People on an SGLT2 inhibitor who become acutely unwell, with vomiting, poor oral intake, fever or before surgery, are at risk of euglycaemic ketoacidosis, where glucose may look near normal while ketones climb. Standard advice is to pause the drug during acute illness or fasting and restart once eating and drinking normally.
Make sure the instruction is written down and covers who to call. Reinforce it at every review, not only at the first prescription. Ketone testing, where available, helps when the person feels unwell but glucose is not high.
In India, where fasting for religious reasons and gastroenteritis are common, it helps to name these situations explicitly.
- Tell patients to pause the SGLT2 inhibitor during vomiting, diarrhoea, poor intake or acute illness, and to seek advice.
- Warn that glucose can be near normal in SGLT2-related ketoacidosis.
- Check for ketones if the person is unwell with nausea, abdominal pain or fast breathing, whatever the glucose.
- Plan pausing before surgery and prolonged fasting with the procedure team.
Why it matters
Early, wider use of this class makes sick-day counselling a routine safety task, not an afterthought.
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