Over a span of several months, I helped care for three separate patients taking sodium-glucose cotransporter-2 (SGLT2) inhibitors for at least the past 2 years who presented to the ICU with euglycemic diabetic ketoacidosis (DKA) within a few weeks of initiating a keto diet.
These days, SGLT2 inhibitors are being prescribed so frequently, it sometimes feels like they’ve been added to the water supply. Yet, most of us can agree that they aren’t always safe, and several US Food and Drug Administration (FDA) warnings have been added or strengthened for [acute kidney injury], [urinary tract infection], and euglycemic DKA.
The FDA warning on euglycemic DKA focuses on pausing SGLT2 inhibitors for several days prior to surgery and asks patient to tell their healthcare professional about any of the following DKA risk…