Patients on SGLT2 inhibitors forget sick-day advice given at the first prescription, and ketoacidosis on these drugs can present with glucose that looks reassuring.
Make the instruction short, written and repeated: pause the SGLT2 inhibitor if vomiting, unable to eat or drink normally, febrile with infection, drinking heavily, or before planned surgery or a procedure. Restart once eating and drinking normally. Keep insulin going in insulin-treated patients, even with poor intake.
If the patient can test ketones, tell them when to test and what level means they should seek care. In an unwell patient on the drug, check ketones or venous gas regardless of the glucose reading.
- Write the sick-day rules on the prescription or discharge card
- Ask at each visit: 'What do you do with this tablet if you are ill?'
- Stop the drug about three days before major planned surgery and restart when eating normally
- Test ketones in any unwell patient on an SGLT2 inhibitor, whatever the glucose
Why it matters
Sick-day counselling should not stop after the first prescription.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for diabetes & endocrinology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free