite journal |last1=Danne |first1=Thomas |last2=Garg |first2=Satish |last3=Peters |first3=Anne L. |last4=Buse |first4=John B. |last5=Mathieu |first5=Chantal |last6=Pettus |first6=Jeremy H. |last7=Alexander |first7=Charles M. |last8=Battelino |first8=Tadej |last9=Ampudia-Blasco |first9=F. Javier |last10=Bode |first10=Bruce W. |last11=Cariou |first11=Bertrand |last12=Close |first12=Kelly L. |last13=Dandona |first13=Paresh |last14=Dutta |first14=Sanjoy |last15=Ferrannini |first15=Ele |last16=Fourlanos |first16=Spiros |last17=Grunberger |first17=George |last18=Heller |first18=Simon R. |last19=Henry |first19=Robert R. |last20=Kurian |first20=Martin J. |last21=Kushner |first21=Jake A. |last22=Oron |first22=Tal |last23=Parkin |first23=Christopher G. |last24=Pieber |first24=Thomas R. |last25=Rodbard |first25=Helena W. |last26=Schatz |first26=Desmond |last27=Skyler |first27=Jay S. |last28=Tamborlane |first28=William V. |last29=Yokote |first29=Koutaro |last30=Phillip |first30=Moshe |authorlink24= Thomas Pieber|title=International Consensus on Risk Management of Diabetic Ketoacidosis in Patients with Type 1 Diabetes Treated with Sodium-Glucose Cotransporter (SGLT) Inhibitors |journal=Diabetes Care |volume=42 |issue=6 |date=6 February 2019 |pages=1147–1154 |doi=10.2337/dc18-2316|pmid=30728224 |pmc=6973545 |quote=As a general guideline, SGLT-inhibitor therapy should not be used in patients using lowcarbohydrate or ketogenic diets as, anecdotally, they seem to be at increased risk of adverse ketosis effects|doi-access=free }}</ref>