Archives of General Internal Medicine

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Short Communication - Archives of General Internal Medicine (2019) Volume 3, Issue 2

Euglycemic diabetic ketoacidosis associated with SGLT2 inhibitor use in non-type 1 diabetes mellitus

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been associated with the development of euglycemic diabetic ketoacidosis (EuDKA), a potentially life threatening condition with an indolent presentation. The rates of EuDKA in clinical trial patients with Type 2 Diabetes (T2D) was under 1%, but there is increasing recognition of this complication in hospitalized patients. This report shares our experience of five cases of non-T1D associated EuDKA during an inpatient hospitalization over an 8-month period between October 2015 and June 2016. In our series, two patients had Type 2 Diabetes (T2D) and three had pancreatogenic diabetes, with one presenting post-Whipple?s resection of a pancreatic cyst and two others with acute pancreatitis. The median time to DKA from last dose of SGLT2 inhibitor was 2 days (range 0.75-6). Glucosuria (>1000 mg/dL) with euglycemia was present at diagnosis in all patients and persisted for up to 12 days after discontinuation of the drug. All patients were treated with dextrose and IV or SubQ insulin, depending on the severity of the acidemia. The time to resolution of acidemia was 0.5-4 days. Based on our clinical experience, current recommendations to stop SGLT-2 Inhibitors 24 hours prior to a surgery with a prolonged NPO are not adequate. Additionally, risks can also be minimized by administering basal insulin and empiric dextrose in at risk hospitalized patients who are NPO, despite normal blood sugars.

Author(s): Lorincz Ilona, Kannan Lakshmi, Rickels Michael R

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